World Congress on Endometriosis: 11-14 March 2008, Melbourne, Australia

"Unfortunately for many Australian women, endometriosis means pain, heavy periods and, for those in their reproductive years, infertility, making this a particularly debilitating disease. Because of the difficulty in diagnosing endometriosis, damage from the disease can be significant. MBF is proud to support the World Congress on Endometriosis in Australia in March where we hope light will be shed on improved diagnostic methods and treatments for the disease." Dr Christine Bennett, MBF's Chief Medical Officer.

What is endometriosis?

The lining of a woman's uterus (womb) is called the endometrium. Each month the endometrium thickens under hormonal influence and then sheds as the monthly bleed (period). For reasons we don't yet understand, sometimes this endometrial tissue grows outside the uterus, most commonly on the ovaries, tubes or inside the pelvis. It may also grow abnormally on the bowel, bladder or elsewhere. This condition is known as endometriosis.

Because this tissue follows the same hormonal cycle as it would inside the uterus, it bleeds at the time of the period, but the blood has nowhere to go. Consequently, small collections develop inside the pelvis or elsewhere and this may cause irritation. The irritation can lead to inflammation, and this can in turn lead to the formation of tight bands of scarring called adhesions.

What are the symptoms?

You may experience one or more of the following symptoms if you have endometriosis:

Commonly -

Lower abdominal pain that often starts a day before the period and lasts for 2-3 days
Deep pelvic pain, sometimes during or after sex
Heavy periods
Difficulty falling pregnant

Less commonly -

Lower back or upper thigh pain
Pain when opening bowels
Fatigue

How is endometriosis diagnosed?

There is no simple diagnostic test for endometriosis and one of the problems with endometriosis is that delays in diagnosis are common. Your doctor may suspect the condition if you present with pelvic pain, including painful periods or painful sex, which does not respond to standard treatments, or with one or more of the above symptoms.

You may complain of tenderness on abdominal or internal pelvic examination. Although sometimes an ultrasound examination will be able to identify endometriosis, the most definitive way to diagnose this condition is by direct observation via laparoscopy. Laparoscopy is a surgical procedure under anaesthetic where a telescope-like instrument is inserted into the abdomen to view the pelvic organs.

This is attached to a video camera to best visualise any areas of concern.

How is endometriosis treated?

When endometriosis is suspected, a trial of anti-inflammatory medication can be used to control pain. If this is unsuccessful, the oral contraceptive pill is often recommended to control and moderate hormonal effects. Advice to avoid periods by taking it for several months without the sugar pills is sometimes suggested. Other hormonal treatments to suppress ovulation and menstruation may also be considered.

However, if symptoms fail to respond to these measures, referral to a specialist for laparoscopy and removal of the lesions is probably necessary. There are also some complementary therapies that may be offered to women with endometriosis. These include nutritional and naturopathic approaches.

Why is endometriosis important?

Endometriosis can significantly interfere with a woman's productivity and ability to enjoy life due to long term and recurrent pain. It can also affect fertility. Because the lower abdominal or pelvic pain of endometriosis may often be taken to be an unwelcome but 'normal' part of a woman's menstrual cycle, women frequently do not seek help for their symptoms for many years. Recurrent monthly pain may result in great inconvenience and distress due to days off work or school and the need for strong painkillers. Delay in the diagnosis of endometriosis can also result in some difficulties conceiving a pregnancy.

Am I at risk of developing endometriosis?

If a family member has endometriosis, you may be at increased risk of developing the condition. Some other suspected risk factors include early onset of puberty, heavy or painful periods, short cycles (less than 27 days) and/or long period time (more than 7 days). It usually occurs, or is diagnosed, at any age between puberty and menopause (relationship with hormones being the connection). However, endometriosis is sufficiently common that the diagnosis should be considered in any woman who is unable to get adequate relief from standard treatments for period pain.

General statistics

The incidence of endometriosis is not easy to measure accurately as it is difficult to diagnose easily. It has been estimated to occur in 8-10% of all women of reproductive age ¹ and reported to occur between 15-70% of women being investigated for pelvic pain or infertility.²

How can I get treatment?

Visit your GP and discuss your symptoms. Simple treatments may be offered such as anti-inflammatory medication or the pill. If these treatments are ineffective, early referral to a specialist gynaecologist with an interest in endometriosis should be considered. Laparoscopic treatment for endometriosis is very advanced and minimally invasive. It may only require less than one day in hospital, and can provide great relief of your pain and other symptoms.

Where do I go for more information?

www.ecca.com.au (Endometriosis Care Centre of Australia)
www.jeanhailes.org.au
www.endometriosis.org.au

Sources:

¹ Peres P (2005) Diagnosis and Treatment of Endometriosis www.goalsforwomen.com.au

² Spaczynski (2003) Seminar of Reproductive Medicine, 21 (2): 193-207

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