The uterus of a woman is lined with a tissue called the endometrium. Sometimes, this tissue may develop outside of the uterus. This condition is called endometriosis. Endometriosis can occur in any woman of childbearing age, including teenagers. It can also recur in women previously treated for endometriosis.


What Causes Endometriosis?

Normally, endometrial tissue lines the inside of the uterus. The presence of endometrial tissue outside the uterus is known as endometriosis. All endometrial tissue, whether inside or outside the uterus, can respond to the female sex hormones controlling the reproductive cycle. Just as the endometrial tissue lining the inside of the uterus grows, thickens, and then breaks down and bleeds, so does the endometrial tissue outside the uterus. 

However, endometrial tissues and blood inside the uterus are discharged in the normal way, by menstruation, if fertilisation of the egg has not occurred. Endometrial tissue outside the uterus has no normal exit. Thus, when breakdown and bleeding occur, the endometrial tissue remains in the body. The growing and bleeding of endometrial tissue remaining in the body may cause pain, abnormal menstruation and scar tissue formation. Endometriosis may also result in infertility.


What Are the Symptoms of Endometriosis?

  • Pain during menstruation
  • Pain in the lower abdomen before or after menstrual bleeding
  • Irregular or heavy menstrual bleeding
  • Pain during sexual intercourse
  • Infertility

 How Is Endometriosis Diagnosed?

Symptom-free endometriosis may be discovered during a routine pelvic examination or surgery for some other condition. Alternatively, your doctor may suspect endometriosis if you have any of the above symptoms, upon which he or she may do a physical examination.

  • Endometriosis is usually diagnosed via:
  • Pelvic examination
  • Ultrasound
  • Laparoscopy

Laparoscopy may be conducted to confirm a diagnosis. This procedure is usually done on an outpatient basis and is performed under general or local anaesthesia. A thin viewing instrument called a laparoscope is inserted through a small incision just below the navel. The laparoscope allows the physician to see the abdominal and pelvic cavity and identify abnormally located endometrial tissue. A second small incision may be made for the insertion of another instrument used as probe or used to remove a small sample of tissue. This sample can then be examined to confirm the diagnosis of endometriosis.


What Are the Treatment Options for Endometriosis?

There are two natural occurrences that often improve the signs and symptoms of endometriosis - pregnancy and menopause. During pregnancy, ovulation and menstruation cease and the symptoms of endometriosis may be temporarily relieved. Following menopause, the ovaries permanently stop secreting female sex hormones and all endometrial tissue withers naturally. Menopause usually occurs when a woman is in her 40s or 50s.

Endometriosis is usually treated with:

  • Hormonal drugs - the administration of hormonal drugs can shrink the endometrial tissue and even cause it to disappear eventually.
  • Conservative surgery - scar tissue and endometrial tissue are removed, while preserving the reproductive organs.
  • Radical surgery - removal of the uterus and ovaries eliminates the source of the hormones that cause endometrial tissue to grow and bleed.
  • Combination treatment - a treatment plan consisting of a combination of hormonal drugs and conservative surgery is often recommended.

Obstetrics and Gynaecology (O&G)

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