WHAT IS ENDOMETRIOSIS?
If endometrial tissue, which normally lines the uterus, grows outside the uterus in the ovaries, fallopian tubes or bladder, this is known as endometriosis. These cells still respond to menstruation hormones, and when they bleed this can become trapped and irritate surrounding tissues, causing scar tissue to form. Over time, the ectopic tissue tends to increase in size and spread to other areas.
Endometriosis affects 10 to 20% of women of menstruating age. Symptoms include lower abdomen or pelvic pain, especially just before and during menstruation, and painful sexual intercourse. Painful bowel movements, diarrhea, constipation and bladder symptoms may also occur if the disease involves segments of the intestine or bladder. Bloating and fatigue are also common.
As well as all these symptoms, 30-40% of women with endometriosis also have trouble falling pregnant. Almost 40% of women with infertility are later discovered to have endometriosis – even if there are no other symptoms.
Dr Haider Najjar specialises in diagnosing and removing endometriosis through advanced laparoscopy, and may also treat the symptoms with medication.
HOW DO YOU DIAGNOSE ENDOMETRIOSIS?
The symptoms of endometriosis vary and other conditions cause similar symptoms. So the only certain way to diagnose endometriosis is by laparoscopy, which uses minimally invasive surgery to view the pelvic cavity.
A pelvic ultrasound and other imaging tests might be carried out first, however these usually only reveal moderate to severe disease.
HOW DO YOU TREAT ENDOMETRIOSIS?
This depends on the extent and location of the disease, the severity of your symptoms, your age and your reproductive plans. Treatments may remove the endometriosis, improve and lessen symptoms and optimise fertility. Endometriosis is a chronic condition and can reoccur, even years later.
Treatment for endometriosis usually includes a combination of pain medications, hormonal therapy, surgery and natural therapies.
Pain medications usually involve various over-the-counter analgesics or anti-inflammatory drugs. Prolonged use may have negative side effects and if the maximum dose has already been reached without providing relief, there are other treatment options.
Hormonal therapies suppress your menstrual cycle and may be used before or after pre- surgery for better outcomes.
Surgery can remove and repair the endometriosis and any organs affected, and increase the chance of pregnancy in women with reduced fertility due to endometriosis. Endometrial foci, scar tissue and adhesions can be removed without removing your reproductive organs through laparoscopy. In rare cases, and only in women with very severe disease who have completed their family, hysterectomy and oophorectimes may be indicated.
Fertility treatment and endometriosis
About 30 % of women with endometriosis report difficulty getting pregnant, however most women with mild endometriosis can have children naturally. As endometriosis tends to worsen with time, it is best to start trying as soon as possible.
In moderate to severe endometriosis, laparoscopic surgery to remove endometrial foci can increase the chance of pregnancy. If you are in your late 30s or early 40s, or have been trying to fall pregnant for some time, IVF treatment may be recommended.