Many women tend to ignore menstrual pains, dismissing it as merely a discomfort and inconvenience that they have to put up with. However, the intense pain may be a symptom of a severe form of endometriosis.

What is endometriosis?

Endometriosis is a condition where tissue grows outside the womb instead of lining it. Each month, the misplaced tissue responds to the hormonal cycle by building up and breaking down. The bleeding that results, unlike menstrual fluid, is not excreted but builds up, leading to growths or cysts. The growths can cause scarring and stick anywhere in the pelvic cavity, but more commonly to the skin lining the pelvis, bowels and ovaries.

Potential complications of endometriosis

Very severe endometriosis is associated with infertility, pain during menstruation, bowel movements, urination or sexual intercourse, and can even damage the kidneys, said Dr Peter Barton-Smith, Senior Consultant, Department of Obstetrics and Gynaecology, Singapore General Hospital (SGH), a member of the SingHealth group.

“When endometriosis is in the later stages of development, it becomes like superglue,” said Dr Barton-Smith. The endometriosis can stick to the bowel or grow around the ureters, squeezing them and restricting the flow of urine from the kidneys. Women with endometriosis may feel pain, but many don’t know they have the condition until they seek help. For some, the disease occurs with no symptoms.

Endometriosis may potentially develop anywhere in the pelvic cavity.“Endometriosis is a common condition that affects an estimated 8-10 per cent of women in their reproductive years. Of the women with the condition, 10-15 per cent of them, or one to two in every 100 women, are likely to have the severe form, known as deep infiltrating endometriosis,” said Dr Barton-Smith.

Diagnosis of endometriosis

The gold standard for diagnosing endometriosis is laparoscopy, where a tiny camera is inserted into the abdomen to allow the surgeon to see inside. A generally trained gynaecological sonographer can diagnose endometriotic cysts in the ovaries by performing a transvaginal or transabdominal ultrasound scan.

However, only a sonographer trained in detecting deep infiltrating endometriosis via transvaginal ultrasound (or transrectal scan for women who have not had sexual intercourse) is able to look for the more serious form of the disease. This is because transabominal scanning is not sensitive enough, said Dr Barton-Smith. These techniques are very recent but accuracy levels are now so good that severe diseases, other than in the ovaries, can be reliably diagnosed.

Ref: Q15