Endometriosis
Here we look at what endometriosis is, the difficulty with diagnosing it, what can be done to manage the symptoms and when we might decide to pursue further investigations.
Definition
Endometriosis is a condition in which there are pockets of tissue similar to (but not the same as) endometrium - the tissue that lines the womb - in areas where it shouldn't be. This may be in the fallopian tubes or the ovaries. It can cause so-called 'chocolate cysts' in the ovaries. If it is in the muscle wall of the womb (the myometrium) this is called adenomyosis. It may even occur in areas distant from the pelvic organs, such as bowel, the appendix, or even the lungs.
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Symptoms
Endometriosis is a chronic, inflammatory, whole-body disease which can cause debilitating symptoms to those affected. The endometrial-like tissue is sensitive to the cyclical monthly hormone changes. It can cause a variety of symptoms depending on where the endometriosis is. Excessive pelvic and back pain during periods is a common symptom. There may be non-cyclical pelvic pain throughout the month. There may be painful bowel movements during a woman's period if it is present in the bowel. Pain during intercourse is also possible. It may cause difficulty becoming pregnant if present in the ovaries or fallopian tubes.
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Diagnosis
Endometriosis can be difficult to diagnose. It is well known that it can take many years to get a diagnosis and many woman can feel frustrated by this delay. The problem is that diagnosis can only be made definitively by laparoscopy (keyhole surgery) where the pockets of endometriosis can actually be seen by the surgeon. Adenomyosis can sometimes be seen on MRI. Chocolate cysts and adenomyosis can sometimes be seen on ultrasound. However, a normal ultrasound or MRI does not mean a women does not have endometriosis.
Management
Despite the difficulty diagnosing it, based on a woman's history, her doctor may be strongly suspicious of endometriosis and they may decide together to manage it as such, without having a definitive diagnosis. The options include painkillers such as anti-inflammatories like ibuprofen or ponstan. Some woman may go on a combined contraceptive pill. This can be very effective as you are effectively shutting down the normal menstrual cycle. Packs can even be taken back to back so the woman is not having any periods. Hormonal coils can also be very effective.
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A GP may refer a patient to a gynaecologist for investigation for endometriosis i.e. laparoscopy, in certain cases. For example, if a woman is having trouble conceiving and endometriosis is the suspected cause. Another reason for referral may be if conservative management has failed to control a woman's symptoms adequately and it continues to significantly affect her quality of life. The benefit of opting for laparoscopy for diagnosis is that the endometriosis can be treated during the same procedure. If pockets of endo are seen during surgery they can be cut away.