News from the 2014 World Congress on Endometriosis

News from the 2014 World Congress on Endometriosis

Associate Professor Luk Rombauts
Fertility Specialist
MD, PhD, FRANZCOG, CREI

Adjunct Clinical Associate Professor, Monash University
Research Director, Monash IVF
Head of Reproductive Medicine, Monash Medical Centre
Board Member, World Endometriosis Society
Editor eJournal,  World Endometriosis Society
Board Member, World Endometriosis Research Foundation
Board Member, Fertility Society Australia

View A/Prof Rombauts biography here

Endometriosis is one of the most common and most challenging gynaecological disorders today affecting 5-10% of all women in the reproductive age group and up to 50% in women with infertility and/or pain. Women are approximately 5 times more likely to have the disease if they have a first degree relative who has been diagnosed with endometriosis.

Endometriosis occurs when tissue similar to the lining of the uterus (the endometrium) begins to grow outside the uterus. Each month the endometrium is shed with the onset of menses. Some of the blood and endometrial tissue fragments may reach the abdominal cavity through the Fallopian tubes. This tissue may then attach itself to the reproductive organs or the lining of the abdominal cavity (the peritoneum).

Each month these little islands of abnormal tissue will break down and bleed during the period, often leading to more severe period pain and pain during sexual intercourse. The repetitive cycles of breakdown and healing lead to the formation of scar tissue (adhesions) which can potentially block the fallopian tubes. Endometriosis may also interfere with ovulation and with the implantation of the embryo.

The majority of women suffering from endometriosis will have superficial lesions on the ovaries or the peritoneum which can be treated by a simple laparoscopy (keyhole operation). Some women however will have deeply infiltrating endometriosis, which requires greater surgical skills and often the assistance of other specialists such as colorectal surgeons or urologists. One of the major themes at the Congress was how to make sure that women with these more advanced stages of endometriosis have access to the right treatment. New specialised imaging techniques using ultrasound and MRI have now been developed that can triage these more challenging cases early on. This allows for much better pre-operative planning and counselling of the patient and it also helps the surgeon assemble the right team for each individual case.

Another important theme at the conference was the treatment of infertility in women with endometriosis. Whilst surgery remains an excellent option for women with mild to moderate disease or those with pain, IVF is usually the only option for patients with more severe disease. A new insight is that endometriosis cysts in the ovary (endometrioma) no longer should be removed in every case. Research has shown that the benefit of surgical removal of the endometrioma is off-set by the reduction in the ovarian reserve (number of remaining eggs) caused by the surgery.

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