Endometriosis is estimated to affect 6 to 10% of women of childbearing age. Endometriosis is a condition in which tissue similar to the endometrium of the uterus (lining of the uterus cavity) is found outside the uterus, most commonly on the peritoneal surface in the pelvis area, in the area between the rectum and the vagina, or in the intestines, bladder or ovaries, but it can also be found elsewhere in the abdominal cavity or even in other parts of the body.
Similarly to the endometrium, endometrial implants react to the monthly hormonal cycle which causes the typical symptoms of endometriosis. The most common symptom is pain in the lower abdomen, which may start several days before menstruation and becomes more intense during menstruation. Pain often depends on the location of the endometrial implants – some experience pain during bowel movements and/or urination or during sexual intercourse. Other symptoms associated with endometriosis include menstrual disorders and fertility problems.
Endometriosis may be suspected based on a gynecological examination. However, if the condition is mild, the findings are often normal. Methods used to detect endometriosis include ultrasound scanning, cystoscopy and/or colonoscopy and MRI (magnetic resonance imaging). However, a definitive diagnosis can only be made by laparoscopy.
Endometriosis is a chronic condition which can be managed with proper medication. Treatment can be initiated when endometriosis is suspected based on the patient's symptoms and the results of a gynecological examination before a definitive diagnosis by laparoscopy. The aim of endometriosis treatment is to relieve pain or improve fertility; typically both cannot be treated simultaneously. In some cases, a surgery is required to confirm the diagnosis, determine the severity of the condition and to remove endometrial implants when medication has failed to provide adequate relief. Endometrial implants which destroy healthy tissue and prevent fertilisation can be surgically removed.
Pain medication
When the condition is mild, anti-inflammatory analgesics are usually the preferred form of pain management. Combination oral contraceptives inhibit ovarian function and often provide pain relief in endometriosis patients. Other effective hormonal treatments include progestogen/progestin-only pills (minipills), capsules and intrauterine contraceptive devices containing progesterone, and progesterone releasing implants. Gonadotropin releasing hormone (GnRH) agonists are sometimes prescribed to inhibit ovarian function and reduce the size of endometrial implants. The treatment regime is determined individually for each patient. Side-effects are carefully considered and different types of hormone products may be combined for optimal effect. When a woman has severe pain, non-hormonal drugs may be used to raise her pain threshold.
Infertility treatment and endometriosis
Because the hormone preparations prescribed to manage pain also prevent pregnancy, they are not suitable for patients suffering from infertility. The possibility of pregnancy is improved when even a mild form of endometriosis is treated with laparoscopy. Infertility patients may also benefit from the surgical removal of a large ovarian endometrioma (chocolate cyst). With prolonged infertility and when the condition is severe, IVF is recommended. During pregnancy, the symptoms of endometriosis are often alleviated and may even disappear after childbirth. Sometimes the symptoms may be reduced with the scarring of endometrial implants. It is possible for women suffering from endometriosis to become spontaneously pregnant without undergoing any infertility treatments, and after childbirth the symptoms do not necessarily recur. The condition usually abates as women reach menopause.
Clinical units
Patients with endometriosis are diagnosed and treated in all gynecology units within the HUS area. However, more demanding surgery is performed in Women's Hospital and infertility treatments are centralized to the Women's Hospital.