Brief Overview of Endometriosis

• Endometriosis affects about 1 in 10 women and may cause pain or infertility. However some women have few or no symptoms.
• The causes of endometriosis are not fully understood. A number of theories exist but most probably small fragments of endometrium (uterine lining) pass backwards through the fallopian tubes and deposit throughout the pelvis.
• Various medications can be taken to suppress endometriosis. These all suppress endometriosis quite well on a temporary basis but it tends to recur once the medication is stopped.
• Complete removal of endometriotic lesions using laparoscopic surgery appears to offer significant and long-term relief of pelvic pain and improved fertility.
• Hysterectomy may not be the best solution for relief of pelvic pain associated with endometriosis. This is because endometriosis lies principally outside of the uterus in the pelvis.
• Advances in laparoscopic surgery have enabled the treatment of endometriosis without hysterectomy for many women.
• Adenomyosis is a form of endometriosis affecting the deep muscle layers of the uterus. Although frequently managed by hysterectomy some new treatment options allow the woman with adenomyosis to keep her uterus.
• Medical treatment will not improve fertility. However surgical treatment of endometriosis improves the chances of spontaneous pregnancy by 40% or more.
• Hormone Replacement Therapy can still be offered to women with a history of endometriosis. It is recommended they take progestogen as well as oestrogen even after a hysterectomy.
• Tibolone (Livial) is a new type of Hormone Replacement Therapy which may be advantageous in women with endometriosis.
• Research into the role of the immune system and genetics in endometriosis is ongoing. Studies continue to look at the newer surgical techniques and their role in the management of pelvic pain and infertility.

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