A women’s reproductive years are often marked by her monthly periods. However, for some women, these periods are overshadowed by intense pain that disrupts daily life. This is not helped when these monthly debilitating menstrual pains are downplayed and attributed to “growing pains” in Singapore due to our Asian cultural beliefs. To avoid social stigma, many women continue to suffer in silence, leading to a long delay in seeking treatment.
What is endometriosis?
Endometriosis is a disease where the tissue that forms the lining of your uterus (also called endometrium) grows outside the uterus instead. This misplaced tissue may grow on women’s ovaries, fallopian tubes, bowels, bladder, or other areas in the pelvis.
How will I know if I have endometriosis? What are the symptoms?
Menstrual pain or cramps are the hallmarks of endometriosis. Sometimes the pain may be so debilitating that one may need to take frequent MCs from school or work. Some women may experience fainting spells from the menstrual pain, others may find themselves needing more painkillers to relieve the period pain.
Other symptoms may include:
- Pain during sexual activities, pain with bowel movement or urination.
- Some women may report irregular periods, or increasing menstrual flow as years pass.
- Occasionally, an abdominal lump may be felt or noticed.
What are the dangers of this condition?
Endometriosis is a progressive disease. Although no exact cause has been found, many believe in the retrograde menstruation theory, where backflow of the menstrual blood occurs during the monthly menstruation.
Endometriosis may cause danger in 3 aspects:
- As the disease progresses, deeper penetration of the pelvic tissue by the endometriotic cells may impact the nerves, causing severe backache or shooting pain down the legs. In severe form, the urine tube from the kidney (ureters) or bladder may be strangulated, leading to kidney failure.
- Fertility problems often develop when the reproductive organs are enveloped by the infiltrative endometriotic cells. In addition, a couple’s relationship may be strained by the frustration or disappointment in setting up family.
- The overall risk of an endometriosis-associated cancer remains low. However, some rare ovarian cancers such as clear cells and endometrioid ovarian cancer are more common in women with endometriosis.
How is it diagnosed?
Endometriosis is difficult to ascertain. Experiencing the relevant symptoms and having a family history or endometriosis may suggest the condition. Bedside pelvic ultrasound scan helps to assess for ovarian cyst or pelvic nodule.
Nevertheless, laparoscopy remains the gold standard in diagnosing this condition. In addition, it provides an opportunity to obtain histological confirmation, and treatment of the disease at the same setting. With improved techniques such as single incision laparoscopic surgery, it is expected that the condition can be diagnosed early and with reduced surgical morbidities.
How is it treated?
Early diagnosis and treatment are the key to management of endometriosis. Generally, the treatment plan is customised according to each individual patient, taking into consideration these 3 factors: Age, desire for pregnancy and severity of symptoms.
Medical options with hormonal regulation or suppression that aim to suppress the endometrial proliferation and inflammation are appropriate initial treatment. Unfortunately, this option does not completely eradicate the condition and more often than not, the recurrence rate can be as high as 50% upon stopping the treatment. For those who wish to conceive, medical treatment may delay the opportunity as the medicines used in treatment of endometriosis inhibit pregnancy.
Surgery establishes the diagnosis and extent of disease. It aims to remove any ovarian cyst or endometriotic nodules, thus improving the fertility opportunity for the women. Endometriosis remains an enigmatic disease which significantly affects the quality of life of our patients.
I hope to help our patients cope with this recurrent illness by providing a holistic approach and customised treatment plan for the condition. Hopefully, many will not continue to suffer in silence.
Dr Ng Ying Woo is a specialist in obstetrics and gynaecology with advanced laparoscopic skills. Dr Ng believes in holistic care for his patients and has vast experience in performing surgeries and deliveries. Dr Ng is passionate about offering the best surgical solutions for management of gynaecological conditions.