Pain relates to a neurological sensation causing emotional or physical discomfort. The endurance of pain not only limits the individuals capabilities but may alter their quality of life. Therefore, the pursue of relief is of outmost importance and need.

Pelvic pain is commonly associated with women and is one of the common reasons for a visit to the gynaecologist. The diligent gynaecologist conducts a through examination, orders several test as required, identifies the root cause and administers appropriate treatment. This task is carried out so that the pelvic pain is relieved and the women is back to her pain free lifestyle.

What if the medical examination and routine test by the gynaecologist yield normal results? In that case, what is the cause of the pelvic pain? Can the pain be relieved?

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I am sure some women have gone through this similar predicament. They are quite familiar with the medical term “Endometriosis”. A condition related to pelvic pain that have silently been endured by these women.

What is Endometriosis ?

Endometriosis is a condition where the cells of the uterus (womb) lining (endometrium) is found outside of the womb. Endometriosis is often associated with cyclical period pain and sometimes  it leads to long term pelvic pain.

Deposits of endometriosis can be found anyway outside of the womb, namely on the innermost layer of the abdomen (peritoneum), ovaries, Fallopian tubes, bladder and large bowels.

In severe cases, it can also be found on the vaginal wall.

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Endometriotic deposits causes inflammatory reaction and causes ‘injury’ to the affected organ. The ‘injury-healing’ cycle can lead to formation of adhesions or ‘stickiness’ within the pelvis. These adhesions can lead to pain symptoms.

The actual prevalence of endometriosis is unknown but it is estimated that between 2% to 10%  of women in general population and up to 50% of women with infertility suffer from endometriosis.

Why is Endometriosis important?

According to a research done overseas, the medical cost for the treatment of endometriosis is comparable to other chronic diseases such as Diabetes Mellitus. In Malaysia, I believe the statistics is similar. This is partly due to the late diagnosis of endometriosis.

Studies in Europe has shown that there is a delay in diagnosis between 4 to 10 years. 

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Amongst the reasons for the delay are intermittent use of contraceptive pills that causes hormonal suppression of the symptoms, use of non-discriminatory examination, misdiagnosis and attitude towards menstruation and normalisation of pain by the women.

Endometriosis could not be reliably diagnosed based on medical history and examination alone. Special investigations in the form of a laparoscopy surgery is needed to confirm the diagnosis.

Early diagnosis of endometriosis is crucial as it can help the women to take steps to reduce the disease burden and  long term complications of endometriosis.

Affects of Endometriosis

Typically, there are two groups of women who presents with symptoms of endometriosis, those who have difficulty conceiving (fertility related) and those with pain symptoms (non-fertility related).

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a) Fertility Related:

Endometriosis causes inflammation of the pelvic organs. Chronic inflammatory process can lead to ‘scarring’ of the affected organs. This can lead to blockage of Fallopian tubes, one or both of it. A blocked or damaged Fallopian tube makes it difficult for the egg to be picked up after an ovulation for fertilisation by the sperm.

Endometriosis is also a common cause of an ovarian cyst formation. Removal of the ovarian cyst, either by a laparoscopy or a conventional surgery, has a risk of reducing the woman’s egg reserve (total number of eggs that she has). Multiple surgeries increase this risk. A woman’s fertility reduces with declining egg reserve.

Endometriosis can also affect the egg quality. Studies conducted among women undergoing an IVF treatment suggest that woman with an endometriosis tend to have a lower quality egg (oocytes). This directly has an impact on the resulting embryos and pregnancy rate.

 

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“Endometriosis of uterus” , more commonly known as adenomyosis may also be present in women suffering from endometriosis. Severe adenomyosis reduces pregnancy rate as it affects embryo implantation in the womb .

b) Non-fertility Related (Pain symptom)

Many women are diagnosed with endometriosis when they present with severe period pain. If fertility is of no concern, period pain can be suppressed with hormonal or non-hormonal medications. Many of these treatment options are not recommended if the women is trying to conceive.

The pain can be due to endometriosis deposits over the undersurface of the abdomen, formation of ovarian cyst or due to ‘scarring’ formation that causes adhesions of the pelvic organs.

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Endometriosis can also cause pain during sexual intercourse .

Coming up next on Healthtips by Teleme: Treatment Options for Endometriosis

 

Download Teleme’s mobile app and consult Dr Agilan, Obstetrician & Gynaecologist (infertility)

Dr. Agilan Arjunan

Dr. Agilan Arjunan

Obstetrician & Gynaecologist (infertility)

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