Endometriosis is a condition where tissue similar to the lining of your uterus (womb) is found in places outside of your uterus, such as on your ovaries, bladder or even bowel. It affects 1 in 10 New Zealand cis females and transgender people.
Meet our multidisciplinary team for Endometriosis
Symptoms
Pain with periods (dysmenorrhoea).
Painful sex (dysparaeunia)
Random pelvic pain (non-cyclical pain)
Fatigue
Infertility
Bladder and Bowel troubles (bloating, pain with bowel movements, pain with urination)
Diagnosis
A “clinical” diagnosis can be made based on symptoms patients experience and/or evidence of deep endometriosis (scarring) felt during a gynaecological exam or seen on ultrasound/ MRI.
A “surgical” diagnosis is made after endometriosis is excised and sent for lab diagnosis. Under the microscope endometriosis shows up as inflammation and glandular tissue. This type of tissue should not be found in the pelvis normally.
Stages of Endometriosis
Many people talk about endometriosis as stage 1 to 4 (minimal to severe) (ASRM). This staging system tries to encapsulate how widespread the endometriosis is. Whether it affects ovaries, fallopian tubes, or other organs in the pelvis (bowel, bladder). Newer staging systems focus on the level of invasion of pelvic organs (ENZIAN). A clinical exam, ultrasound and/or MRI are used to establish the level of disease.
Treatment
Treatment should involve a multi-disciplinary approach. What this means is there is more than just an endometriosis doctor is involved in a patient’s care. Other key health professionals include physiotherapists, nurses, dieticians, psychologists. Treatment should take into account a patient’s age, severity of symptoms, fertility desire and a patient’s preference.
Conservative and Medical treatment
This can include counselling and education on triggers of symptoms. Particular foods can trigger pain in many people. Mental health and management of fatigue is important. Women’s physiotherapists help with tailored treatment of tense pelvic floor muscles that can seize up due to endometriosis pain (see link- easy stretches to relax the pelvis)
Medication can be used at times of need and a GP or gynaecologist can speak with you about the best approach for you. Some medications are prescribed daily whereas others can be used only when pain is present.
Hormonal medication is used in endometriosis to stop the flares that glandular endometriosis tissue creates in your body. Hormones work for many but not for all and many type and preparations exist.
Surgical management
Surgical management is recommended as the “gold standard” for diagnosis and treatment. Not only will it confirm or exclude endometriosis in people but excising it will remove the endometriosis. In many people this leads to a significant improvement in pain and fertility success. Surgery is reserved as a option when conservative and medical management has failed or if endometriosis is particularly advanced.
Endometriosis can invade other pelvic organs such as the bowel, bladder and ureters (drainage system for the kidneys). Excision of deep endometriosis around these organs is challenging and has risks. It should only be performed by and AGES accredited level 6 surgeon.