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Michael East
M.B.B.S, FRANZCOG, FRCOG, MAOG

T +64 9 522 3797
F +64 9 520 9526

Level 2, Suite 3
Ascot Hospital
90 Greenlane Rd East
Remuera
Auckland 1051
New Zealand
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Endometriosis

Endometriosis occurs when cells, similar to those that line the uterus, are found outside the uterus in the pelvic cavity. Each month these cells respond to hormones in the same way they would if they were in the uterus and bleed. This bleeding causes inflamation in the pelvis causing pain and subsequent scaring. Endometriosis affects approximately 10% of women.

Click here - to view an endometriosis video clip and images. 

No one is completely sure how endometriosis occurs, however;

  • We suspect that during foetal development in your mother’s uterus, the cells that will form the lining of the uterus (the endometrium) lie near the cells that will form the lining of the pelvis (the peritoneum)
  • These two groups of cells can intermingle, with islands of endometrial cells growing within the lining of the pelvis as it develops
  • At puberty the hormones that cause a period to occur also activate the endometrial cells in the pelvis. They start to bleed and this leads to scarring and subsequent pain

Endometriosis can be diagnosed by listening to your story. Common symptoms include:

  • Distreddingly painful periods that are unable to be managed by taking common pain killers
  • Pain with bowel motions at the time of a period
  • Pain passing urine
  • Painful intercourse
  • Mid cycle pain
  • Pain throughout the month often similar to period pain but at a lower level and getting worse at the time of a period
  • Bleeding between periods
  • bleeding may or may not be heavy but up to 50% of women with endometriosis have heavy periods. This may be due to adenomyosis;
  • This is a cousin of endometriosis where the endometrial cells are buried with the the muscle layer of the uterus
  • When these cells bleed each month the muscle layer of the uterus swells and can cause heavy, painful periods, and on occasion bleeding between periods

40% of women with endometriosis also have an irritated bowel syndrome;

If you wish to print the pre-operative assessment - simply click on the image to expand it, and then print.

 

Treatment of Endometriosis

 If endometriosis is suspected, a Laparoscopy is required for formal diagnosis and treatment of the disease.

  • One operation (occasionally two) is usually all that is required to diagnose and treat the condition

A Laparoscopy involves:

  • General anaesthetic (being put to sleep)
  • A telescope is inserted through the tummy button (umbilicus)
  • A photo is taken of the pelvis
  • If endometriosis is found it is removed through three small incisions below the umbilicus.

The surgery takes on average 1 to 2 hours.  When you awake after surgery you have small dressings over each of your incisions. All stitches are under the skin and will dissolve. Most women require 1-2 nights in hospital and upon your return home you are able to walk, lift, and drive a car within 4-5 days.  You are generally able to return to work in 10-14 days.

In 95% of cases, all of the endometriosis found can be removed, however 5% will have “severe endometriosis”.

  • This is extensive disease which involves either the bowel wall (the rectum) and the ovaries or both, and ofiten infiltrates into the deeper tissue of the pelvic floor.
  • Although endometriosis can be removed safely from the bowel it may require a second operation.
  • For women with severe endometriosis the findings are discussed after surgery and subsequent surgery arranged.
  • Appropriate bowel preparation is necessary and a General Surgeon is available if required.

The endometriosis pain you have experienced can take up to three months after surgery to start to improve.

  • This happens because the nerves in your pelvis that were irritated by the endometriosis are also irritated by the removal of the disease.

After surgery the majority of women require no further operative treatment;

  • In my own audit 12.8% of patients with stage I and II disesase need repeat surgery within 2-3 years.
  • This does not always indicate that endometriosis has returned
  • If a second look laparoscopy is performed then 25% of cases have either post operative scarring rather than endometriosis as the reason for their discomfort
  • Scarring occurs following all surgery to a greater or lesser extent.
  • By dividing the scar tissue the symptoms will often improve considerably

Approximately 60% of women with endometriosis can conceive although it may take a little longer than usual.

  • In those couples having difficulty conceiving, where no other cause for their infertility has been identified, removal of endometriosis, if present, will markedly improve their chances of becoming pregnant.
  • Surgical risks and complications are low.

 Surgery will improve the pain syndrome related to endometriosis, however, it has little effect on heavy periods. The heavy periods can be managed medically using one of the following:

  • Cyclokapron
  • Oral progesterone therapy
  • Mirena IUCD
  • Combined oral contraception pill (the pill)
  • Anti-inflammatories (will also help any residual discomfort)

Michael does not use danazol, gestrinome or LH analogues as they suppress rather than cure symptoms, and can have significant side effects.

Michael finds managing women with endometriosis rewarding as outcomes following surgery are generally very good.

Click here - to view some endometriosis images and a video clip of endometriosis being removed Laparoscopically.