Endometriosis

Endometriosis (end-oh-me-tree-oh-sis) is a chronic condition that can cause debilitating abdominal pain. It affects 1 in 10 women of reproductive age.

What is endometriosis?

Endometriosis is a condition in which cells that usually line the uterus grow in other parts of the abdomen.

These cells form a type of tissue called ‘endometrium’. Endometrium responds to hormonal changes that happen as part of the menstrual cycle. It’s the tissue that thickens, breaks down and bleeds when you have your period.

The problem is, during your period, endometrium usually leaves the body through the vagina. But when it’s growing elsewhere in your abdomen, it has nowhere to exit the body. So instead it thickens, bleeds, becomes inflamed and painful, and then heals. Over time, this cycle creates scar tissue, and can cause reproductive organs to stick together or to the abdominal wall.

The result is often very long and painful periods, and sometimes debilitating pain at other times of the month too.

This condition can be difficult to diagnose, because it presents differently in different women. Endometriosis can also appear in a variety of forms depending on where it is occurring and which organs it’s affecting.

Sometimes, women suffering from endometriosis aren’t even aware of it until they try to have a baby, and have trouble conceiving. Endometriosis can make getting pregnant difficult for up to 50% of women with the condition.

Causes of endometriosis

We don’t know exactly why endometriosis occurs. Because possible causes or influencing factors often differ from one person to another, it’s hard to pin down a singular reason why endometrium sometimes forms where it shouldn’t.

What we do know is that there are certain things that are definitely linked in some way to endometriosis.

Some of these include:

Family history
If you have a close relative with endometriosis, you’re more likely to suffer from it as well. (Unfortunately, it’s more likely to be severe too.) If you’re a twin, you and your sister are also more likely to get endometriosis.

Retrograde menstruation
During your period, blood not only flows out of your vagina, but some of it also flows backward up the fallopian tubes into your pelvis.

Usually, this blood is broken down and absorbed back into the body. But in women with endometriosis, the endometrial tissue within this blood doesn’t reabsorb - it starts to grow instead.

Other factors that may play a role in causing endometriosis are:

  • Having your first pregnancy at an older age
  • Heavy bleeding during your periods
  • Short menstrual cycles (less than 27 days)
  • Periods that last longer than 5 days
  • Getting your period before you turned 12 years old
  • Changes in your immune system

Lastly, certain lifestyle factors help to keep your levels of estrogen stable, which in theory may influence the development of endometriosis, or at least reduce its symptoms.

Things like smoking, drinking too much, not exercising and being an unhealthy weight can all influence your hormone levels. So while there’s no definite evidence linking these factors to endometriosis, it’s still good practice to maintain a healthy lifestyle as much as you can.

How do you know if you have endometriosis?

Every woman’s body is unique, so your experience of endometriosis may not look like another sufferer’s reality. Endometriosis might present in a range of symptoms, just one or none at all.

The type of symptoms you might experience, and their severity, are likely to be related to the location of your endometrial tissue. While the vast majority of endometriosis occurs in the abdomen, it can actually be found anywhere in the body - but that is very rare.

One of the most common indicators of endometriosis is pain during your period. Pelvic pain might continue on and off throughout the month, and even might radiate into the lower back, or shoot down your leg. This unfortunately gets worse over time, especially if your endometriosis goes untreated.

All womenEndometriosis symptoms

Endometriosis pain is the main key symptom of the condition. That pain can present in a variety of ways, including:

  • Painful periods
  • Pain during sex
  • Pelvic pain at any time of the month
  • Pain when you ovulate
  • Pain in your lower back and legs
  • Pain when going to the toilet

Other indicators include:

  • Feeling nauseous and lethargic
  • Bleeding heavily during your period
  • Irregular bleeding / cycles
  • Changes in bowel habits
  • Increased abdominal bloating
  • Pelvic floor muscle spasms
  • Having trouble getting pregnant

Symptoms of endometriosis usually go away after menopause. Naturally, we don’t want you to wait that long for the pain to go away, so make sure you get any symptoms assessed by a gynaecologist.

 

Diagnosis of endometriosis

As endometriosis presents in such varied symptoms, diagnosis can involve more than one test. Diagnosis usually begins with a detailed medical history to help your doctor get a well-rounded understanding of your symptoms, as well as rule out other possible causes of them.

From there, the method of diagnosis will depend on what’s most likely to show what’s going on. These can include -

Pelvic examination
To identify sore areas, and areas with attached deposits or unusual surfaces.

Ultrasound
Using sound waves to create an image of your pelvic organs and look for signs of endometrial tissue.

Colonoscopy
If endometriosis may be affecting your bowel, your doctor may also use a tiny medical camera to view your colon.

Laparoscopy
A surgical procedure where a small specialised probe with a camera on the end is inserted into your pelvic cavity, and used to look for endometriosis.

At Northside Gynaecology, we use a new laparoscopic method that involves a small single cut under the belly button. This method offers fast recovery times and leaves you with only one barely-noticeable scar (as opposed to other laparoscopies that leave you with three small scars).

Endometriosis treatment

There is currently no known cure for endometriosis. But it can be treated with medication or surgery. Some women also opt for natural treatments to help relieve their symptoms.

As the type, location, and severity of symptoms can vary so widely, there is no ‘right’ treatment that works for everyone. Your gynaecologist will develop an appropriate treatment plan with you while taking into account your age, whether you want to have children, and how far your endometriosis has progressed.

Let’s have a look at the most common treatments you might consider.

Hormone treatment for endometriosis

Because endometrial cells respond to hormonal changes in your body, hormone therapy can sometimes help. Medication such as hormonal therapy generally aims to suppress menstruation, relieving the symptoms of endometriosis. However, hormone therapy cannot reduce the size of endometrial tissue that’s already there.

Options for hormone therapy may include:

  • Progestins that suppress the growth of misplaced endometrium.
  • Gonadotrophin-releasing hormone (GnRH) agonists that can control hormone release from the brain, inhibiting the growth of endometrium cells.
  • Oral contraceptive pills may be used to slow the progression of endometriosis.

Hormonal treatments come with side-effects, so your gynaecologist will make sure you are well-informed if deciding on this option.

Surgery for endometriosis

A laparoscopy - also known as keyhole surgery - can be used to both diagnose and treat endometriosis. Because of the nature of the procedure, multiple specialised instruments can be inserted into the one puncture site, allowing your surgeon to cut out or burn any endometriosis that’s found.

For women who don’t want any more children, or don’t wish to have children at all, a hysterectomy is another surgical treatment option to consider. A hysterectomy involves removing the uterus and ovaries entirely.

Hysterectomy is usually recommended when endometriosis is significantly impacting quality of life, and other treatments haven’t worked. However, it is not a guaranteed cure.

Endometrial ablation

If you bleed between periods, have a heavy flow, or have periods that last for a long time, you might want to consider ablation. Endometrial ablation removes the lining of the uterus, which either partially or completely stops you from having periods.

At Northside Gynaecology, we use NovaSure, which is a 5-minute procedure. It is performed in our medical suites in Kedron, Brisbane.

Endometrial ablation isn’t right for everyone. Your gynaecologist can discuss your suitability during your treatment discussion.

 

Natural endometriosis treatments

Some women find natural therapies helpful in managing their endometriosis symptoms. These treatment options may include:

  • Herbal medicine
  • Traditional Chinese medicine
  • Homeopathy
  • Massage
  • Yoga

It’s important to make sure you tell your gynaecologist about any natural therapies you are using, as they might affect other treatments she advises for you.

Endometriosis diet

It’s well known that diet can make a big difference to your overall level of health. That’s no different when considering nutritional support for endometriosis symptoms.

Eating a diet rich in whole grains, vegetables, nuts and seeds, and fish give your body loads of healthy vitamins that assist a variety of functions. They also provide antioxidants which may help reduce inflammation, which is the body’s natural reaction to processes such as endometrial tissue bleeding and scarring.

In particular, a diet with plenty of vitamin B, zinc, calcium and essential fatty acids can help boost the body’s natural pain relief abilities. There’s even some evidence that Omega-3 fats can help discourage the development of endometrial cells.

Avoiding foods that contain trans fats, limiting your red meat intake, and cutting out processed foods will also not only reduce endometrial inflammation and pain, it will also be much better for your overall health!

Brisbane Endometriosis Clinic

It’s important to remember that pain is your body’s way of telling you something is not right. If you’re experiencing pelvic pain that’s stopping you from doing things you normally do, like going to work, or even getting out of bed, see your GP for a referral to one of our caring female endometriosis specialists. We can investigate what’s going on and help you treat the problem.

Come and see us at Northside Gynaecology if you:

  • Miss work, school or other activities you usually do
  • Can’t get relief from over-the-counter pain medication
  • Are unable to get out of bed due to the pain
  • Notice your symptoms getting worse
  • Feel unable to cope with your symptoms

Just call us on 1300 780 138 to arrange your appointment.

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Symptoms of endometriosis usually go away after menopause. Naturally, we don’t want you to wait that long for the pain to go away, so make sure you get any symptoms assessed by a gynaecologist.