What is Endometriosis?
Endometriosis affects 1 in 9 women and is one of the most commonly seen gynaecological diseases. Despite it’s prevalence it is poorly understood and not commonly talked about. Symptoms of endometriosis can begin prior to menstruation beginning, and for most women, it causes lifelong symptoms. On average it takes 6.5 years to receive a diagnosis, and women commonly have difficulty finding a treatment that works for them.
What’s the cause and the main concern?
Endometriosis a condition where tissue similar to the uterus lining (endometrium) is found in other areas of the body, most commonly the pelvic organs (uterus, bladder or bowel). Less commonly it can be found outside the pelvis.
The main concerns with endometriosis are pain and infertility. If you have endometriosis and it is not causing pain or infertility, it does not need to be treated, though your doctor may recommend ongoing monitoring as appropriate.
Image from www.hopkinsmedicine.org
Symptoms
Symptoms are usually worse at certain times in the cycle. Many women experience more severe symptoms during ovulation, just prior to menstruation and during the period. Many women’s symptoms are more severe during their period leading them to take time off work, school, or other daily activities.
The stage of endometriosis (determined by the quantity and location of the endometriosis tissue found in surgery) does not coincide with the severity of symptoms. While some women with endometriosis experience severe pelvic pain, others have hardly any symptoms.
There are a wide variety of symptoms, and women experience endometriosis differently, so you may experience some, all or none of the symptoms.
Endometriosis Australia lists these as common symptoms:
Fatigue
Pain that stops you on or around your period
Pain on or around ovulation
Pain during or after sex
Pain with bowel movements
Pain when you urinate
Pain in your pelvic region, lower back or legs
Having trouble holding on to your bladder or having to go to the bathroom frequently
Heavy or irregular bleeding
The chronic nature of these symptoms often contribute to fatigue, depression and/or anxiety.
Getting a diagnosis
Endometriosis is diagnosed through laparoscopy surgery, where a biopsy on a tissue sample is taken. The laparoscopy allows your doctor to see and assess the organs of the pelvis and abdomen and remove a section of tissue that is thought to contain endometriosis, which is sent to pathology to be viewed under a microscope and confirm the diagnosis. It may be diagnosed as mild, moderate or severe (or stages 1-4).
If you’re reading this and thinking you might have endo, we encourage you to speak to
your doctor as a starting point. Endometriosis Australia also has a lot of great information available.
What are the treatment options
A good GP and gynaecologist who specialise in endometriosis is essential for the best outcomes. The approach you and your doctor choose will depend on the severity of your symptoms and whether you want children. Not all treatments work well for all women and symptoms may return after a treatment is stopped. If you have surgery symptoms may return after the passing of time. For these reasons, treatment is usually most effective when it is multi-disciplinary and includes medication, surgery and pelvic physiotherapy.
Treatment/management options include:
Laparoscopic surgery to remove the affected tissue
Medications (including pain medications, hormone therapy etc)
Physiotherapy
Pain management
Psychology
Physical/exercise therapy
Dietician
Sexual therapist
Natural therapies
Lifestyle management
Next week we discuss how a pelvic floor physio can help.
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