Endometriosis is a debilitating disease brought on by chronic inflammation because of the migration of the endometrial tissue.
The tissue is supposed to be present only in the womb but it is growing abnormally outside of it in the pelvis and other parts in the body.
It affects up to 10% of women worldwide and almost 30% to 40% of infertile women suffer from it.
There are many theories to explain the cause of this crippling disease but the exact cause and how it actually appears in some women is still very much a mystery.
Although the disease has been known since the 18th century, doctors still find it challenging to diagnose this chronic illness.
The disease is almost similar to cancer in some ways — it gets more severe over time, its dependent on estrogen hormones, it recurs, it migrates to other places, it cripples women and it robs women of their quality of life.
The main symptoms of endometriosis is pain and infertility. The pain may manifest in the form of period pain which gets severe over time, pain during sexual intercourse, back pain and pain in passing motion during menstruation. In advanced stages, women may also experience menstruation which is irregular, erratic and heavy.
Researchers believe endometriosis could start during adolescence. Period pain is often ignored and dismissed by the patient and her doctor as normal period pain which may disappear after childbirth.
Over the years, the disease becomes more severe to the point that it cripples the pelvis and reproductive system as a result of scarring and adhesion formation and brings about infertility problems in some women.
Confirmation of the disease can only be made by direct visualisation of the endometriotic lesion in the pelvis and abdomen using laparoscopy.
Severe endometriosis result in a blood cyst in the ovaries and those deep in the pelvis tissue might be detected by ultrasound imaging coupled with a measurement of blood tumour marker Ca 125.
However, until today, there is no other diagnostic modalities that could detect early or mild endometriosis.
Under direct visualisation through laparoscopy, there are many stages of the disease as illustrated in the diagram.
Treatment of endometriosis
Currently, there are many treatment options available to control the disease but there is no medical treatment to cure endometriosis once and for all, especially for young women.
The choice of treatment depends on the age of the woman, the severity of pain symptoms, the stage of the disease, infertility and her desire for pregnancy.
If the woman, especially a young adult, has many pain symptoms, the doctor would treat her with analgesics at the beginning and hormone pills such as OCP, progestins or anti-gonadotrophins (GnRH) for more long-term pain control.
For those with blood cysts and infertility problems, surgery may be the best option to restore the reproductive organ and remove the endometriotic lesions in the pelvis.
Studies have shown that surgery through laparoscopy or keyhole operation for endometriosis offers more benefits as the women have a better chance of pregnancy as compared to open surgery.
For older women with advanced endometriosis, it usually co-exists with other estrogen dependent illnesses such as uterine fibroid and adenomyosis.
In this situation, surgery and removal of uterus and ovaries is the only treatment option.
Endometriosis, if detected and treated in the early stages, may save a woman from chronic recurring pain and protect her future childbearing potential.
Early detection and treatment reduces the chance of complication that cripples the reproductive organ silently over a period of time.
Do not dismiss or ignore symptoms of period pain in young women until she has been seen by the doctor and endometriosis has been completely ruled out.