What is endometriosis?

Endometriosis is a fairly common condition, especially in women over 30 who have not had children. The cells that normally line your uterus make up a membrane called the endometrium, but sometimes these cells grow outside the uterus, such as in the pelvis. This condition is known as endometriosis.

Your endometrium normally responds to the sex hormones oestrogen and progesterone, associated with ovulation. For women with endometriosis, the misplaced endometrial cells in the pelvic cavity also respond to these hormones, but they cannot leave the body via menstruation. Instead they bleed, become inflamed, and then heal. Over time this process can cause scar tissue.

Causes of endometriosis

The exact cause of endometriosis is unknown. It is related to retrograde menstruation, which is the backward movement of menstrual blood through the tube and into the abdominal cavity. This blood carries endometrial cells with it, which can implant in places where they are not supposed to implant.

Retrograde menstruation cannot be the only cause of endometriosis, however. All women experience some retrograde menstruation, but only some develop endometriosis. It is thought that women with endometriosis have a genetic predisposition to it, but this is not yet understood by doctors. Certain populations, such as Asian women, seem to be more prone to the condition.

Symptoms of endometriosis

The major symptom of endometriosis is pain. Many women experience pain around the time of menstruation, but for some women the pain can be more constant. You may experience painful periods, pain during intercourse, and premenstrual spotting.

Endometriosis can be associated with infertility. The scarring from severe endometriosis can distort the fallopian tubes and ovaries, causing a blockage that inhibits the transport of sperm.

Common queries about endometriosis

How is endometriosis treated?

Many women live their whole lives with endometriosis and never find out. If the endometriosis is not causing you any pain, and you are not trying to conceive, the contraceptive pill is a simple method of treatment. The pill stops ovulation and will usually suppress the endometriosis activity, and put a stop to any pain.

For women with severe pain that is not helped by taking the pill, or for women whose fertility is affected, endometriosis can be treated with laparoscopic surgery. This is a type of minimally invasive keyhole surgery that can be used to diagnose the condition and remove the misplaced cells. The surgeon is able to look into the abdominal cavity through a very small microscope, inserted through a small incision in the navel.

If Dr Wang thinks you need laparoscopic surgery for endometriosis, she will refer you to a specialist surgeon for diagnosis and treatment.

How can I reduce the risk of developing endometriosis?

There is no proven way to reduce the risk of endometriosis, though there are some theories out there. Women who have children early in life seem to be at less of a risk, because when you are pregnant you don’t menstruate. Similarly, women who use the pill for long periods of time and have light periods may minimise the amount of blood flowing back. But there is no objective evidence about these theories.

If you have pelvic pain or bad period pain and suspect you may have endometriosis, you should seek medical advice. It is better to have it diagnosed and treated earlier rather than later.