Dr Kenneth Leong
MBBS BMedSc FRANZCOG MReproMed
View Dr Leong’s biography here
Endometriosis is a common and pervasive condition that affects a large number of women during their reproductive age. Endometriosis occurs when the lining of the uterus known as the endometrium, starts growing outside the uterus causing scar tissue and adhesion. This problem results in tissue destruction and anatomical distortion. Eventually the natural function of the reproductive organs is affected causing infertility.
The classical symptoms of endometriosis include significant and recurring period pain where regular strong pain killers are required. The pain typically starts during the period but may occur a few days earlier and lasts for a variable duration. However it is noted that most women experience some kind of period pain or discomfort during their cycle and not all will have endometriosis. It is this reason that can make clinical diagnosis a challenge.
Endometriosis related period pain generally worsens over time and can become resistant to oral pain killers. Some women may develop other pain patterns such as back pain and bowel pain. Sometimes the pain becomes more entrenched and presents at times other than during the period. Occasionally the pain pattern may help to pinpoint which part of the pelvis and its related organ the endometriosis affects.
Some women may not have any symptoms whatsoever to suggest endometriosis. It can often become a surprise diagnosis discovered during surgery. Hence, we know that the severity of the disease does not necessarily go hand in hand with symptom severity.
Many patients have a “frozen pelvis” where the internal pelvic organs are matted together and they may display minimal symptoms. Whereas others have significant pelvic pain and minimal disease discovered at laparoscopy.
Currently there is no reliable way of diagnosing the disease without surgery. Imaging modalities such as high resolution pelvic ultrasound scan and MRI performed by specially trained experts may help to diagnose the disease and provide information about severity. However only up to about 50% of cases can be diagnosed using imaging scans.
Endometriosis affects fertility in a number of ways, essentially by the tissue destruction and anatomical distortion. The female reproductive system including ovaries and fallopian tubes are quite delicate and are easily compromised by endometriosis.
When the fallopian tubes are affected, the delicate fimbrial ends of the tubes are matted together. The fimbria are like the delicate petals of an orchid flower. They sweep the surface of the ovaries picking up the egg during ovulation. When they are destroyed, they lose this function. Hence the fallopian tubes do not have to be fully blocked to loose the function as a conduit for egg and sperm. Furthermore the demonstration of tubal patency on specialised ultrasound or X ray imaging scans using special dyes does not suggest full and uninterrupted tubal function.
Endometriosis may also affect your fertility by inducing inflammatory changes within your pelvis to create a “hostile” environment for the egg, sperm and embryo. The uterus lining known as endometrium is often affected in severe cases of endometriosis and this in turn affects implantation of the embryo.
Endometriosis may also affect the quality of eggs and the downstream embryo quality. Eggs can be destroyed by severe disease which often involve the ovaries. It should be highlighted that surgery could also decrease egg number by unavoidable use of thermal energy or tissue excision technique on the ovaries.
Endometriosis cannot be prevented but early diagnosis helps to prevent disease progression and worsening of fertility prospects.
As a fertility specialist with a special interest in endometriosis, it is worrying to learn that there is still a significant time delay from the onset of symptoms to the eventual diagnosis of disease. This delay could take as long as six to nine years. Greater patient awareness combined with increased clinical vigilance about the condition amongst the medical profession would assist in providing timely diagnosis.
Dr Kenneth Leong is a fertility specialist with Monash IVF. He is an advanced laparoscopic and robotic gynaecology surgeon, specialising in diseases of infertility including endometriosis and uterine fibroids.
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