Endometriosis




Endometriosis is a condition where the endometrial tissue (the lining of the inner uterus) is found outside the uterus.  Most commonly, endometriotic tissues may be found in the ovaries, fallopian tubes, peritoneum (tissue lining the pelvic and abdominal cavity), and even uterosacral ligaments, bladder and rectum. Endometriosis chiefly causes ovarian cysts, pain or infertility.  These may manifest as:

  • Persistent ovarian cyst(s) with low-level echoes on ultrasound scan

  • Painful periods over the abdomen and/or lower back that may begin before and extend a few days into the menstrual period.

  • Painful sexual intercourse during or after sex

  • Pain with bowel movements or urination

  • Infertility - by causing pelvic adhesions that obstruct the fallopian tubes thereby preventing the egg and the sperm to meet, or via less direct ways such as damaging the sperm or egg

Endometriosis may increase the risk of cancer slightly.  A rare type includes endometriosis-associated adenocarcinoma.  


Treatment options are different, depending on the nature of the complaint.  


Treatment options for persistent ovarian cyst and/or pain

1. Painkillers - These include the simple paracetamol and the NSAIDs (non-steroidal anti-inflammatory drugs) that should be taken only when there is pain.

2. Oral contraceptive pills / contraceptive patches - These may be especially useful for those also require contraception.

3. GnRH agonist injections - These injections cause a transient menopausal state, thereby "inactivating" the endometriosis process.  These may be useful when the patient is near menopause.

4. Dienogest (or Visanne) - These oral medications have been licensed for use in endometriois specifically, and may cause shrinkage of the endometrial tissue and reduce pelvic pain and painful periods.

5. Surgery to remove or ablate endometriotic tissues may be useful, especially if there is a persistent ovarian cyst.


Treatment options for infertility

1. Therapeutic surgery to ablate endometriosis, lyse adhesions resulting from endometriosis and ovarian cystectomy (removal of ovarian cyst) may be performed at the time of diagnostic laparoscopy that may be performed as part of the investigations of infertility.

2. Early access to in vitro fertilization may be an option for patients suffering from infertility and endometriosis. 

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