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Endometriosis

Endometriosis is a common gynaecological problem affecting women of reproductive age.

It occurs when the glandular tissue of the uterus lining is found outside the uterus in the pelvis, ovaries or other pelvic organs.

The exact cause for the endometriosis is not known, but it is thought to relate to menstrual cycle processes, or genetic factors, or developmental abnormality during the growth of the embryo, or may be modified by environmental factors and hormonal or immune system issues.

Understanding endometriosis, its impact, and the available treatments is essential for those affected and their healthcare providers.

Statistics & Impact

Endometriosis affects approximately 1-in-10 women during their reproductive years, equating to about 176 million women worldwide.

An Australian publication reported there were more than 34,000 hospitalisations in Australia related to endometriosis in 2016-2017. It is most commonly diagnosed in women in their 30s and 40s, though it can occur in any woman who menstruates.

Despite its prevalence, endometriosis is often underdiagnosed due to the normalisation of menstrual pain and the variability of symptoms.

Symptoms & Diagnosis

Symptomology of endometriosis can be extremely variable between individuals. It can cause painful cramps in the lower abdomen, back or in the pelvis during menstruation, pain during intercourse, abnormal bleeding between periods, painful bowel movements or urination, and infertility. Some women can have no symptoms as well. Because of the variability in presenting symptoms, and non-specific nature of some of the symptoms, diagnosis can be challenging and often delayed.

Diagnosis of endometriosis may be suspected when clinical history is suspicious, or abnormalities are seen on ultrasound, MRI or CT scan. Sometimes, raised levels in the tumour marker in CA125 can also suggest endometriosis.

However, the only direct way to diagnose endometriosis is by visualising it during laparoscopy (day procedure under general anaesthesia) where a thin long camera is inserted through an incision in the abdomen and a biopsy is taken for histopathological testing.

Treatment Options

While there is no cure for endometriosis, a range of treatments exists to help manage symptoms and improve quality of life. Treatment plans are highly individualised, based on symptom severity, the extent of the disease, and desire for fertility.

  • Pain Medication: Over the counter pain relievers may be helpful for mild pain, such as non-steroidal anti-inflammatory medications or paracetamol. Sometimes stronger medication is required.
  • Hormone Treatment can suppress activity of endometriosis or decrease recurrence after surgical treatment. This is not appropriate when wanting fertility.
  • Surgery is a good option for women wishing to improve natural fertility, as well as those with severe pain. This is most often done laparoscopically with the aid of a long thin camera inserted through small incisions in the abdomen, where endometriosis lesions are removed at the time of operation. Endometriosis can also be removed during an open operation called a laparotomy where a long incision is made on the abdomen.
  • Fertility Treatment: Women with endometriosis who are trying to conceive may need fertility treatments, such as In Vitro fertilisation (IVF). IVF treatment is the best option for women wanting fertility, , to improve their chances of pregnancy.
  • Pelvic Clearance operation and hysterectomy is another option reserved for women not desiring fertility, or who experience very severe symptoms. This is usually reserved as a last resort.
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Living with Endometriosis

Living with endometriosis can be challenging, affecting physical health, emotional well-being, and fertility. Support groups, counselling, and lifestyle modifications, including diet and exercise changes, can help manage the condition. Building a support network of healthcare providers, family, and friends is crucial.

Conclusion

Endometriosis is a complex condition that requires a multidisciplinary approach to care.

By staying informed and advocating for comprehensive medical support, those affected can find relief and improve their quality of life. With ongoing research and advancements in treatment options, there is hope for better management of endometriosis and its symptoms, allowing women to lead fuller, less painful lives.

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