ENDOMETRIOSIS

• Overview
• Treatment
• Complication

Endometriosis is a painful condition in which the endometrium (the tissue lining the uterus) is found on other organs of the body like the ovaries and fallopian tubes.

Women with endometriosis suffer pains and sometimes have difficulty getting pregnant. It is most common in women of reproductive age and rare in girls before they start their period. There are available treatments that can help.

Symptoms

Endometriosis usually appears on the lower abdomen although, it can appear in any other place. Some women have a symptom; others may not. Some symptoms are:

• 1. Lower abdominal pain
• 2. Painful periods
• 3. Pain during sexual intercourse
• 4. Difficulty getting pregnant
• 5. Painful urination or pooing during their period
• 6. Feeling sick, constipation, diarrhoea, or blood in your pee during period
• 7. Heavy periods and feelings of depression

When to see your GP

Having symptoms of endometriosis can have a big impact on your life. Diagnosing it can be difficult but discussing with your doctor will help. They may recommend treatments or refer you to a gynaecologist.

Further tests like an ultrasound scan or Laparoscopy is an excellent way to diagnose endometriosis.

Treatments

Endometriosis currently has no cure, but treatments can significantly ease the symptoms. Treatments include:

• 1. The surgical procedure to remove part or all infected organs like hysterectomy
• 2. Pain killers like Ibuprofen or paracetamol
• 3. Hormone medicines and contraceptives
• 4. Surgery to remove patches of endometriosis tissue

Your doctor can best advise you on what to do.

Further Problems caused by Endometriosis

Infertility is one major complication of endometriosis. Surgical treatment of endometriosis can aid your chances of conception although it is not a guarantee. It could further lead to issues like infections, bleeding or damage to affected organs.

Learn more about complications of endometriosis

Causes of Endometriosis

Since the cause of endometriosis is unknown, some of the suggested causes are:

• 1. Retrograde menstruation – when the blood that’s supposed to leave the body as period retracts and remain on organs of the pelvis
• 2. Immune system problems
• 3. Genetics
• 4. Endometrium cells spreading via the body in the bloodstream or lymphatic system

Endometriosis is not completely explained by these causes. Thus, a combination of varying factors is responsible for it.

TREATMENT OF ENDOMETRIOSIS

Endometriosis can be difficult to treat and has no known cure but, treatments are given to lower the symptoms and provide relief.

Treatment also:

• 1. Soothe pain
• 2. Impede the growth of endometriosis tissue
• 3. Reduce infertility
• 4. Eliminate recurrence of endometriosis

Deciding which treatment

You will get comprehensive information on all available treatments from your gynaecologist. Choosing which is best for you depends on:

• 1. The severity of your signs and symptoms
• 2. Your age
• 3. Any previous treatment
• 4. Whether you plan to get pregnant
• 5. Your take on surgery

Since endometriosis often gets better on its own but can worsen if untreated, it’s opined that you hold off treatment if symptoms are mild and commence it once they get worse.

Pain Medication

Over-the-counter anti-inflammatory drugs such as Ibuprofen or naproxen sodium (Aleve) can reduce your pains. They are available in pharmacies and have no side effect. If you’re not planning to get pregnant, your doctor may recommend a combination of hormone therapy and pain relievers.

Let your doctor know if you’ve been taking pain relievers without any relief.

Hormone treatment

Hormone medications lower or stops oestrogen production; oestrogen helps endometriosis to thrive. This treatment cannot improve fertility. Some hormone therapies include:

• 1. Hormonal contraceptives – birth control pills, vaginal rings and patches aid in controlling the hormones that build up endometrial tissue; reducing period cycle and sometimes pain.
• 2. Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists – the aim of this is to prevent menstruation.
• 3. Progestogens, including the intrauterine system (IUS), the contraceptive injection, the implant and progestogen pills.

Discuss the different side effects of this treatment with your doctor. Hormone treatment has no permanent effect on your fertility.

Progestogens

These are synthetic hormones that act like the natural hormone progesterone. They include the Mirena intrauterine system; contraceptive injection; contraceptive implant; progestogen-only-pill (POP). Some side effects of these are bloating, weight gain, etc.

Surgery

Surgical procedures like Laparoscopy and Hysterectomy can be used depending on the tissue location. Discuss associated risks with your doctor.

Laparoscopy

This procedure uses a laparoscope and heat devices to destroy endometriosis tissue through incisions made in your tummy. It’s also called keyhole surgery.

Laparoscopy also destroys ovarian cysts and patients are induced to feel no pain.

This method is effective in improving fertility but to avoid recurrence, hormone treatment should be taken before and after surgery.

Hysterectomy

This treatment is best when all others have failed, and you have no plans to get pregnant. It treats endometriosis by removing the womb. It’s a major operation that should be well discussed with your doctor. Hysterectomy is irreversible, and endometriosis can return if the ovaries are not removed.

This risk can be reduced by using a combined course of HRT (oestrogen and progesterone), but it can increase the risk of breast cancer. Consult your doctor for the best treatment option.

Gonadotrophin-releasing hormone (GnRH) analogues: Synthetic hormones that reduce oestrogen production and amount of endometrial tissue. Use contraception while using them.

Complementary therapies like traditional Chinese medicine have no evidence of treating endometriosis.

Complications

Endometriosis-infected women can experience several complications

Fertility issues

Endometriosis is linked to infertility because it is assumed to damage the fallopian tubes or ovaries. Some women in spite of this can still get pregnant. For others unable to conceive, IVF may be recommended.

Adhesions and Ovarian cysts

Adhesions in women are sticky areas of endometriosis tissue capable of joining organs together.

Ovarian cysts are fluid-filled sacs on the ovaries causing pain

Learn how ovarian cysts are treated

Surgery complications

It can be less serious like:

• 1. Wound infection
• 2. Bruising near the wound
• 3. Minor infection

More serious like:

• 1. Organ damage
• 2. Severe bleeding
• 3. A blood clot in the leg or lungs

Have a comprehensive knowledge of surgery from your doctor before you undergo it.

Bladder and bowel problems

This complication arises when the bladder or bowel is infected by endometriosis. It may be difficult to treat thus, surgery come in handy. Surgical procedures could involve cutting away part of the bladder. In the meantime, a urinary catheter may be provided to assist you pee after the surgery.

For bowel, a colostomy is used in the interim for collecting waste.