ENDOMETRIOSIS - Full extract 

Endometriosis affects about 10 per cent of women in the reproductive years, with a peak incidence between the ages of 25 and 35. Although fairly common, it can be a puzzling condition; the symptoms vary greatly in their type and severity.

Frequently, several years may elapse before the diagnosis is made.

Endometriosis gets its name from the word endometrium, the tissue that lines the inside of the uterus.

Somehow, deposits of this tissue appear in areas such as the ovaries, Fallopian tubes and the outer surface of the uterus. The outside of the bladder and the bowel can also be affected.

These deposits of endometrial tissue can increase in size and become inflamed, especially with menstruation. Bleeding may also occur. The affected areas can become stuck down and bound together with scar tissue. Cysts containing old blood may also form on the ovaries. Most cases run a milder course, with areas affected limited to the ovaries and behind the uterus. The precise cause of endometriosis is unknown.

A common symptom of endometriosis is painful periods, especially after not being a problem previously. Pain with intercourse is also common. General symptoms like tiredness and back pain may occur. A degree of infertility is present in about 30 per cent of women with endometriosis. Often it is a combination of symptoms that raises the question of endometriosis. Clinical examination may be normal. However, there may be tenderness in the lower part of the abdomen, and an internal examination may reveal tenderness or thickening next to the uterus.

A positive diagnosis can only be made by laparoscopy. Under a general anaesthetic, a gynaecologist inserts a tiny telescope with a light on the end through a small incision in the umbilicus. Each organ inside the pelvis can be directly visualised, and endometriosis can be distinguished from other conditions such as pelvic infection or ovarian cysts.

Several medications are used to treat endometriosis. Danazol acts on the pituitary gland at the base of the brain to block the release of female hormones. It improves symptoms in about 80 per cent of cases and is often used in courses of several months. However, it can have side effects such as oily skin, acne and weight gain.

Progesterone type medications such as Duphaston and Provera are another option. They are usually well-tolerated, although some women do complain of side effects such as headaches, bloating and breast tenderness. A number of other hormone preparations are available. Extra precautions to prevent pregnancy are required with some of these medications.

Sometimes the pill itself can help to alleviate the symptoms of endometriosis. Simple pain killers and a range of alternative therapies may also give some relief.

For complications such as cysts and scar formation, laparoscopic surgery can be very helpful. Patients are often given a hormone preparation such as Synaral nasal spray for several weeks prior to surgery - to reduce the amount of swelling and inflammation. Decisions about treatment are influenced by the women's fertility status and her intentions of having further children. For chronic severe symptoms, more definitive surgery such as hysterectomy might need to be considered.

Health Tip:
* Intermittent pelvic pain is a very distressing symptom and the actual cause may not be obvious. Endometriosis should be considered. Ask your doctor for advice.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001