6733 8810 
Endometriosis
Dr Christopher Ng
Consultant Obstetrician & Gynaecologist
MBBS (Imperial College, UK), MMed (O&G) (S’pore), FRANZCOG (Aust-NZ), FAMS (O&G) (S’pore)
Endometriosis is one of the main causes of pelvic pain and infertility, and about 1 in 10 women are affected by this condition. Endometriosis happens when the tissue that lines the inside of the uterus (endometrium) grows outside of it.
Endometriosis can be found in the muscle layer of the womb (adenomyosis), ovary (endometriotic cyst), bladder and bowel. In adenomyosis, the endometriotic cells will accumulate in the muscle layers of the uterus overtime causing the uterus to enlarge which ultimately leads to pelvic pain especially during menses.
Types of Endometriosis
There are three types of endometriosis, which can be classified according to their location:
Superficial Peritoneal Lesion
This is the most common type of endometriosis. Patients diagnosed with this type of endometriosis have lesions on the peritoneum, which is a thin film lining the pelvic cavity.
Endometrioma or Endometriotic Cyst (Ovarian Lesion)
This type of endometriosis develops in the ovaries. It is also known as "chocolate cysts" as the fluid inside the ovarian cyst resembles chocolate syrup.
Deeply Infiltrating Endometriosis (DIE)
This type of endometriosis develops below the peritoneum and can affect organs near the uterus such as the bladder and the bowels. About 1% of women of reproductive age have it.
Endometriosis Symptoms
Some of the common symptoms of endometriosis are:
Painful Periods
Patients who are diagnosed with endometriosis often experience painful periods as the pelvic endometriosis breaks down and leads to bleeding inside the pelvis. Eventually, this results in inflammation, swelling, and pain. Endometriosis that develops within the muscle layers of the uterus (adenomyosis) also bleed during menses and distends the uterus causing painful periods too.
Heavy Menstrual Bleeding
Endometriosis that invades into the muscle layer of the uterus is called Adenomyosis. Due to hormonal changes during the menstrual cycle, the adenomyosis proliferates, the uterine cavity enlarges and the endometrium thickens resulting in heavy menstrual bleeding.
Prolonged Menstrual Bleeding
Aside from heavy periods, women with endometriosis also experience longer menstrual bleeding. This is because the thickened endometrium needs to be shed, making their menstrual periods last longer than usual.
Pain During or after Sexual Intercourse
Women who have endometriosis experience pain during intercourse due to the physical interaction between the penis against the enlarged uterus and pelvic endometriosis.
Long-term Lower Back and Pelvic Pain
The wide spread proliferation of endometriosis in the uterus, ovaries and pelvis results in inflammation and pelvic adhesions (which are filmy attachments that can bind pelvic organs, bowel and bladder together). This eventually results in tension and chronic lower back and pelvic pain.
Infertility (Decreases a Woman’s Ability to Conceive)
When endometriosis abnormally forms around the fallopian tubes, it can damage the fallopian tubes resulting in blockage. Fertilisation between the egg and sperm occur within the fallopian tubes so any blockage will lead to tubal infertility.
Endometriosis Treatment
Medication and Hormonal Therapy
Over-the-counter medicines can be used to treat patients who are experiencing mild endometriosis pain. Alternatively, hormonal therapy in the form of oral medication or injections is used to suppress endometriosis activity during the menstrual cycle in order to reduce any discomfort and regulate menstrual periods.
Some medications that can alleviate symptoms of endometriosis include:
- Gonadotropin-releasing hormone (GnRH) medicines
- Oral contraceptives (birth control pills)
- Progesterone and progestin
- Androgenic hormones
- Aromatase inhibitors
Endometriosis Surgery
Surgery is recommended by your gynaecologist when medication is proven to be ineffective. Endometriotic lesions and cysts can be successfully removed via open or laparoscopic surgery (minimally invasive surgery). During laparoscopic surgery, a small incision is made in the belly button so that a tiny tube-like camera (laparoscope) can be inserted. Once the laparoscopic instruments have been inserted, the surgeon can proceed to remove the pelvic endometriosis lesion and endometriotic cyst.
On the other hand, open laparotomy is a more invasive procedure. This is done by creating a horizontal incision across the lower abdomen. The gynaecologist usually performs this when the endometriosis is severe and the risk for laparoscopy is too high.
As endometriosis tends to recur, women who have plans to conceive are advised to do so as soon as possible after the endometriosis surgery.
Endometriosis FAQ
Some factors that put women at risk of developing endometriosis include:
- Family history (e.g. a family member who has endometriosis)
- Never been pregnant before
- Medical conditions that affect the normal outflow of menstruation (e.g. an abnormal uterus)
- Abnormal menstrual cycle (i.e. shorter menstrual periods of less than 27 days or heavy menstrual periods that last longer than 7 days)
- Early menstruation and late menopause
- Low body mass index
Classic symptoms of endometriosis include pain in the pelvis that worsens during periods, pain during or after sex, pain during bowel movements and urination while on one’s period, excessive heavy menstrual bleeding, and infertility.
Some complications of endometriosis include infertility and damage to surrounding tissues such as the bladder and bowel.
Before undergoing endometriosis surgery, ask a friend or family member to accompany you; avoid eating or drinking for a sufficient period of time prior to the surgery (specific instructions will be given, depending on the timing of your surgery); notify your doctor about any medications you are taking; and stop smoking.
If the patient had a laparoscopy (minimally invasive surgery), she can go home on the same day if the endometriosis is mild and as long as she is cleared by the doctor. Returning to normal activities will take two weeks or more. For laparotomy surgery (open surgery), this will take up to one month to recover. Be sure to attend your follow-up appointments with your doctor to ensure that you have properly healed.
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Dr Christopher Ng
Consultant Obstetrician & Gynaecologist in Singapore
Qualifications & Credentials
- Bachelor of Medicine, Bachelor of Surgery (Imperial College, UK)
- Master of Medicine in Obstetrics and Gynaecology (Singapore)
- Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists
- Fellow of the Academy of Medicine, Singapore (Obstetrics & Gynaecology)
Dr Christopher Ng is a dedicated obstetrician and gynaecologist with over two decades of experience. Having been educated and trained in Singapore, the UK and the US, Dr Ng brings with him a wealth of experience and medical knowledge that puts his patient’s wellbeing to the fore.
Dr Ng also complements his practice with aesthetics and has obtained Certificates of Competence in all aesthetic procedures recognised by the Singapore Medical Council Aesthetic Practice Oversight Committee.
With over 30 years of dedicated service in the field of women’s health and rejuvenation, Dr Ng remains steadfast in his commitment to provide compassionate, personalised and effective care to all his patients.
Dr Christopher Ng is a dedicated obstetrician and gynaecologist with over two decades of experience. Having been educated and trained in Singapore, the UK and the US, Dr Ng brings with him a wealth of experience and medical knowledge that puts his patient’s wellbeing to the fore.
Dr Ng also complements his practice with aesthetics and has obtained Certificates of Competence in all aesthetic procedures recognised by the Singapore Medical Council Aesthetic Practice Oversight Committee.
With over 30 years of dedicated service in the field of women’s health and rejuvenation, Dr Ng remains steadfast in his commitment to provide compassionate, personalised and effective care to all his patients.
1 Orchard Boulevard, #04-03A Camden Medical Centre, Singapore 248649
Phone:+65 6733 8810
Fax:+65 6733 8850
After Office:+65 6535 8833
Email:gynaemd@singnet.com.sg
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Lunch Break:1300h to 1400h
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