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Endometriosis: ‘It’s poorly understood and treatments are limited’

Woman experiencing endometriosisWhy have a special month for endometriosis?

Because it impacts hundreds of millions of women worldwide and many more close to them.

Because it is poorly understood and our treatments are limited.

Because it can cause debilitating pain and is a cause of infertility for many couples.

So we need to be reminded of the condition and the need for better treatments.

What is endometriosis?

It is a condition where tissue similar to endometrial tissue that normally resides on the inner layer of the uterus is found elsewhere in the body. The most common area is on the internal skin layer of the lower abdomen known as the pelvic peritoneum. ‘Endo’ has also been found in unusual places like the eye. The abnormal location of the tissue causes inflammation that can lead to pain and make the area sticky or scarred.

Chances are you know someone who has endometriosis. You might also know someone that has pain, infertility or other symptoms such as painful sex, and are curious about whether it’s due to endo.

How is endometriosis diagnosed?

The only certain way to diagnose endometriosis is with biopsy of internal tissue. This means a laparoscopy or ‘keyhole’ surgery to look inside the abdomen is usually required for diagnosis.

Increasingly, medical imaging such as ultrasound and MRI can give us some evidence it is there. Gynaecologists are specifically trained to look out for this condition and some gynaecologists specialise in the removal of severe endometriosis. But it’s symptoms can be very subtle and sometimes overlooked by doctors. So if you have symptoms of period pain, heavy menstrual bleeding, painful sex, infertility, pain with emptying the bladder or bowel or other symptoms that seem to coincide with the onset of your period—find a doctor who is interested in endometriosis.

While public and health professional awareness of the condition has increased, there is still much work to do. If we know what to look for, we are more likely to seek help as well as get a diagnosis.

How is endometriosis treated?

Early treatment can slow it’s spread, reduce any associated pain and impact on the organs needed for fertility.

Treatment can help with the symptoms. This includes basics like pain relief medication, or more complex treatments to suppress or remove the abnormal tissue.

Endometrial tissue is glandular so it grows and can bleed in response to the hormonal cycles of ovulation and menstruation. It’s sensitivity to hormones is one way we can medically suppress it’s growth. We do this with synthetic hormones similar to the progesterone made in the ovary. The abnormal areas of tissue inside the body can also be surgically removed in most cases.

Treatments can also extend to physical, psychological and lifestyle changes that reduce pain and inflammation. For women with associated muscle tightness, pelvic physiotherapy might help.

There are also health professionals trained to deal specifically with people that suffer persistent pain that hasn’t responded to the usual treatments.

Can endometriosis cause infertility?

Many women will never know they have endo. For some, this will never be a problem. But for others, it has unwanted consequences. For example, research at Mater has found that more than 80% of women with unexplained infertility—that is infertility with no obvious cause—will have endometriosis found during surgery. So research into other ways of diagnosing endo is needed to prevent unwanted consequences.

How can we improve the life of women with endometriosis?

So during this Endometriosis Awareness Month, what can we each do to improve the lives of women with endometriosis? Some of us are called to prioritise this in our work or volunteering efforts. If you wish to find an organisation to help, there are lots of local and global organisations working hard in this area. In my own city of Brisbane, QEndo is raising awareness and money for research.

Have you ever considered reaching out today to someone you know with endometriosis to acknowledge the impact it has had in their life? Their stories deserve to be heard.

About Dr Gabriel James

Dr Gabriel James is a specialist in Women's Health. Gabriel has always had a passion for helping mothers to birth their babies in a safe and secure environment. He also has a passion for precise and thorough ...

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