Endometriosis Melbourne

Understanding Endometriosis

Endometriosis is more than simply having painful periods. It is a condition where tissue similar to the lining of the uterus grows outside the uterus, most commonly within the pelvis. It may be found around the ovaries, fallopian tubes and surrounding pelvic tissues and in some women can also involve areas near the bowel or bladder. These areas can become inflamed and painful and over time, may lead to scar tissue or adhesions. Endometriosis can also form cysts on the ovaries, known as endometriomas.

One of the difficult things about endometriosis is that what a woman feels does not always match how much disease is present. Some women experience significant pain with relatively limited endometriosis, while others may have more extensive disease with fewer symptoms. The exact cause is still not fully understood, which is also why the condition can present so differently from one woman to another.

Could Your Symptoms Be Endometriosis?

Endometriosis does not always look the same from one woman to another. For some, the main sign is severe period pain. For others, it may be pelvic pain at other times in the month, pain during intercourse, bowel or bladder symptoms, heavy bleeding or difficulty becoming pregnant.

What often matters is the pattern. Symptoms that return around the same point in your cycle, have become more noticeable over time or are beginning to interfere with work, exercise, sleep or intercourse are worth discussing. You do not need to have every symptom for endometriosis to be considered and symptoms can change over time.

How Is Endometriosis Diagnosed?

There is no single test that diagnoses every case of endometriosis. The starting point is usually your symptoms, including when the pain occurs, how it relates to your cycle and whether anything has changed over time. A pelvic ultrasound is usually the first imaging test when endometriosis is suspected. It can help identify ovarian endometriomas and some forms of deeper endometriosis, including disease around the bowel, bladder or ureters. MRI may also be useful in some situations.

A normal scan does not completely rule out endometriosis. If your symptoms continue, the next step will depend on what has already been found and how much the symptoms are affecting you. In some cases, laparoscopy may be considered, particularly when imaging has not given a clear answer or when surgery may also help treat the condition. The aim is to build a clear enough picture of what is going on before deciding what treatment, if any, is appropriate.

Treatment Options for Endometriosis

There is no single treatment that suits every woman with endometriosis. What may be appropriate will depend on the symptoms you are experiencing, how much they are affecting you, what you have already tried and whether pregnancy is something you are considering now or in the future.

Treatment may include pain relief or hormonal options such as the contraceptive pill, progestogen treatment or a hormonal IUD. Pelvic floor physiotherapy and other forms of pain management may also be useful for some women. The goal of treatment is also different for everyone. It may be reducing painful periods, managing pelvic pain between periods, making intercourse more comfortable or finding an approach that fits with plans for pregnancy. Dr Peter will explain what each option is intended to do and how it fits with your circumstances before deciding on the next step.

When Surgery May Be Considered

For some women, surgery becomes part of the conversation when symptoms are continuing or other treatments have not helped enough. That does not mean surgery is automatically the next step. If it is being considered, Dr Peter will look at what has already been tried, what your imaging shows and what you are hoping to improve. Laparoscopic surgery can allow endometriosis and adhesions to be treated at the same time but the decision should always be based on whether it is likely to make a meaningful difference for you.

Endometriosis and Fertility

Having endometriosis does not mean you will necessarily have difficulty becoming pregnant but it can affect fertility for some women. Australian health guidance estimates that around one in three women with endometriosis experience fertility difficulties.

If pregnancy is part of your plans, it is worth including that in treatment decisions from the beginning. Some hormonal treatments used to manage endometriosis prevent pregnancy while they are being used and the role of surgery may also need to be considered differently when fertility is a priority. As both an obstetrician and gynaecologist, Dr Peter can take your future pregnancy plans into account when discussing how your endometriosis is managed.

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Endometriosis Care with Dr Peter

Dr Peter has more than 30 years of experience in obstetrics and gynaecology, including laparoscopic surgery and the ongoing management of endometriosis. Care starts with understanding your history, what has already been tried and what you need help with now.