Endometriosis

Endometriosis affects about 15% of women, causing pain and fertility issues for many.  Essentially endometriosis is the presence of the cells that usually lining the womb, which you shed monthly with menstruation, growing in other areas.  Minor endometriosis may cause no symptoms, and it's important to be aware that the diagnosis of endometriosis does not necessarily mean that you will have problems getting pregnant.  It may cause fertility problems, particularly if more severe, but this is by no means inevitable.  

The most common symptoms of endometriosis are pain with, or before, your periods, and pain with sexual intercourse.  These type of symptoms, combined with the findings from a pelvic/vaginal examination may lead to a diagnosis of possible endometriosis.  

Ultrasound scans and other forms of radiological imaging have traditionally not been very useful in the diagnosis of endometriosis.  However, more recently specialist pelvic ultrasound has become useful in identifying the disease, and it's extent.  

The definitive diagnosis is made with a laparoscopy.  At that time the diseased areas may be excised or burned away.    

There are other reasons for experiencing similar symptoms.  Initially, it may be appropriate to manage the symptoms with hormones, such as the combined oral contraceptive pill, or a long-acting progesterone (the Implanon or the Mirena).  As mentioned earlier,

It is important, however, to identify endometriosis early, to ensure that it doesn't progress to more severe disease.  Unfortunately the average time from a patient reporting symptoms, and being diagnosed with endometriosis, is 9 years.  

There is a risk that endometriosis returns following surgery.  About 30% of women would expect a recurrence of the disease.  

When you come for an appointment, as a matter of routine and good clinical practice, you should expect to have a vaginal examination, which gives good information on the health of your pelvis.  There are occasionally reasons for not having an examination, and we can discuss that at the time.