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:

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