What is endometriosis?
Endometriosis is a disorder where tissue that usually lines the womb (endometrium) is found outside of the uterus and in other parts of the body. The tissue could be on the ovaries, fallopian tubes, and ligaments that support the womb. Other areas for these growths may include the bladder, bowel, vagina, cervix and vulva. In complex cases, they are found in the lung, arm, thigh or other locations.
What are the causes?
The cause of endometriosis remains unknown. Some theories suggest that endometriosis occurs due to a process called retrograde menstruation. The menstrual blood flows back through the fallopian tubes into the pelvic cavity instead of leaving the body through the vagina. Another theory for the cause of endometriosis is that hormones transform cells outside of the womb into cells like those lining the inside of the uterus (endometrial cells).
What are the symptoms?
The symptoms of endometriosis can vary, with some women more affected. These symptoms include:
- Menstrual period pain
- Heavy periods
- Pelvic pain
- Pain during and after sexual intercourse
- Pain when going to the toilet
- Blood in the stool
- Gastrointestinal upsets – diarrhoea, constipation and feeling nauseous.
What is the treatment of endometriosis?
Advanced ultrasound techniques can identify endometriosis, especially on the ovaries or larger deposits on bowel. MRI and laparoscopy may be required to diagnose more subtle lesions.
- Anti-inflammatory painkillers
- Hormonal therapy, such as the combined pill, contraceptive patch or Mirena intrauterine device.
What are the stages?
Endometriosis is classified into one of four stages:
- Stage I-minimal,
- Stage II-mild,
- Stage III-moderate, and
- Stage IV-severe
This staging system is based on the location, organs affected, depth of the endometriosis lesions, and severity of scarring as well as size of endometriosis ovarian cysts, where present.
Stage 1 and 2 endometriosis have superficial lesions with minimal scarring. Stage 3 and 4 have large ovarian cysts and more severe scarring with deep infiltration of the lesions into adjacent structures.
The stage of endometriosis is not related to the symptoms (some grade 1 cases have severe symptoms, while some grade 3 and 4 cases have none or only mild symptoms). However, infertility is common with stage 3 and 4 endometriosis.
What surgery is available?
Endometriosis surgery aims to remove or destroy the deposits of endometriosis. The endometriosis is cut out or destroyed using heat or laser. Surgery provides relief from symptoms and improves fertility potential.
Almost all endometriosis surgery is performed laparoscopically (keyhole surgery). This will usually be a day surgery procedure under general anaesthetic, with patient discharge on the same day. In severe cases, especially where bowel or bladder surgery is required as well, an overnight stay or on occasion, a couple of days in hospital could be necessary.
In cases with large lesions, significant bowel surgery required or where complications arise, an open procedure may be necessary.
How long is the surgery?
Depending on the severity and grade of endometriosis, surgery could take between 45 minutes to 90 minutes in most cases of grade 1-3 endometriosis. Severe grade 4 cases could longer than 2-3 hours, depending on the extent of endometriosis to be removed and location.
What is the recovery time after surgery?
Recovery from endometriosis will depend on type of surgery (much quicker recovery with keyhole laparoscopic surgery compared to open procedure), as well as grade of endometriosis.
The surgery is usually a day surgery procedure with most patients able to resume normal activities after 1-2 weeks.
Life after surgery and getting pregnant
Endometriosis could reduce fertility potential especially where it damages fallopian tubes or where ovarian endometriosis cysts affects egg reserve and quality. There is good evidence that suggests that inflammation from endometriosis also affects implantation potential.
Endometriosis surgery not only relieves the pain symptoms, but also improves the chances of a spontaneous conception. For those patients that do not conceive spontaneously, surgery improves the chances of success with fertility treatments such as IVF.
When can I start trying for a baby after endometriosis surgery?
Your surgeon will see you after surgery to confirm that you are healing well after surgery. They will also confirm when you can start trying for a baby. In our practice, most patients can start trying for a baby after 1-2 months following surgery.
For more information about how we can help you, have a look at our Endometriosis Care Package.
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