When endometriosis strikes

She came to the gynaecology clinic week after week; her complaint was the same. She was in pain and needed relief. Medications had failed and she wanted surgery. It was a difficult decision for me.

It was my first job after completing residency training and although I knew that surgery was a treatment for her condition, I thought that she was too young to undergo this type of surgery. I discussed it with my more senior colleagues. The patient did well post-operatively and after her recovery I never saw her again. I heard that she had left the area and started a new relationship. I hope that it meant that she had a new lease on life and that surgery had indeed cured her. She had been suffering from endometriosis.

Endometriosis is a condition in which the cells which usually grow in the lining of the womb grow in locations outside the womb. It is most often found in the ovaries but may also be scattered throughout a woman's pelvic wall such as behind her womb. It may even be located on a woman's intestines, bladder, kidneys, lungs or arms, among other locations. Although it is non-cancerous, it can worsen over time. The exact cause of the condition is not known but there are many theories which attempt to explain the disease.

Pain and infertility

Although one third of women with endometriosis have no symptoms, women with the disease may have pain associated with menses or even infertility. Her pain may start a day or two prior to her menses and may last for several days after it has stopped. She may have pain with intercourse which occurs with deep penetration. Some women may experience spotting before their menses, or heavier-than-normal menses, and in others ovulation is affected. The disease can lead to difficulty achieving pregnancy in other ways such as scarring in a woman's pelvic and growths on her ovaries called endometriomas.

Laparoscopic surgery

The diagnosis can be confirmed by laparoscopic surgery in which a camera is placed in the abdomen to identify the disease. A sample of an abnormal area is taken to confirm the disease. Ultrasound cannot usually make the diagnosis unless a woman has an endometrioma.

Certain hormones can be used to treat endometriosis, with the main goal being to suppress a woman's menses. Surgery is used if medications are not effective or if a woman is unable to take medications (for example, if she wants to become pregnant). Surgery may range from removing endometriotic lesions and repairing of scarring, to the removal of a woman's reproductive organs, including her uterus, tubes and ovaries along with any disease. The latter is considered the 'cure' for the condition.

If you think you are suffering from this disease, I encourage you to discuss this with your physician so that you can receive appropriate diagnosis and treatment.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.