All about endometriosis

Endometriosis affects up to 190 million people worldwide. While some women may not have any symptoms, others may have to seek gynaecological help to manage the effects brought on by endometriosis.

Here, Mr Zeiad El Gizawy, renowned consultant gynaecologist, provides a comprehensive overview of endometriosis, including symptoms, diagnosis and treatment.

What is endometriosis, and what are the common symptoms?

Endometriosis is a chronic medical condition where tissue similar to the lining of the uterus (called the endometrium) grows outside the uterus. This endometrial tissue can be found on the ovaries, the Fallopian tubes, the pelvic organs, and in other parts of the body. Endometriosis can affect all aspects of life, including fertility.

Common symptoms of endometriosis include:

• Pelvic pain: Pelvic pain can range from mild discomfort to severe debilitating pain. This pain may occur at any time, but it is usually worse during menstruation.
• Painful periods: Women who have endometriosis often experience intense period pain (called dysmenorrhoea) that interferes with their daily activities.
• Dyspareunia: Pain during or after sexual intercourse is a common symptom.
• Lower back and abdominal pain: Endometriosis can cause chronic pain in the lower back and in the abdomen.
• Heavy periods: Some women who have endometriosis may have heavy or irregular periods.
• Gastrointestinal symptoms: Endometrial tissue that grows outside the uterus can cause digestive issues, such as diarrhoea, constipation and bloating, especially during menstruation.
• Infertility: Endometriosis can affect fertility by blocking the Fallopian tubes, which interferes with the function of the ovaries.

How is endometriosis detected and diagnosed?

Diagnosing endometriosis typically involves a combination of medical history, clinical evaluation, and medical tests.

A specialist will start by taking a detailed medical history, including information about your symptoms, menstrual cycles, and family history of endometriosis or other gynaecological conditions. A pelvic examination is usually the next step. During this procedure, the specialist may manually check for abnormalities such as cysts, scar tissue, or masses in the pelvis.

A transvaginal ultrasound may be performed to examine the reproductive organs. In some cases, an MRI may also be recommended to visualise the pelvic region in more detail to identify endometrial tissue.

Still, the most definitive method for diagnosing endometriosis is a surgical procedure called a laparoscopy to visualise the pelvic organs.

What are the different treatment options available for endometriosis?

Several treatment options are available for the management of endometriosis. The choice of treatment depends on the severity of your symptoms, your age, your fertility plans, and other individual factors.

Pain medications

Pain relievers, such as non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, can help alleviate pain associated with mild endometriosis.

Hormonal therapy

Hormonal therapy may be prescribed to suppress the growth of endometrial tissue.

• Combined oral contraceptives, or birth control pills, can help regulate menstrual cycles and reduce pain associated with endometriosis.
• Progestin-only contraceptives like progestin-only pills, hormonal IUDs, and injections can help manage symptoms.
• Gonadotropin-releasing hormone (GnRH) agonists lower oestrogen levels, inducing a temporary menopausal state to alleviate endometriosis symptoms.

Hormonal therapy can be used for extended periods, but its effectiveness and side effects should be monitored.

Surgery

• Laparoscopy

During a laparoscopy, a surgeon will make small incisions in the abdomen and then insert a laparoscope (a thin tube equipped with a camera) through these incisions to visualise the pelvic organs. If endometrial tissue is found, the surgeon will perform simultaneous treatment during the same procedure to remove the tissue. Laparoscopy is a minimally invasive procedure that often allows for a quicker recovery compared to traditional open surgery.

• Laparotomy

In cases where endometriosis is severe or extensive, or where laparoscopy isn’t suitable, a laparotomy (open surgery) may be performed. During a laparotomy, a surgeon will make a larger incision in the abdomen to visualise the pelvic organs. If endometrial tissue is found, the surgeon will perform simultaneous treatment during the same procedure to remove the tissue.

• Hysterectomy

In cases where endometriosis is severe and doesn’t respond to other treatments, or when fertility is no longer desired, a hysterectomy (the removal of the uterus) may be considered. A hysterectomy can be performed via laparoscopy or laparotomy, and may or may not also include removal of the ovaries and the Fallopian tubes (called a salpingo-oophorectomy).

• Excision surgery

Excision surgery is a meticulous surgical technique where the surgeon removes endometrial tissue by cutting it out. This method aims to completely remove the endometrial tissue while preserving surrounding healthy tissue.

• Bowel surgery

In rare cases where endometriosis has infiltrated the bowel, bowel resection surgery may be necessary to remove affected tissue and repair the intestine.

The decision to undergo surgery should be made in consultation with a specialist, who will consider your individual needs. It’s essential to discuss the potential risks, benefits, and expected outcomes of each surgical procedure.

Surgical interventions can be highly effective in managing endometriosis, providing long-term relief from pain and improving fertility outcomes.

Nerve blocks and ablation

In cases where pain is localised and associated with specific nerves, nerve blocks or ablation may be considered to provide pain relief.

When is surgery recommended for endometriosis?

Surgery for endometriosis is recommended when other treatment options haven’t provided relief or when the condition is causing significant complications.

Surgery may be considered if:

• You experience severe pain that isn’t effectively managed with medication or hormonal therapies.
• You have large cysts on the ovaries.
• You have adhesions, which are bands of scar tissue that can cause pain and interfere with organ function.
• Endometriosis is affecting fertility. Surgery can remove endometrial tissue, clear blockages in the Fallopian tubes, and improve fertility outcomes.

What is the outlook for managing endometriosis in the long term?

Early diagnosis and intervention are crucial for effectively managing endometriosis. When diagnosed and treated promptly, many women experience significant relief from symptoms and can lead normal lives.

For women who have mild to moderate endometriosis, pain management strategies such as medication or hormonal therapies can be effective in providing long-term relief from pain and discomfort.

Endometriosis can affect fertility, but with appropriate treatment and the guidance of a specialist, many women can still achieve pregnancy. Assisted reproductive technologies (ART) like in vitro fertilisation (IVF) may be recommended in some cases.

It's important to know that endometriosis can vary significantly from one person to another. While some women may find long-term relief with a specific treatment, others may require a combination of approaches. The long-term outlook for managing endometriosis is generally positive, especially with early diagnosis and access to a range of treatment options.

If you’re living with endometriosis and would like to consider your options with an expert, don’t hesitate to book an appointment with Mr Zeiad El Gizawy via his Top Doctors profile today.