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Everything you need to know about endometriosis

02 March 2022

Womens health
As a part of Endometriosis Awareness Month, our Obstetrician and Gynaecologist Dr Marilla Druitt who helped write the Australian Endometriosis Guideline (released in 2021 with RANZCOG) shares her experience caring for women experiencing endometriosis.

What is endometriosis?

Endometriosis is a chronic condition of pain and subfertility in which tissue similar to the inside lining of the uterus appears in the pelvis, in ovaries, and occasionally in other places. From the latest estimates from a large study of women in Australia, one in nine Australian women between 18 and 44 years old have been diagnosed with endometriosis. 

What are the signs or symptoms of endometriosis?

Endometriosis can have no symptoms and not discovered until a couple is having trouble conceiving, or it can present with period pain, and occasionally it is diagnosed when surgery happens for another reason. 

Researchers are busy looking for a non-invasive way to diagnose endometriosis, but at this stage, the gold standard is with a laparoscopy for direct visualisation. We can see the tissue and can treat it at an operation. Interestingly, the amount or stage of endometriosis has not been shown to correlate particularly well with amount of pain or difficulty with conceiving.   

Based on some work done especially in Brazil over 15 years ago, ultrasound experts can see large amounts or nodules of endometriosis, and this can help us to plan how long an operation may take, and whether a bowel surgeon should be involved from the beginning. Access to these ultrasound experts currently in Australia is limited, but women should know they exist as this is rarely an acute need. MRI is also great for endometriosis, but somewhat outrageously, this is not MBS funded for women with pelvic pain. 

How does endometriosis affect fertility?

Subfertility is usually multifactorial, and we think endometriosis can delay conception because of chemicals released, adhesions obstructing fertilisation in the fallopian tubes, and sometimes with painful sex. 

What pain is associated with endometriosis?

Pain is  always multifactorial, and women with endometriosis can suffer period pain, pain with using their bowels and bladder, sexual pain, and pelvic floor muscle pain. An amazing brain study (As-Sanie et al, 2012) has even shown women with endo have different brains to those with pain and no endo.

Is endometriosis treatable?

Unfortunately, pelvic pain is common, but it is not okay, and it is treatable. An interdisciplinary approach is best!

What treatment is available?

If women are not trying to conceive, we can use hormones for ovarian suppression and to stop periods. Medicines seem as good, if not better than surgery for the treatment of pain associated with endometriosis.

Women with endometriosis, and those with all the pains and  a negative laparoscopy, almost always benefit from a holistic approach to their care. 

  • Pelvic floor pain physiotherapy is excellent for tight sore muscles, pain neuroscience education and helping bladder and bowel symptoms. 
  • Cognitive behavioural therapy with pain psychologists has also been shown to decrease pain
  • We should treat Irritable bowel syndrome and other pains such as migraines which often co-occur, as it’s hard to fix one pain if you don’t fix all pains
  • The low FODMAP diet and – believe it or not – Gut Directed Hypnotherapy – have great evidence for effectiveness for IBS.

Exercise treats pain, melatonin has evidence for sleep, and improving mental health should always be considered from the outset – not one then the other.

Marilla Druitt Geelong
Dr Marilla Druitt - Gynaecologist and obstetrician
Dr Druitt is an obstetrician gynaecologist and has a special interest in endometriosis and pelvic pain and minimally invasive surgery including hysteroscopic management of fibroids and total laparoscopic hysterectomy.