Endometriosis is a common condition affecting 1 in 10 Australian women, but can go undiagnosed for a long time. The reasons for this are complex. Endometriosis can cause symptoms like period pain, but doesn’t always. Endometriosis can be aggressive and progressive, but isn’t always. 50% of women who are later found to have laparoscopically diagnosed endometriosis, did not have any signs of the condition on pelvic ultrasound imaging.
Endometriosis can cause infertility without causing pain, and can conversely cause pain without causing infertility. In short, the condition is a nightmare for patients and for clinicians to diagnose and to treat. The gold standard investigation and surgical treatment modality for endometriosis is a pelvic laparoscopy, a form of key hole pelvic surgery requiring general anaesthetic.
As you can imagine, going through a laparoscopy is intense and can be expensive (cost of private surgery, time off work). To undertake this option, a strong suspicion of endometriosis is warranted. Many doctors, quite rightly suggest medical management first with agents like the oral contraceptive pill as more than 90% of women find their symptoms resolve with this strategy without experiencing any adverse complication or side effects. For women trying to conceive, contraceptive management is inappropriate and a surgical management strategy is often suggested. IVF can also help many women, even with the most advanced endometriosis, achieve pregnancy. If you have endometriosis, freezing your eggs at a young age can be a protective strategy against future infertility.
Endometriosis can be very mild or can be extreme. AGES fellowship is completed by advanced laparoscopic gynaecological surgeons interested in treating the most severe forms of endometriosis (Stage 3 and above), while mild endometriosis can be effectively managed by RANZCOG (Royal Australia and New Zealand College of Obstetricians and Gynaecologists) trained specialist Obstetrician/Gynaecologists.
Endometriosis can cause pelvic pain. Sometimes, even after surgery to excise all disease thoroughly, pelvic pain persists with normal stimulation, as the pelvic nervous system harbours a deep pain memory caused by previous endometriosis. Women who have had, or live with recurring endometriosis can develop secondary syndromes of sexual pain and vaginismus (involuntary reactive pelvic floor muscle contraction, making penetrative sex uncomfortable or even impossible).
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