Endometriosis

Endometriosis is a common and troublesome condition affecting many women of childbearing age and occasionally in teenagers as well.

It is a progressive disease when the lining of the womb (endometrial tissues) is spilled into other parts of the reproductive organs including the fallopian tubes, ovaries and the back of the womb. These abnormal and wayward endometrial tissues bleed every month during menstruation. The surrounding areas become irritated and form scars.

The exact cause of endometriosis is not well understood although many theories have been proposed to explain its development. There is a genetic basis for the disease as it can run in the family.

Most common symptom is abdominal cramps, pain or backache during menstruation and intercourse as in your case. Difficulty in having baby (infertility) may also be a presenting symptom. The menstruation may be irregular with staining before or after menstruation. There may be clots in the menses. The symptoms may not correlate well with the disease. For example, some women may experience extreme symptoms with mild disease while others with sever disease may not have symptoms.

The diagnosis of endometriosis requires careful clinical history and examination and interpretation of laboratory and imaging techniques. Ultrasound scan may suggest ovarian cyst and blood test of tumour marker (CA125) may be raised in advanced stage of the disease. Ultimately the diagnosis is confirmed by laparoscopy with removal of cyst if present.

Treatment of Endometriosis

Endometriosis is generally a difficult disease to treat as there is no definitive cure. The disease will die off only at menopause when there is no stimulation of the endometrial tissues by the ovarian hormones. If the disease is very mild causing menstrual discomfort only, pain killer such as panadol, aspirin and ponstan may alleviate the pain.

Doctors may encourage patients who are married to get pregnant as the hormonal changes during pregnancy may cause the diseased areas to soften up. However, the relief may be temporary and symptoms may return within months after pregnancy is over.

If the disease is more severe, drug treatment may be useful. Drugs that have been used include oral contraceptive pills or male-like hormone (Danazol). They are taken continuously for several months. The basis of using these drugs is to stop the menstruations so that the disease may be temporary arrested. However, oral contraceptive pills may cause side effects like irregular bleeding, putting on weight and bloated ness in the abdomen and Danazol may cause side effects like excessive pimples (Acne) weight gain, hoarseness of voice and muscle cramps.

A relatively new group of drugs have been developed for the treatment of endometriosis. They are called GnRH agonists. They suppress the female hormone estrogen and thus causing the diseased tissues to die off. They are usually given in the form of injection for 3 to 6 months. They may cause side effects similar to those experienced during menopause such as hot flushes, vaginal dryness and mood swing. However, if the doctor adds some hormone as supplement (add-back therapy) these side effects can be avoided.

If the disease is getting more severe forming ovarian cysts (sacs of chocolate fluid or blood cysts) then surgery may have to be performed. This could be done through key-hole surgery (laparoscopy) or by the conventional way (laparotomy). However if the disease is far too advanced causing a lot of abdominal pain, and the wombs and ovaries are destroyed, removal of the womb (hysterectomy) and ovaries (oophorectomy) may be necessary.