Endometriosis

Endometriosis is a disease characterised by the growth of cells similar to those in the endometrium, the lining of the uterus, outside the uterine cavity. This condition affects various parts of the female reproductive system and can extend to other organs.

It is commonly associated with pelvic pain and infertility, affecting 10–15% of women of reproductive age globally.

Signs and Symptoms

Endometriosis often presents with recurring pelvic pain, which can range from mild to severe and may include cramping or stabbing sensations. This pain is typically associated with menstruation but can persist throughout the menstrual cycle. Other symptoms include dysmenorrhea, chronic pelvic pain, dyspareunia (pain during sexual intercourse), dysuria (painful urination), and ovulation pain (mittelschmerz). The severity of the pain does not always correlate with the extent of the disease.

Infertility is another common symptom, with about 30-40% of women with endometriosis experiencing difficulty conceiving. Other symptoms may include heavy or irregular periods, chronic fatigue, nausea, vomiting, and bowel or urinary symptoms.

Diagnosis

Diagnosis typically involves a combination of clinical evaluation, medical imaging, and sometimes tissue biopsy. Transvaginal ultrasound (TVUS) is often the first step in diagnosing endometriosis. Laparoscopy remains the gold standard for definitive diagnosis as it allows direct visualisation and biopsy of endometriotic lesions.

Histopathological examination usually confirms the presence of endometrial stroma and glands outside the uterine cavity. MRI can also be useful, especially in detecting deep infiltrating endometriosis.

Treatment

There is no cure for endometriosis, but several treatments can manage symptoms and improve quality of life. Pain management often begins with NSAIDs, and hormonal treatments can include continuous birth control pills, progestogens, and GnRH agonists. These treatments aim to reduce or eliminate menstrual flow, thereby reducing the growth of endometriotic tissue.

Surgery, particularly laparoscopic surgery, is another treatment option for removing endometriotic lesions and adhesions. This can help alleviate pain and improve fertility outcomes. However, surgery carries risks, including the possibility of recurrence.

Risk Factors and Complications

Risk factors for endometriosis include a family history of the disease and prolonged exposure to oestrogen. The condition can lead to several complications, including chronic pain, infertility, and an increased risk of certain cancers like ovarian cancer.

Endometriosis can also have significant mental health impacts, contributing to depression and anxiety due to chronic pain and fertility issues.

Epidemiology

Endometriosis affects approximately 10-15% of women of reproductive age. It is more commonly diagnosed in women of East Asian and Southeast Asian descent compared to White women. However, many women remain undiagnosed due to the complexity of symptoms and diagnostic delays.

Historical Perspective

Endometriosis was first identified microscopically in 1860 by Karl von Rokitansky. Historically, treatments included oophorectomy and hysterectomy. Modern treatments have evolved to include hormonal therapies and minimally invasive surgical techniques.

Overall, endometriosis remains a significant medical condition with complex diagnostic and treatment challenges. Greater awareness and research are needed to improve outcomes for those affected.

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Self-assessment MCQs (single best answer)

What characterises endometriosis?

Which of the following is a common symptom of endometriosis?

What percentage of women with endometriosis experience infertility?

What is considered the gold standard for the definitive diagnosis of endometriosis?

Which treatment option is NOT commonly used to manage endometriosis symptoms?

Which of the following is a risk factor for developing endometriosis?

Endometriosis can lead to complications such as:

Who first identified endometriosis microscopically?

Which imaging technique is often the first step in diagnosing endometriosis?

Which population is more commonly diagnosed with endometriosis?