FAQs

1. These are the types of pain that we commonly see in women with endometriosis:

• Period pain that causes you to take pain medication, spend time in bed or have time off work
• Heavy menstrual bleeding
• Bleeding between periods (including break-through bleeding on the Pill)
• Pain between your periods
• Pain when having sex
• Pain with bowel motion
• Pain with a full bladder
• Low back pain

NB: Endometriosis can occur with minimal or no pain.

There is not necessarily a direct relationship between the amount of disease present and the degree of pain experienced. Some women with small amounts of endometriosis may experience severe pelvic pain while other women with significant endometriosis may experience minimal pain.

2. Although Endometriosis is the most common cause of pelvic pain there are other causes of pelvic pain such as:

• Fibroids: overgrowths of smooth muscle in the wall of the uterus and rarely outside the uterus. They can cause uterine cramping between periods and severe cramping and heavy bleeding with a period.
• Ovarian cysts: a cyst is a fluid-filled cavity, usually within the lining of the ovary. Cysts can occur in the normal monthly cycle of the ovary. Two common types of "normal" cysts are follicular cysts, which prepare the egg, and the corpus luteum cyst, which forms after ovulation each month. Although these two types of cysts are usually temporary, each may persist longer than they should and can cause pain. Cysts don't always have to be large to cause pain. Several small cysts can occur within an ovary and cause pain by stretching the ovary slightly.
• Adhesions: also called scar tissue; literally stick things together. They can be thin and wispy like wet tissue paper or dense and thick like hardened glue. An adhesion goes from one point in the pelvis to another point. Adhesions form after injury to the peritoneum (lining of the pelvic cavity), whether by infection, surgery, or chronic inflammation.
• Adenomysis: is a structural change within the muscular wall of the uterus which occurs when tissue resembling the uterine lining invades the muscle. The uterus can look and feel normal, yet still have adenomyosis. Neither laparoscopy nor hysteroscopy can diagnose adenomyosis, and there is no medical treatment known to eradicate it.
• Pelvic Inflammatory Disease: caused by severe and untreated sexually transmitted infections such as Chlamydia and Gonorrhoea

If you think that you have symptoms of endometriosis then you need to visit a gynaecologist specialising in the treatment of endometriosis. They will be able to take a careful history being certain to gain all the information required to make an accurate assessment about whether your symptoms are suggestive of endometriosis. Then they will be able to discuss with you your diagnosis and treatment.

Pregnancy often suppresses the symptoms of endometriosis during the pregnancy and sometimes for a period of time following delivery. However, women with endometriosis usually find that their symptoms return some time after delivery.

Menopause is a significant time of change for a woman. The hormonal cycles which have been occurring for the majority of your life cease. For many women menopause signals an end to the pain caused by endometriosis. However, this is not the end for all women. Endometriosis can continue to be present and cause pain.

Medication

The alternatives to surgery are hormone-based medications, which act by suppressing hormonal activity and the growth of endometriosis. They are often effective in controlling symptoms however once these medications are stopped the symptoms of endometriosis return.

The use of pain relief may help women to adequately manage their symptoms of pain. A combination of Panadol and anti-inflammatories often allows women enough relief from pain to be able to rest without pain and continue with daily activities. However if pain is not being adequately controlled by these medications then you would have to consider a consultation with a gynaecologist specialising in the care of women with endometriosis.

Lifestyle Management

In combination with any form of treatment for endometriosis we encourage women to look at the lifestyle and make changes to promote a healthy lifestyle.

• Exercise - regular, gentle exercise of 30 - 60 minutes 3 - 5 times a week is ideal. Walking is the simplest way of achieving this exercise, all you need is a pair of walking shoes!
• Diet - we encourage women to think about what they are eating and to ensure a balanced diet including a variety of fresh fruit and vegetables, lean protein and carbohydrates complimented by plenty of water to drink. If you wish to have further dietary advice can refer you to a dietitian for an individualised eating plan.
• Stress Management - this may be a good time to look at all of the activities and demands of daily life and review what you can change or reduce to achieve or alter the amount of stress in your life. Reducing demands on your life may free up time that can be used to promote your health. You may also consider adding a stress-reducing activity such as relaxation or meditation on a regular basis 3 - 5 times a week to help with this goal.

An 80% reduction in the symptoms of pain occurs with women who have had surgery with excision of endometriosis.

Laparoscopic surgery for endometriosis requires a highly skilled laparoscopic gynaecological surgeon to perform it successfully. It requires training and expertise by gynaecologists to develop appropriate techniques for excising endometriosis, especially in the difficult area of cul de sac (around the bowel).

There are risks in terms of damaging underlying structures that the endometriosis has grown into. Endometriosis can infiltrate deeply into adjacent tissues and its removal can be difficult and time consuming. To remove deposits from the bladder and bowel wall may involve repair by laparoscopy or occasionally laparotomy (incision into the abdomen/ 'open surgery'). One of the most important risks is immediate or delayed perforation of the bowel. Extensive precautions are undertaken to avoid this serious complication.

Likewise endometriosis often grows over the ureter (tube draining urine from the kidney to the bladder) and important blood vessels.

The risks are lower in early superficial disease and higher in longstanding deep infiltrating disease. Both early and late complications necessitating return to theatre and further surgery are rarely encountered, in experienced hands.

Many women with endometriosis are able to become pregnant naturally. Endometriosis has not affected their fertility. About 40% of women with endometriosis have difficulty becoming pregnant. This can be predominantly related to impaired ovarian and fallopian tube function. Other causes may be related to immunological changes or chemical changes in the pelvic cavity. The improvement in fertility rates following surgical excision for endometriosis is as high as 40-60%, with successful fertility following surgery.

It is desirable, but not essential.

The cost of a consultation ranges between $200 - $300. Each gynaecologist has there own charges however they all allow a 45-60 minutes for a first consultation with a women suspected of having endometriosis. In this consultation you will be asked extensively about your symptoms and history; treatment options will be discussed and there will be an opportunity to discuss any questions you may have.

If you have significant bowel symptoms you may also see the General Surgeon, Graeme Washer.

As the extent of endometriosis affecting you cannot be accurately estimated prior to surgery it is difficult to predicate the time required in theatre to remove the endometriosis. Time spent in theatre is the major cost. The cost of surgery involves charges from the gynaecologist, the anaesthetist and the hospital. The total cost of surgery for minor to moderate cases of endometriosis is between ten and fifteen thousand dollars. More severe cases can be estimated on a per case basis.