Endometriosis
Endometriosis is a disease where tissue that is similar (endometrial like tissue) to the lining of the uterus (womb) grows outside of the womb. It can cause severe pelvic pain, scarring within the pelvis and fertility issues. It is most commonly found in the ligaments that support the uterus in the pelvis and the ovaries, however can also be found in the bowel, bladder, appendix and less commonly outside of the pelvis.
Stage 1-2 Pelvic endometriosis. Endometriosis, Nature Reviews Disease Primer, 2018, Vol 4(1) pp.9
Stage 3-4 Pelvic endometriosis. Endometriosis, Nature Reviews Disease Primer, 2018, Vol 4(1) pp.9
Causes
The causes of endometriosis are unknown, however it is believed to be multifactorial (genetic predisposition, immunologic, environmental) and several theories exist including retrograde menstruation, metaplasia of the cells within the pelvis and stem cells giving rise to the disease.
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Endometriotic deposits, similar to the lining of womb, react to the hormones in the menstrual cycle, which leads to a chronic inflammatory reaction that may result in the formation of scar tissue (adhesions, fibrosis) within the pelvis and other parts of the body.
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There are several types of endometriotic deposits described:
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Superficial endometriosis (found mainly on the pelvic peritoneum)
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Cystic ovarian endometriosis (endometrioma) found in the ovaries
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Deep endometriosis found in the recto-vaginal septum, bladder, and bowel
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In rare cases, endometriosis has also been found outside the pelvis.
Symptoms
Endometriosis affects around 1 in 10 women. It often causes severe pain in the pelvis, especially during menstrual periods. It can also cause pain during sex or when using your bladder or bowels. It can cause fertility problems, bloating, nausea, fatigue, heavy periods and bleeding between periods, depression and anxiety. It has significant social, economic and public health impacts.
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Symptoms often improve after menopause, but not always. Endometriosis symptoms are variable and broad, and some patients may have no symptoms at all. As such, healthcare workers may not easily diagnose it.
Diagnosis
There is no screening test for endometriosis, ultrasound and MRI scans can be useful but may not diagnose it.
To make a diagnosis requires a careful clinical assessment of your symptoms and examination findings.
Medical Therapy
There are no treatments that can cure endometriosis, however a range of medications can help with the symptoms of pain and bleeding including anti-inflammatory drugs (NSAIDs) and hormonal medicines (which are the mainstay of treatment). These include contraceptive pills and hormonal intrauterine devices.
Surgery in endometriosis
Surgery is able to both confirm a diagnosis of endometriosis and also treat endometriosis by excising (removing) it. Dr Goulding is an experienced and skilled endometriosis surgeon and is able to excise advanced disease, remove scar tissue and fibrosis, and remove endometriosis outside of the pelvis. She works within a multidisciplinary team at her rooms, being able to tailor a patients treatment moving forward aiming to address the many facets of this disease and optimise your care.