What is Endometriosis?
Endometriosis is a chronic condition that affects the female reproductive system. In endometriosis, tissue similar to the lining of the uterus (endometrium) grows outside the uterus. This tissue can grow on the ovaries, fallopian tubes, bladder, bowel, or other pelvic organs. It can cause significant pain and discomfort, as well as fertility problems.
The exact cause of endometriosis is uncertain, but several theories exist, including retrograde menstruation, lymphatic or bloodstream spread, or genetic factors.
Symptoms of Endometriosis
- Pelvic pain, especially during menstruation
- Infertility
- Painful intercourse
- Painful bowel movements or urination
- Fatigue, nausea and vomiting
Diagnosis
Endometriosis is diagnosed through a pelvic examination, specialised ultrasound (USS), MRI, and/or laparoscopy.
Laparoscopy, a minimally invasive surgical procedure, involves inserting a thin tube with a camera through a small incision in the abdomen, allowing doctors to visualise and diagnose endometriosis.
Types of Endometrioses
Endometriosis can be classified into three types based on the location and depth of the endometriosis implants.
- Superficial peritoneal endometriosis (SPE): This is the most common type of endometriosis, affecting the thin lining of the abdomen and pelvis (peritoneum). SPE implants are usually small and flat, but they can be raised and red.
- Ovarian endometriomas (chocolate cysts): These are fluid-filled cysts that form on the ovaries. The fluid inside the cysts is often dark brown or black, which is why they are sometimes called chocolate cysts. Chocolate cysts can range in size from a few millimetres to several centimetres.
- Deep infiltrating endometriosis (DIE): This is the most severe type of endometriosis, affecting the tissues deeper in the pelvis, such as the bladder, bowel, and rectum. DIE implants can be very painful and can cause significant damage to the affected organs.
Endometriosis can also be categorised by stage, which is based on the severity of the disease. The four stages of endometriosis are:
- Stage I: Minimal endometriosis with a few small, superficial implants.
- Stage II: Mild endometriosis with more implants and some adhesions (scar tissue).
- Stage III: Moderate endometriosis with many deep implants, adhesions, and possibly ovarian cysts.
- Stage IV: Severe endometriosis with many deep implants, adhesions, and large ovarian cysts.
It’s important to note that the stage of endometriosis does not necessarily correlate with the severity of the symptoms. Some women with mild endometriosis may experience severe pain and symptoms, while other women with severe endometriosis may have mild or no symptoms.
Treatment
While no definitive cure exists, various management options can alleviate symptoms and improve quality of life:
- Pain medication: Over-the-counter or prescribed pain relievers such as ibuprofen or naproxen for mild to moderate pain. Stronger medications might be recommended for severe pain.
- Hormonal therapy: Involves medications that suppress estrogen production, inhibiting the growth of endometrial tissue. Common hormonal therapies include birth control pills, progesterone-only contraceptives, gonadotrophin-releasing hormone (GnRH) agonists, and danazol.
- Surgical treatment of endometriosis: Dr. Farag and the Coastal Women’s Health team specialise in diagnosing and treating endometriosis, including deep infiltrating endometriosis, with a focus on managing pain and infertility.
If you are experiencing any symptoms of endometriosis, seeking medical attention from Dr. Farag is crucial to obtain a diagnosis and discuss appropriate treatment options based on the individual’s situation, type, stage, and severity of the condition.