Endometriosis is a gynaecological condition where cells from the endometrium (tissue lining the uterus) are found outside the uterus and in other areas like the ovaries, fallopian tubes, and ovarian ligaments. The tissue begins to grow and thicken and releases blood and inflammatory chemicals during menstruation, which usually results in painful menses.
About 10% of the female population have endometriosis. In the sub-fertile population, it could go up as high as 40% to 50%. In fact, these numbers may be even higher since affected women might not be aware and even if they do experience symptoms, many tend to brush them aside thinking that it is normal.
There are 4 stages of endometriosis. Determining factors include the location, size, number, and depth of the endometrial tissue being implanted.
Stage 1: Minimal
There are some small lesions and endometrial tissue growing on the ovaries. Some inflammation around the pelvic area might be observed.
Stage 2: Mild
There are small lesions and shallow implants on the ovaries and pelvic area.
Stage 3: Moderate
There are more lesions and deep implants on the ovaries and pelvic area.
Stage 4: Severe
There are even more lesions and deeper implants on the ovaries and pelvic area. Other organs such as the bladder, ureter and bowels may also be affected.
Apart from implants outside the uterus, endometrial tissue can also grow and penetrate the muscle layer of the womb. This is also known as adenomyosis.
A common symptom of endometriosis is severe pain during menstruation. The endometrial tissue growing outside of the uterus tends to bleed during menses, which brings about the release of certain chemicals that are inflammatory, leading to pain and other problems. As a guide to differentiate between normal menstrual cramps and pain caused by endometriosis, the pain should not affect your day-to-day functions. If you are skipping social activities or needing time away from work because of painful periods, it is essential to seek medical help.
Other symptoms include:
There is no exact cause for endometriosis but there are a few theories. The main accepted one is the back flow of menstrual blood during menstruation in some women. It is not clear why this happens but some women from this group then go on to develop endometriosis. The back flow carries the cells to other organs like the ovaries, rectum and pelvic ligaments, and causes other problems. When the endometriosis cells penetrate into the deeper layers, they can impact the nerves, and cause severe back pain or even shooting pain down the legs. In severe cases, the ureter, which carries the urine from the kidney to the bladder, can be strangulated, preventing the excretion of urine and possibly leading to kidney failure.
Although the causes of endometriosis remain unknown, there may be several risk factors that could contribute to developing this condition:
Seek help from a gynaecologist, particularly one who is an endometriosis specialist, as early as possible once these symptoms are experienced.
Early diagnosis will allow for a wider range of treatment and management options, rather than at a later stage where treatment options are limited, often requiring surgery.
The gynaecologist will first assess the patient based on symptoms experienced and family history. The assessment will also include pelvic ultrasound scan but a definite diagnosis will be from a laparoscopic examination. Laparoscopy is a minor surgical procedure performed under local or general anesthesia. A thin, pencil-like instrument called a laparoscope is inserted via the abdomen to identify any endometrial implants in the abdomen or pelvic area so as to determine the treatment for the patient. Biopsies may be done during the procedure to provide more information on the abnormal tissues.
Find out more about the symptoms you experience during your period and if it is time to see a specialist about it by filling out this comprehensive questionnaire.
Endometriosis treatment will depend on the patient’s age and fertility considerations.
As endometriosis is known to recur even after surgery, most doctors will manage the condition with continual medical therapy thereafter.
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