Endometriosis is a chronic condition that affects one in nine Australian women by the age of 44. Despite its prevalence, it is often misunderstood, misdiagnosed, or dismissed as "just bad period pain." However, endometriosis is much more than that, it can cause severe pelvic pain, fertility challenges, and significant impacts on daily life. This article explores how endometriosis affects reproductive health, the available diagnostic methods, and the latest treatment options to manage symptoms and improve fertility.
What is Endometriosis?
Endometriosis occurs when tissue similar to the lining of the uterus (endometrium) grows outside the uterus, commonly on the ovaries, fallopian tubes, bowel, or bladder. This tissue responds to hormonal changes during the menstrual cycle, thickening, breaking down, and bleeding. However, unlike menstrual blood that leaves the body, this tissue has nowhere to go, leading to inflammation, pain, scar tissue, and adhesions (internal scarring that can cause organs to stick together).
Symptoms of Endometriosis
Symptoms vary widely, but common signs include:
Severe period pain (dysmenorrhea) that does not improve with painkillers.
Chronic pelvic pain even outside of menstruation.
Pain during or after sex (dyspareunia).
Heavy or irregular periods.
Painful bowel movements or urination during menstruation.
Bloating and digestive issues (sometimes called "endo belly").
Fatigue and low energy levels.
Difficulty conceiving or infertility.
Some women may have mild endometriosis but severe symptoms, while others with severe endometriosis may experience little pain.
How Endometriosis Affects Reproductive Health
One of the biggest concerns for women with endometriosis is its potential impact on fertility.
Blocked Fallopian Tubes: Adhesions and scarring can block the fallopian tubes, preventing sperm from reaching the egg.
Ovarian Cysts (Endometriomas): These cysts can damage ovarian function.
Inflammation: Chronic inflammation in the reproductive organs can make implantation difficult.
Hormonal Imbalances: Endometriosis may disrupt normal ovulation and hormone levels.
However, not all women with endometriosis experience infertility. Many women with mild to moderate cases conceive naturally or with medical assistance.
How is Endometriosis Diagnosed?
Diagnosis is often delayed—on average, it takes 7-10 years to diagnose endometriosis in Australia. This is because symptoms can be mistaken for other conditions like irritable bowel syndrome (IBS) or pelvic inflammatory disease (PID).
1. Medical History and Symptom Review
A doctor will first take a detailed history of symptoms, pain levels, menstrual cycle patterns, and any family history of endometriosis.
2. Pelvic Examination
A doctor may check for tenderness, cysts, or abnormalities in the pelvic area. However, this cannot confirm endometriosis.
3. Imaging Tests (Ultrasounds and MRI Scans)
Transvaginal Ultrasound: Can detect endometriomas (ovarian cysts) but does not always show superficial endometriosis.
MRI Scans: Used in more complex cases to detect deep infiltrating endometriosis.
4. Laparoscopy: The Gold Standard for Diagnosis
Laparoscopy is a minimally invasive surgery where a small camera is inserted through the abdomen to look for endometriotic tissue and adhesions. If found, tissue samples can be taken for biopsy confirmation.
Treatment Options for Endometriosis
While there is no cure for endometriosis, various treatments can manage symptoms, reduce pain, and improve fertility. Treatment depends on the severity of symptoms, age, fertility goals, and overall health.
1. Pain Management
Over-the-counter pain relief: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can reduce inflammation and pain.
Prescription medications: Some women may require stronger painkillers or nerve pain medications for chronic pain management.
Physiotherapy: Pelvic floor therapy can help reduce tension and pain.
2. Hormonal Treatments
Hormonal therapy suppresses the menstrual cycle, reducing the growth of endometriotic tissue. Options include:
Combined Oral Contraceptive Pill: Helps regulate periods, reduce bleeding, and manage pain.
Progestin-only Therapy (Mini-pill, IUD, or Injection): Stops ovulation and thins the uterine lining.
Gonadotropin-Releasing Hormone (GnRH) Agonists: Temporarily induces menopause-like effects to shrink endometriotic tissue.
These treatments help with pain but do not improve fertility and are not a permanent solution.
3. Surgical Treatment
For women with severe pain, infertility, or unresponsive symptoms, surgery may be necessary.
Laparoscopic Excision Surgery
Laparoscopy (Keyhole Surgery): A surgeon removes endometriotic tissue, cysts, and adhesions.
Excision vs. Ablation: Excision surgery (cutting out endometriosis) is more effective than ablation (burning the tissue).
In cases of severe damage, hysterectomy (removal of the uterus) may be considered, but this is not a cure and does not always relieve symptoms.
4. Fertility Treatment
If endometriosis affects fertility, reproductive specialists may recommend:
Ovulation Induction & Timed Intercourse (for mild cases).
Intrauterine Insemination (IUI) (if tubes are open and ovulation is normal).
In Vitro Fertilisation (IVF): For women with blocked fallopian tubes, ovarian damage, or severe endometriosis.
5. Lifestyle Changes and Natural Remedies
Anti-inflammatory Diet: Avoiding processed foods, dairy, gluten, and red meat may reduce flare-ups.
Exercise & Yoga: Helps relieve pelvic pain and improve circulation.
Acupuncture: Some women find relief through acupuncture and herbal medicine.
Heat Therapy: Applying heat packs to the lower abdomen can help relax muscles and ease cramps.
Living with Endometriosis: Support and Awareness in Australia
Australia has dedicated support networks and medical advancements for endometriosis care:
Endometriosis Australia: A national organisation raising awareness and funding research.
Jean Hailes for Women's Health: Offers resources and support for managing endometriosis.
Medicare Rebates for Specialist Consultations: Helps cover costs for diagnosis and treatment.
In 2022, the Australian Government launched the National Action Plan for Endometriosis, improving research, diagnosis, and treatment accessibility.
Endometriosis is a complex condition that requires early diagnosis, personalised treatment, and long-term management. While it can affect fertility and daily life, many women successfully manage their symptoms with the right medical care and lifestyle adjustments.
Raising awareness, advocating for faster diagnosis, and seeking specialist care are crucial steps in ensuring that women with endometriosis receive the support they need. If you or someone you know is experiencing chronic pelvic pain, irregular periods, or fertility issues, consulting a gynaecologist is essential.
