Endometriosis

16 September 2022

It’s estimated that over 10% of Australian females will suffer from endometriosis at some point in their life , and sadly, many of them will do so in silence. The impacts of this can be both painful and devastating. But what exactly is it, and how can it be treated?

Because of its critical function in reproduction, the human uterus contains a very particular type of lining called ‘endometrium’. In the womb, this tissue is vital for fertility and reproductive health. However, tissue similar to this lining can start to appear outside the uterus – usually the ovaries, the fallopian tubes and the pelvic lining, but also other nearby organs such as the bladder and the bowel. This condition is endometriosis.

In fact, this tissue is so similar to regular endometrium, that it responds to the same hormonal triggers – and that’s where problems begin.

Why is it a problem?

Unless fertilisation has taken place, the uterus sheds its lining every 28 days or so. This is commonly known as a menstrual ‘period’. And while the uterus is designed to get rid of this tissue easily, other parts of the female reproductive system are not, and there’s nowhere for the tissue to go. This can lead to debilitating pain, scarring, inflammation and even cause organs to stick to each other.

In addition to the pain, endometriosis can also lead to infertility.

What causes endometriosis?

Unfortunately, the exact causes of endometriosis are still unknown, but research has managed to identify some things that can raise the risk, including:

• Retrograde menstruation – where menstrual blood flows the wrong way, back through the fallopian tubes and into the pelvic cavity. This blood contains cells similar to endometrium cells, which can be left behind to take hold and start growing.
• Cellular metaplasia –  when one type of cell morphs into another.
• Stem cells – particular cells that start the disease and then spread through the body.

Other risk factors include:

• Family history of endometriosis
• Never giving birth
• Starting menstruation young or menopause late in life
• Short menstrual cycles (less than 27 days) or heavy periods of more than a week
• High oestrogen levels

What are the symptoms?

The symptoms of endometriosis are quite varied, and sometimes don’t appear until the condition is advanced or can be confused with other conditions, however in general, the main symptoms are:

• Pain – the most common symptom, and can include:
  • Painful periods, bowel movements and/or urination
  • Pain during or after sex
  • Long-term pelvic pain
• Digestive problems including bloating, nausea, diarrhoea or constipation, especially around menstruation
• Fatigue, depression or anxiety
• Heavy or irregular periods
• Spotting or bleeding between periods
• Infertility

How is it diagnosed?

Because the symptoms of endometriosis can mimic the symptoms of other conditions, if you think that you might have endometriosis, your GP or gynaecologist will often recommend a laparoscopy – a generally straightforward type of surgery used to look for endometriotic cells outside the uterus ­– and a biopsy to analyse cells that may be found.

How is it treated

Depending on the extent of endometriosis, there are three main ways to treat it:

• Medication, such as ongoing hormone therapy and pain relief medication
• Allied health (e.g. a physiotherapist for bladder/bowel control or psychologist for pain management)
• Surgery, such as a laparoscopy to remove tissue, or in very severe cases, a hysterectomy.

Given the different levels of severity, your GP and/or gynaecologist will provide expert advice on the best treatments to explore.

The gynaecology unit at Burnside Hospital is highly experienced and very well equipped to provide all levels of treatment, from reducing pain and discomfort to working through fertility issues resulting from endometriosis and other factors.