How to manage endometriosis

Endometriosis is a disorder of the uterus where the tissue that normally lines the uterus (the endometrium) grows outside and around the uterus, and can spread to other organs in the pelvis like the ovaries, the bladder, and the intestines – and in rare cases, even as far as the lungs. In this article, a leading obstetrician and gynaecologist explains endometriosis, and goes through some of the treatment options that patients with the condition can explore.

How does endometriosis affect the body?

During the ovulation period of the menstrual cycle, the reproductive hormones, namely oestrogen, cause the endometrium in the uterus to thicken, and if the egg released by the ovaries is not fertilised, then the endometrium should break down and be purged as the menstruation via the vagina. Thus, during menstruation with endometriosis, the endometrium peels off the uterine walls and sheds through the vagina, but as the endometrium that grows in other places cannot be expelled, it causes internal scarring, organ adhesion, and cysts.

What causes endometriosis?

There is no known cause for endometriosis, but it is theorised that it may be due to a process called retrograde menstruation, where some of the menstrual blood doesn’t leave the body through the vagina as it should, but flows back up through the fallopian tubes, and the cells of tissue reattach to pelvic organs. Other theories suggest that the condition is triggered by immune system function, stem cell behaviour, and genetics.

The risk factors for developing endometriosis are early puberty, late menopause, and those who have normally heavy periods.

What are the symptoms of endometriosis?

Endometriosis can cause a lot of discomfort and pain for those with the condition; however, it can also be completely asymptomatic for some. Common symptoms include:

• Severe pelvic pain, particularly during the period
• Heavy menstruation
• Pain during sexual intercourse
• Fatigue
• Bleeding between periods
• Bloating

People with endometriosis are likely to have fertility issues or infertility, and those with asymptomatic endometriosis may only discover the affliction upon getting tested after repeatedly failing to get pregnant or having multiple miscarriages. Natural conception is still possible for those with endometriosis, but medical assistance and fertility treatments (such as in vitro fertilisation) can improve the chances.

How can endometriosis be treated?

At this point in time, there is no cure for endometriosis, and it can only be managed. Treatment can be medicinal, surgical, or both. A treatment plan will be devised with consideration of the patient’s symptoms, age, plans for future pregnancies, and the severity of the endometriosis.

The best treatment for a patient will depend if they are looking to manage the pain and symptoms, or if they are looking to improve their fertility.

Medication tends to be the first method used for treating endometriosis, such as:

• Painkillers for pain management, like ibuprofen or paracetamol. These can be prescribed or purchased over the counter.
• The combined contraceptive pill, which contains oestrogen and progestin (a synthetic form of progesterone), is used to suppress the ovaries and pause or lighten the period and will thus ease the pain. A hormonal coil can also be utilised to the same effect.
• Gonadotrophin-releasing hormone (GnRH) antagonists are administered via injection and halt the period entirely by lowering the oestrogen levels in the body. They also help shrink endometriosis-related growths and pain, but can cause menopausal-like symptoms.

If medicinal treatment does not yield significant results, the option of surgery is available. Using a laparoscopic technique, surgeons can excise or destroy scar tissue and growths with blades, lasers, or electricity (electrocautery). This can help to alleviate pain, but it is temporary as the endometriosis is still present and the tissue can regrow. Surgery for shallow endometriosis, where is it present closer to the abdomen, has been proven to increase pregnancy rates.

A hysterectomy may be performed for patients who have not responded to other treatments and have no wish for future pregnancies, as this procedure will render patients infertile and irreversible. It is highly effective for reducing pain and may even “cure” the condition, but again there is the risk of the tissue regrowing.

If you believe you may be suffering from endometriosis and want to explore your treatment options, book a consultation with a specialist via Top Doctors.