Painful periods are just the start, but there are still ways to deal with endometriosis. Aileen Lalor seeks out expert advice.
Dr Steven Teo, obstetrician and gynaecologist from STO+G Practice in Thomson Medical Centre. He specialises in the diagnosis and treatment of endometriosis
1. Up to 10 per cent of women may have it
The actual prevalence is unknown as it is likely to vary widely across different populations, depending on ethnicity and socio-economic demographics. According to Dr Teo, endometriosis is estimated to affect about half the women in the subfertile group of patients. The condition occurs when parts of the endometrium (the lining of the womb) migrate outside the womb. These are known as endometrial lesions and end up on the ovaries, fallopian tubes, bowel or the tissue lining the pelvis, which causes inflammation and scarring. This inflammatory process continues throughout the reproductive years of affected women.
2. It’s not just a painful period
While a painful period is the most common sign, some women may experience pelvic pain or backache. “Symptoms can vary from no pain at all to severe pain related to menstruation, sexual intercourse, defecation and urination,” says Dr Teo, obstetrician and gynaecologist at Thomson Medical Centre. “Some women even have blood in their urine or stool when the womb lining infiltrates the bladder or intestines, but this is rare.”
3. No genetic predisposition
Dr Teo says it’s unclear why some people suffer from the condition while others don’t. “There is no conclusive evidence that it runs in families,” he says. What is typical is it tends to strike those in their childbearing years. “The onset is most likely to be in your 20s or 30s, although we have seen adolescent girls with endometriosis,” he says. According to Dr Teo, more younger women are coming forward for fertility screening, allowing the disease to be detected in the earlier stages so that timely treatment can be administered.
4. It affects fertility
Women who don’t experience symptoms like pain may only visit their doctor if they have trouble getting pregnant. “The inflammation and scarring resulting from endometriosis can distort the reproductive environment, scar and block fallopian tubes or cause ovarian cysts to form, all of which can make pregnancy difficult,” explains Dr Teo.
It doesn’t help that these women may experience pain during sex, which may put them off intercourse. However, some women with endometriosis can get pregnant naturally, adds Dr Teo.
5. Lifestyle changes may help, though evidence is lacking
“There is no evidence that lifestyle modifications have any conclusive benefit for endometriosis,” says Dr Teo. “However, maintaining a healthy, active lifestyle, and avoiding excessive alcohol and cigarette smoke are generally viewed as a good step for those planning to start a family.” Further studies are required before it can be recommended that changing one’s diet by including more anti-inflammatory foods, reducing soy products and choosing hormone-free meat can help.
6. Treatment is complex
Treatment can be surgical or medical. Laparoscopic or keyhole surgery is usually performed at the time of diagnosis, and is recommended for women who still want to have kids. During the procedure, peritonectomy or the stripping away of the diseased lining covering the affected pelvic structures is performed with precision. Lesions that are not suited to be stripped away have to be removed using a heat source such as a laser or electro-surgical devices.
Medical treatment involves suppressing ovulation, in the form of the Pill, injections or inserting a progesterone-impregnated coil inside the womb – which is why it’s not suitable for women trying to get pregnant, says Dr Teo. Hence, the type of treatment varies across individuals and has to be customised according to needs.
7. There’s no real cure
Dr Teo says that surgery is closest to a cure, but in advanced cases – where there may be deep implants on the pelvic lining and ovaries, even lesions on the fallopian tubes and bowels – it is almost impossible to remove all the lesions and the condition may recur.
In extreme cases, a hysterectomy to remove the ovaries is performed. “Removal of the ovaries renders the woman menopausal, which means she stops producing oestrogen,” Dr Teo explains. Oestrogen is needed for endometrial lesions to form, so the removal of ovaries prevents new lesions from developing while existing lesions shrink. However, scarring from the previous disease will remain.
8. It’s difficult to diagnose
While many gynaecological conditions can be detected via an ultrasound, endometriosis is most accurately diagnosed by laparoscopy, says Dr Teo. But as this is invasive, doctors will recommend it after detailed consultations and examinations – which is where the problem lies. “Endometriosis isn’t well-understood by many people,” says Dr Teo. “It’s important that women have the basic awareness that endometriosis exists and don’t dismiss symptoms that are suggestive of the disease.”
9. It can affect your whole life
The condition can have far-reaching effects on your sex life, social life, even your career. “Pain can result in absenteeism, impaired physical performance and avoidance of sexual intimacy,” says Dr Teo. “It’s not uncommon for patients to become depressed due to the pain, fertility issues and effects on their social life.” The medication too, may have side effects including menopausal symptoms, mood swings and depression.
10. It is related to ovarian cancer
Dr Teo says: “Some studies show that women with endometriosis may have up to four-fold increased risk of developing aggressive ovarian cancer later on in life.” However, the exact link between endometriosis and cancer has yet to be established. While endometriosis is not cancerous by nature, severe endometriosis can affect individuals as seriously as cancer.