Deep Infiltrating Endometriosis

about infiltrating endometriosis

What is deep infiltrating endometriosis?

Deep infiltrating endometriosis (DIE) is an advanced and aggressive form of endometriosis, whereby the endometrial-like tissue has extended more than 5 millimetres into the peritoneal tissue of the pelvic organs. Deep infiltrating endometriosis is much more prevalent than we previously assumed – affecting roughly 20% of women with endometriosis.

Deep infiltrating endometriosis can be found in any part of the body, resulting in the manifestation of different types of pain. The most common areas that are affected by deep endometriosis include:

Uterosacral ligament: most common location for deep infiltrating endometriosis to occur. Endometrial cells are found in the uterosacral ligament – a supporting ligament that connects the lower part of your uterus (cervix) to the base of your spine (sacrum).
Gastrointestinal tract or bowel: some patients may also struggle with various digestive issues in cases where deep infiltrating endometriosis is found in the intestine (also known as intestinal endometriosis).
Bladder: deep infiltrating endometriosis is found inside or on the surface of the bladder.
Rectovaginal: endometrium growth is found around the rectum, vagina and the structures between them. Rectovaginal endometriosis affects between 3.8 and 37% of patients with endometriosis.
Diaphragm: rare occurrence of endometrium growth on the diaphragm– a skeletal muscle that separates the abdomen from the chest. Patients with diaphragmatic endometriosis are susceptible to chest pains, stiffness, shortness of breath and in severe cases hemoptysis (coughing up blood).
Pleura: commonly known as thoracic endometriosis syndrome (TES), pleural endometriosis is characterised by the growth of endometrial tissue on the pleura, a membrane lining the lungs and chest cavity. Symptoms include chest pains and hemoptysis.

Deep infiltrating endometriosis is characterised by endometrial-like tissues developing beyond the uterus, and infiltrating nearby organs.

diagnosed

How is deep infiltrating endometriosis diagnosed in Singapore?

Deep infiltrating endometriosis, can be a tricky condition to diagnose. The average delay in diagnosis can range between 7 to 10 years based on Singapore data. At Dr Ma Li Clinic For Women & Advanced Pelvic Surgery, the process of diagnosing deep infiltrating endometriosis would typically include:

Medical history: your doctor will first review your overall health status. Details about your symptoms will also be collected to determine the likelihood of deep infiltrating endometriosis, such as chronic pelvic pain, pain during urinating (dysuria), painful menstrual cramps (dysmenorrhea), pain during intercourse (dyspareunia), rectal bleeding, and digestive discomfort.
Physical examination and gynaecological examination: a physical examination will be performed next to detect any fibrosis, nodularity, or trigger point of pain in the pelvic area.
Endometriosis mapping scan: the first line of diagnosis for endometriosis. This scan will be performed in-clinic after physical examination to determine the exact location of endometriosis. Below is an example of what an endometriosis mapping scan looks like.
Magnetic Resonance Imaging (MRI): may be conducted if there is suspicion of upper abdominal endometriosis, pleural endometriosis or diaphragmatic endometriosis.

Severe pelvic pain during menstruation is one of the primary symptoms of deep infiltrating endometriosis.

pelvic pain

Does deep infiltrating endometriosis cause pelvic pain?

Yes. Pelvic pain is one of the main symptoms of deep infiltrating endometriosis. Endometriosis at different locations will cause different kinds of pain.

Patients have described pelvic pain caused by deep infiltrating endometriosis as a sharp and stabbing pain that persists for up to 6 months or more. Patients have also described the sensation of intense pressure throughout the abdomen, accompanied by a heavy, and knotted feeling.

Beyond severe pelvic pain, deep infiltrating endometriosis can also cause pain during sexual intercourse and bowel movements. The pain is usually the result of the vagina and the rectum fusing together.

Pelvic pain caused by deep infiltrating endometriosis can significantly deteriorate a woman’s quality of life.

infertility

Does deep infiltrating endometriosis cause infertility?

Unfortunately, deep infiltrating endometriosis is one of the most common reasons for infertility. For patients who are affected by deep endometriosis, only 2-10% of women can conceive naturally without any medical intervention unfortunately. On top of that, an estimated 30- 50% of women with endometriosis diagnosis are projected to experience infertility. Some of the reasons that deep infiltrating endometriosis affects fertility include:

Adhesions
Contorted pelvis anatomy
Damaged ovarian function
Disrupted immune system
decreased egg quality
Impaired implantation of embryos
Scarred, or blocked fallopian tubes
Pelvic inflammation

Whilst deep infiltrating endometriosis is often accompanied by an insidious tone, early intervention and prompt treatment can significantly improve patients’ condition. Whether it is overcoming chronic pelvic pain or infertility associated with endometriosis, with the help of endometriosis specialists , these issues can be addressed effectively. Schedule a consultation to explore treatment options that best fit you.

FAQs

Frequently asked questions

What are the chances of living a normal life with deep infiltrating endometriosis?

Deep infiltrating endometriosis undoubtedly deteriorates your quality of life. However, with effective management and treatment, patients can live a life unperturbed by their diagnosis. A delay in treatment intervention will result in continued worsening of one's condition.

What happens if deep infiltrating endometriosis is left untreated?

Some of the common complications of deep infiltrating endometriosis if it is left untreated include infertility, worsening pain , and damage to organ function such as bowel function, kidney function etc.

Is deep infiltrating endometriosis an inherited condition?

There is not enough research to prove that deep infiltrating endometriosis is a hereditary condition. However, genetics do play a role in increasing your risk of developing deep infiltrating endometriosis.

Speak to Dr Ma Li today

book an appointment

Screenings

Procedures

Surgery

Other Services