Endometriosis

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, typically affecting the ovaries, fallopian tubes, and surrounding pelvic tissues. This condition leads to chronic inflammation, causing pain and potential fertility issues. During each menstrual cycle, this misplaced tissue responds to hormonal changes by thickening, breaking down, and bleeding. However, since it has no way to exit the body, it can lead to scar tissue formation and adhesions.

Dr. Harvard Lin

Obstetrician & Gynaecologist

MBBS (SG) | MRCOG (UK) | MMed (OBGYN) (SG)

Symptoms Causes Diagnosis Treatment Prevention FAQ

Symptoms of Endometriosis

Endometriosis can cause a range of symptoms that may disrupt daily activities and impact overall quality of life. Common symptoms include:

Pelvic Pain: Pain occurs during menstruation and can persist throughout the month, ranging from mild to severe. The pain may radiate to the lower back and legs.
Painful Periods: Menstrual cramps extend beyond normal duration and intensity, often starting before and lasting longer than typical period pain. The pain may be severe enough to interfere with work or daily activities.
Pain During Intercourse: Discomfort or pain occurs during or after sexual activity due to inflammation and tissue involvement.
Irregular Bleeding: Women may experience spotting between periods or heavy menstrual flow requiring frequent pad or tampon changes.
Digestive Issues: Pain during bowel movements or urination is common, especially during menstruation. Other symptoms may include bloating, constipation, or diarrhoea.
Fertility Difficulties: The condition can make conception more challenging due to its effects on reproductive organs.

Causes and Risk Factors

A combination of genetic, hormonal, and immune system factors can influence the development and progression of endometriosis.

Genetic Predisposition

Women with a family history of endometriosis have a higher likelihood of developing the condition.

Early Onset of Menstruation

Starting periods at a young age increases exposure time to menstrual cycles and hormonal fluctuations.

Short Menstrual Cycles

Having periods less than 27 days apart creates more frequent opportunities for retrograde menstruation.

Immune System Function

Alterations in immune response may prevent the body from identifying and removing misplaced endometrial tissue.

Hormonal Factors

Higher levels of oestrogen or imbalances in hormone levels can promote tissue growth outside the uterus.

Diagnostic Methods

Medical History and Physical Examination

The diagnostic process begins with a detailed review of symptoms and menstrual history. A pelvic examination can reveal pain areas, nodules, or restricted organ mobility.
Ultrasound Scanning

Transvaginal and pelvic ultrasounds help detect endometriomas and deep endometriosis. These scans provide insight into the size and location of cysts and can identify adhesions between pelvic organs.
MRI (Magnetic Resonance Imaging)

This imaging technique provides detailed views of soft tissues and can map the extent of deep infiltrating endometriosis. MRI helps surgical planning by showing the relationship between endometriotic lesions and surrounding organs.
Laparoscopy

A minimally invasive surgical procedure that allows direct visualisation of endometrial implants. During the procedure, tissue samples can be taken for biopsy to confirm the diagnosis and assess the extent of the disease.

Treatment Options

Treatment approaches for endometriosis focus on managing pain, slowing disease progression, and preserving fertility.

Non-Surgical Treatment

Pain Management: Over-the-counter pain relievers and anti-inflammatory medications help control pain and reduce inflammation during menstrual periods and throughout the month.

Hormonal Therapy: Birth control pills, patches, or hormonal IUDs suppress menstruation and reduce pain. GnRH agonists create a temporary menopausal state to limit disease progression.

Lifestyle Modifications: Regular exercise and dietary changes can help manage symptoms. Some women find relief through acupuncture or pelvic floor physiotherapy.

Surgical Treatment

Laparoscopic Excision: This method involves carefully cutting out endometrial implants, adhesions, and cysts while preserving healthy tissue. Excision is particularly effective for deep infiltrating endometriosis, reducing pain and lowering recurrence risk. This technique is also beneficial for women seeking to improve fertility.

Laparoscopic Ablation (Cauterisation): Ablation (also called fulguration or coagulation) uses heat, laser, or electrical energy to destroy endometrial tissue. While this method can provide symptom relief, it is generally less effective than excision, especially for deeper lesions, as it only destroys surface-level tissue without fully removing it. Ablation may be suitable for mild cases or when full excision is not possible.

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Prevention and Management

While endometriosis cannot be prevented entirely, several strategies help manage its impact. Regular exercise maintains healthy hormone levels and reduces inflammation. Tracking symptoms helps identify triggers and patterns, enabling better preparation for flare-ups. Working with healthcare providers to develop a long-term management plan allows for adjustments as symptoms or life circumstances change.

Frequently Asked Questions (FAQ)

Can endometriosis affect organs beyond the reproductive system?

Endometrial tissue can grow on the bowel, bladder, and in rare cases, the lungs or other organs. This widespread involvement may cause symptoms specific to the affected areas and requires specialised treatment approaches.

How does endometriosis impact fertility?

Endometriosis can affect fertility through multiple mechanisms, including altered egg quality, blocked fallopian tubes, and distorted pelvic anatomy. However, many women with endometriosis conceive naturally or with assisted reproductive technologies.

Can endometriosis cause chronic pain even outside of periods?

Yes, some women experience constant pelvic pain due to inflammation, adhesions, or nerve involvement. Pain may also worsen with bowel movements, urination, or intercourse, depending on the location of the endometrial growths.

How often do I need a colonoscopy if polyps are found?

If polyps are detected, your doctor will recommend a follow-up colonoscopy based on the size, number, and type of polyps. In many cases, follow-up is recommended within 3 to 5 years to monitor for recurrence or new growth.

Dr. Harvard Lin

Obstetrician & Gynaecologist

MBBS (SG)|MRCOG (UK)|MMed (OBGYN) (SG)

Dr. Lin has a clinical focus on female pelvic medicine and reconstructive surgery, encompassing the management of urinary incontinence, overactive bladder, and prolapse.

Dr. Lin completed his medical training at the National University of Singapore and obtained advanced certifications in Obstetrics and Gynaecology. He is a Member of the Royal College of Obstetricians and Gynaecologists in the UK.
Dr. Lin serves as a clinical tutor at NUS and contributes to laparoscopic and pelvic floor workshops. His research includes stem cell therapy, synthetic meshes, and translational medicine, with publications in peer-reviewed journals and textbooks.

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