Endometriosis

What is endometriosis?

Endometriosis is a condition where endometrial glands and the supporting tissue, very similar to the tissue that comes away at the time of your period, is located outside the uterus. Because the tissue is similar in structure to the normal lining tissue in the uterus it responds to female hormones in a similar way and goes through cyclical changes very similar to those that occur during the normal menstrual cycle.

Endometriotic tissue can either be small deposits or large pieces of tissue especially on the ovaries where the large cystic areas are called endometriomas.

Where does endometriosis occur?

Endometriosis can occur at any site within the pelvis but most commonly occurs on the ligaments on the back of the uterus called the uterosacral ligaments, the pelvic side wall or on the ovaries. It is also possible for endometriosis to be present on the bowel or less commonly the bladder. These deposits can either be superficial or can invade into deeper tissues and this occurrence is often associated with more symptoms.

What are the symptoms of endometriosis?

The most common symptoms that we find in women with endometriosis is pelvic pain. This pain is often present just prior to or during periods and is then called dysmenorrhoea. Endometriosis can also be associated with pain with intercourse, pain at other times outside the period and bowel pain. These symptoms are often suggestive of significant endometriosis. Sometimes endometriosis can be asymptomatic or not associated with any symptoms at all, and in this case it is often found as part of the investigation of infertility.

If Dr Kliman suspects that you may have endometriosis the first investigation may be an ultrasound. As the detection of endometriosis can be difficult, it is important you have an ultrasound with a specialist who is well trained in the detection of endometriotic deposits. This often involves bowel preparation prior to the scan to allow the scan to be also performed via the bowel.

How to diagnose endometriosis?

The definitive way to diagnose endometriosis is with a keyhole procedure called a laparoscopy performed under general anaesthetic. The endometriosis can then be visualised and the deposits can either be surgically excised or lasered off if they are superficial. In cases where the endometriosis is extensive, surgery may be followed with hormonal treatment to help remove any residual deposits and prevent recurrence.