March is Endometriosis Awareness Month. We spoke to Mr C P Lim, Consultant Gynaecologist and Endometriosis Specialist, to get a quick overview of the condition.
Endometriosis is estimated to affect one in ten women, most commonly affecting women between the age of 20 to 50. Painful and heavy periods can be accepted as ‘normal’ for many women to a certain extent, but when quality of life is significantly affected, it is worth exploring if there are any other symptoms that may suggest endometriosis.
Laparoscopy is the only true reliable way to diagnose Endometriosis, but Mr Lim believes that taking a good story from the patient can be as accurate as having a laparoscopy in diagnosing endometriosis.
What is endometriosis?
Endometriosis is when tissue similar to the lining of the uterus occurs outside of the uterus. Most commonly this happens in the fallopian tubes or at the lining of the abdomen within the pelvis and near the ovaries, causing a small amount of internal bleeding and inflammation every time the woman has a period and causing periods to be very painful.
What are the symptoms?
Many women who have endometriosis do not have troubling symptoms at all and unfortunately many of the symptoms listed here are thought ‘normal’. The most common problems are very heavy and painful periods. Sometimes the pain is so bad that it causes women to feel physically exhausted all the time. Sex can be very painful and this pain can sometimes carry on for hours or days afterwards.
If endometriosis happens at the bladder or bowel, women sometimes also report bloating and pain on opening bowels or passing urine around the time of having their periods. These women may look forward to actually having a period because there is a drastic relief after a period.
Pain on opening bowels during periods
Shooting pain in the back passage during periods
Pain on bladder filling or emptying during periods
Feeling tired all the time
Can endometriosis affect fertility?
If endometriosis happens in the fallopian tubes, this can affect the woman’s ability to get pregnant. Even if it is not in the fallopian tubes, women with endometriosis are known to be less able to conceive than women without. In fact, up to 50% of women with difficulties to conceive are found to have endometriosis and there is good quality research to say that removing endometriosis surgically improves the chances of pregnancy. Having said that, the majority of women with endometriosis have no trouble getting pregnant and having children.
How is endometriosis diagnosed and treated?
An ultrasound will confirm if there is obvious endometriosis, but the most accurate way to diagnose endometriosis is to have a laparoscopy. Laparoscopy is an operation carried out under general anaesthetic in which a small telescope (laparoscope) is inserted into the abdomen to look directly at the tissues. If endometriosis is found it can be treated immediately. Other treatments include pain killers, hormone medicines and contraceptives, or a hysterectomy.
Recurrence after surgery
Endometriosis can return and patients may have more than one laparoscopic procedure over several years.