Endometriosis

Some of the risks that can increase your chances of developing endometriosis are:

• Age: endometriosis is often diagnosed among women between the ages of 24 and 40 years old although it can begin developing as early as 13 years old. The likelihood of children with early menarche (≤11 years old) is also positively correlated with endometriosis diagnosis.  
• Genetic: a recent study has revealed that specific genetic variants increase the risk of developing endometriosis by altering the expression of certain genes in the endometrium and blood.
• Elevated estrogen level: having elevated levels of estrogen, or long-term exposure to estrogen can increase a woman’s chances of developing endometriosis. 
• Heavy period flow: women who experience heavy menstrual bleeding for more than 7 days per cycle are more likely to be diagnosed with endometriosis. 
• Irregular period cycle: the length of your menstrual cycle (especially if it is shorter than 27 days), has been linked with the likelihood of developing endometriosis.
• Congenital structural abnormalities: patients born with a birth-related malformation of female reproductive structures such as uterine malformations are at increased risk of developing endometriosis. 

Diagnosing endometriosis can be intricate as it cannot be easily identified by a single imaging test or physical examination. Additionally, as endometriosis symptoms tend to mirror those of ovarian cysts, pelvic inflammatory disease, and irritable bowel syndrome (IBS), diagnostic tests may be required to rule out other possible diagnoses.  At Dr Ma Li Clinic For Women & Advanced Pelvic Surgery, the process of diagnosing 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:  is the first line of diagnosis  (link to endometriosis mapping page) for endometriosis. This will be performed in-clinic after a 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.
• Laparoscopy: a minimally invasive procedure (insert link to gynaecological laparoscopy page) that can provide a definitive diagnosis of endometriosis by visualising the condition of your pelvic organs. However, laparoscopy surgery should be used for excision of endometriosis, rather than just for diagnosis.

Once an endometriosis diagnosis has been confirmed, a treatment plan is formulated by considering several factors, such as your age, the stage of endometriosis, your pregnancy plans, and the severity of your symptoms. It is important to understand endometriosis is a chronic condition that requires regular follow-up and monitoring.  The goals of treatment will also vary at different stages of your fertility life. Treatment options for endometriosis may include; 

• Surgery:  “Just one good surgery at the right time “ should always be the goal of the endometriosis surgery plan. When surgery is required, complete excision surgery (link to surgery for endometriosis service page) is preferred over ablation surgery.  Frequently conducted via laparoscopy, this surgical procedure involves separating all the adhesion that stuck organs together and removing all visible endometriosis. An endometriosis excision surgery is effective at alleviating pain associated with endometriosis and has been linked with improving fertility rate.
• Progestin therapy: progestin therapy is a lab-made medication that mimics pregnancy hormone and it can also reduce estrogen levels in the body, thus slowing down or suppressing the growth of endometriosis tissues, and alleviating symptoms. Various forms of progestin therapy are available, including oral tablets, injectables, implants, intrauterine devices, etc. 
• Birth control: birth control helps to control the hormones that trigger endometriosis, leading to women experiencing less intense period pains, and lighter menstrual flow. 

If you suspect that you may be struggling with endometriosis, schedule a consultation to discuss your concerns or symptoms.