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OBGYN Matters Endometriosis and Pain Management Clinic aims to operate an outpatient clinic with a comprehensive patient centered approach to the care of women with endometriosis and pelvic pain.

 

As in all areas of medicine, the key to successful treatments for endometriosis is in the careful selection of the right treatment for each individual patient. Patients have different needs and it is important that these are acknowledged and that treatment is centered round them. 


What is Endometriosis?

Endometriosis is a condition where tissue similar to the lining of the Womb (endometrium) is found elsewhere in the body, usually the pelvis. It is a benign (non-cancerous) but often painful condition, which is characterized by the presence of endometriotic deposits mainly in the pelvis (the ovary, areas around the womb, on the bladder and the intestines).

Each month this tissue breaks down causing internal bleeding which has no way of leaving the body. This leads to inflammation, pain and the formation of scar tissue. In the ovary the endometriosis tissue can bleed and cause fluid contained areas which are called endometriomas (chocolate cysts). These cysts are usually detected by an ultrasound scan.

Endometriosis is very common, it is estimated that endometriosis is present in between 10% – 25% of young women and up to 35% of  women with fertility problems

 

What are the Symptoms/Signs of Endometriosis?

Although women may not show any signs of endometriosis, the common symptoms of endometriosis include:

  • Painful and or heavy periods.
  • Premenstrual pain
  • Pelvic pain possibly radiating to back and thighs
  • Moderate to severe pain at the time of ovulation
  • Painful sex
  • Pain when passing urine and or blood in the urine
  • Pain and difficult with opening bowels
  • Bleeding from the bowel with the periods
  • Difficulty in becoming pregnant

The amount of endometriosis does not always correspond to the amount of pain and discomfort. A small amount of endometriosis can be more painful than severe disease depending on the site of endometrial deposits. The majority of women with this condition will experience some of these symptoms. Some women will have no symptoms!

 

Why does Endometriosis Occur? 

Stages of edometriosis

The exact cause is unknown, although a few theories have been put forward:

  • Genetic predisposition to the condition

    Researchers are looking into the gene that could identify women predisposed to endometriosis. A woman who has a mother or sister with endometriosis has a six times greater risk of developing endometriosis.
     
  • Retrograde menstruation

    Some of the menstrual blood flows backwards through the fallopian tubes and into the pelvis. Some of this endometrial tissue implants and causes endometriosis.
     
  • Lymphatic or circulatory spread

    Blood vessels and lymphatic channels carry Endometrial tissue into the pelvis where it proliferates.
     
  • Immune dysfunction

    There are theories suggesting an altered immune response that could lead to the development of endometriosis possibly by failing to prevent implantation of endometrial tissue that has entered the pelvis by retrograde menstruation.

 

How is Endometriosis Diagnosed?

History and Examination:

A thorough history may highlight suspicion about endometriosis.  The commonest  symptom is pelvic pain which may be worst around menstruation or during and after sex. However, many women have atypical symptoms and the diagnosis is often delayed or missed altogether. A vaginal  examination may demonstrate painful symptoms or  reveal that the womb is stuck in the place and that there are nodules of endometriosis in the pelvis.

Ultrasound Scan:

A high quality ultrasound scan may show the presence of endometriosis. This is not always easy to see which is why it is important that this performed by an expert in this area. Ovarian cysts (endometriomas) are easy to see but deposits deep in the pelvis are easy to miss.

Diagnostic Laparoscopy:

This is the only definitive way to diagnose endometriosis. In this operation a telescope is inserted into the pelvis under general anaesthesia via a small cut near the navel. This allows the surgeon to see the pelvic organs and any endometrial spots or cysts. It may also be possible to surgically treat the endometriosis at the time of diagnosis.

Tissue biopsy

Slide showing endometrial glands and stroma from outside the womb

Slide showing endometrial glands and stroma from outside the womb.