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Endometriosis is a painful and chronic disease that is often mistaken for normal menstrual pain. It occurs when endometrium tissue, which lines the uterus, is found outside of the uterus. This tissue develops into growth or lesions which respond to the menstrual cycle in the same way the tissue of the uterine lining does: each month the tissue builds up, breaks down and sheds. Menstrual blood flows from the uterus and out of the body via the vagina, but the blood and tissue shed from endometrial growth has no way to leave the body. This could result in internal bleeding, breakdown of blood and tissue from the lesions and inflammation, causing pain, infertility, scar tissue formation, adhesions and bowel problems.
Endometriosis affects about 10 per cent of the female population, with up to half of all infertile women suffering from it. Many women suffer in silence during their monthly periods, assuming that painful cramps are normal. Many endometriosis sufferers go undiagnosed until they try to conceive without success or when the pain worsens, leading the sufferer to see a gynaecologist.
Symptoms generally develop before the age of 30 and can include any of the following:
Typically, women with endometriosis experience pain during or just before menstruation, some have pain during sex and occasionally, a few may complain of pain when moving bowels or passing urine. Certain individuals with severe, long-standing disease may have constant pain which no longer fluctuates cyclically.
Another common symptom of endometriosis is infertility. The inflammation process and resultant scarring can adversely affect the reproductive organs, as well as distort the reproductive structures (e.g. kinking or blockage of fallopian tubes, formation of ovarian cysts, etc) and make pregnancy difficult. In addition, the pain from endometriosis may preclude regular intercourse, further contributing to infertility.
The only method of diagnosing endometriosis is by laparoscopy or keyhole surgery, especially with removal of the diseased tissue removed for examination. However, it is an invasive procedure and care must be taken to avoid unnecessary risks for women without endometriosis.
The formula for detecting the disease involves detailed interview and physical examination, as well as pelvic ultrasound scans. Hence, we rely heavily on the specialists’ experience, clinical acumen and high index of suspicion in order not to miss cases with endometriosis. There is no need for blood tests or high-resolution imaging studies for most cases, which are not accurate for endometriosis anyway.
This can generally be categorised into either surgery (laparoscopy, mini-laparotomy, aparotomy) or medication. The choice of treatment has to be tailored to the woman (or couple, in some cases), depending on level of suspicion for endometriosis, the impact of the disease on the patient and the desired outcome of treatment (pain control, fertility or both).
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