John Flynn Medical Centre
2A/42 Inland Drive
Tugun, QLD, 4224

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Endometriosis – Symptoms, Causes and Treatment

Endometriosis is a condition where tissue similar to the endometrium (which lines the uterus) grows outside the uterus.

Sites that can be affected

  • most often in the pelvis or lower abdomen e.g on ovaries
  • Fallopian tubes/on outside of uterus
  • behind uterus – Pouch of Douglas
  • on ligaments, bowel , bladder or ureter
  • on pelvic side wall
  • rarely on diaphragm, lungs, bone, brain, nasal passages.

Appearance:

  • black/brown/bluish/white/red patches or clear/yellow brown
  • often associated scar tissue or adhesion present as a reaction to the presence of endometriosis

Occurrence:

  • 10 – 20% of women between 12 and 50 have endometriosis
  • Increased risk of first degree relative affected

Presentation:

  • as endometriotic implants or patches
  • as endometriotic nodules
  • as endometriomas – cyst ovaries
  • as adenomyosis – in the muscle wall of the uterus

Severity:

  • mild – small patches in the pelvis – no scarring
  • moderate – larger patches with cysts and scarring
  • severe – large patches with severe scarring involving most of the pelvic organs

Causes of Endometriosis (not fully understood):

  • retrograde (back flow) menstruation
  • abnormal immune system response
  • genetic basis

Symptoms:

  • pain – dysmenorrhoea (painful periods)
  • deep dysparuenia – deep pelvic pain with intercourse/sex – pain experienced on vaginal examination
  • if endometriosis involves bowel – irritable bowel symptoms, rectal bleeding, constipation
  • if endometriosis involves bladder – haematuria – blood in urine, irritable bladder.
  • Sometimes even with severe endometriosis no symptoms at all
  • Infertility – endometriosis may reduce fertility in 3 – 4 women in 10 with endometriosis. Mechanism – decreased sperm movement – interferes with sperm/egg interaction. If severe – adhesions (scar tissue) effect
  • Endometriosis improves after menopause (ovary failure) – oestrogen from the ovary stimulates endometriosis (pregnancy – no periods and no surging of oestrogen often improves endometriosis)

Diagnosis of Endometriosis:

  • history examination
  • ultrasound for endometriotic cysts

All give a strong suspicion of the possibility of endometriosis, however laparoscopy (keyhole surgery under general anaesthetic) is the way to prove the presence of endometriosis.

Treatment:

  • endometriosis varies in its “progress” until menopause. Most will get worse over time, some will stay the same and some will get better.

Hormonal Treatment:

  • Oral Contraceptive pill – reduces oestrogen surge
  • Progesterone – Mirena, Depo-Provera, Implanon all reduce oestrogen surge
  • Danazol – stop periods for up to 6 months
  • Zolodex implants – also stop periods – 80% pain free for up to 2 years

Surgery:

  • Laparoscopy – key hole surgery, often followed by the Oral contraceptive pill
  • Laparotomy – (open) surgery
  • Hysterectomy – last resort

Our Services Include:

Fertility Clinic

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Gynaecologist

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IVF

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Obstetrician

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