9 things you need to know about endometriosis

1. It's not just a painful period

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While a painful period is the most common sign, some women may experience pelvic pain or backache. “Symptoms can vary from no pain at all to severe pain related to menstruation, sexual intercourse, defecation and urination,” says Dr Steven Teo, obstetrician and gynaecologist at Thomson Fertility Centre. “Some women even have blood in their urine or stool when the womb lining infiltrates the bladder or intestines, but this is rare.”

2. No genetic predisposition

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Dr Teo says it’s unclear why some people suffer from the condition while others don’t. “There is no conclusive evidence that it runs in families,” he says. What is typical is it tends to strike those in their childbearing years. “The onset is most likely to be in your 20s or 30s, although we have seen adolescent girls with endometriosis,” he says.

3. It affects fertility

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Women who don’t experience symptoms like pain may only visit their doctor if they have trouble getting pregnant. “The inflammation and scarring resulting from endometriosis can distort the reproductive environment, block fallopian tubes or cause ovarian cysts to form, all of which can make pregnancy difficult,” explains Dr Teo.

It doesn’t help that these women may experience pain during sex, which may put them off intercourse. However, some women with endometriosis can get pregnant naturally, adds Dr Teo.

4. Lifestyle changes don't help much

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“There is no evidence that lifestyle modifications have any conclusive benefi t for endometriosis,” says Dr Teo. “However, maintaining a healthy, active lifestyle, and avoiding excessive alcohol and cigarette smoke are generally viewed as a good step for those planning to start a family.”

5. Treatment is complex

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Treatment can be surgical or medical. Laparoscopic or keyhole surgery is usually performed at the time of diagnosis, and is recommended for women who still want to have kids. During the procedure, known as endometrial ablation, lesions are removed using a heat source such as a laser.

Medical treatment involves suppressing ovulation, in the form of the Pill, injections or inserting a progesterone-impregnated coil inside the womb – which is why it’s not suitable for women trying to get pregnant, says Dr Teo.

6. There's no real cure

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Current treatment methods include oral contraceptive pills, uterus implants and hormonal injections. But oral contraceptive pills, while able to treat the symptoms of endometriosis, are not very effective against the disease itself.

Dr Teo says that surgery is closest to a cure, but in advanced cases – where there may be deep implants on the pelvic lining and ovaries, even lesions on the fallopian tubes and bowels – it is almost impossible to remove all the lesions and the condition may recur.

In extreme cases, a hysterectomy to remove the ovaries is performed. “Removal of the ovaries renders the woman menopausal, which means she stops producing oestrogen,” Dr Teo explains. Oestrogen is needed for endometrial lesions to form, so a hysterectomy prevents new lesions from developing while existing lesions shrink, although the scarring from previous disease will remain.

As the condition is incurable, patients need to continue long-term treatment until menopause to prevent the growths from recurring.

7. It's difficult to diagnose

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While many gynaecological conditions can be detected via an ultrasound, endometriosis is most accurately diagnosed by laparoscopy, says Dr Teo. But as this is invasive, doctors will recommend it after detailed consultations and examinations – which is where the problem lies. “Endometriosis isn’t well-understood by many gynaecologists, let alone general practitioners,” says Dr Teo. “It’s important that women have the basic awareness that endometriosis exists and don’t dismiss symptoms that are suggestive of the disease.”

8. It can affect your quality of life

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The condition can have far-reaching effects on your sex life, social life, even your career. “Pain can result in absenteeism, impaired physical performance and avoidance of sexual intimacy,” says Dr Teo. “It’s not uncommon for patients to become depressed due to the pain, fertility issues and effects on their social life.” The medication too, may have side effects including menopausal symptoms, mood swings and depression.

 

9. It increases your risk of cancer

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Dr Teo says: “Some studies show that women with endometriosis have up to three times the risk of contracting ovarian cancer.”



This story was originally published in the March 2016 issue of Simply Her.