Endometriosis is a common disease, affecting approximately 10% of women. In Hong Kong, it’s estimated that many women are suffering from the symptoms but remain undiagnosed. This is a disease that affect women’s quality of life so it’s important that our society develops compassion and the tools to help women suffering with the disease. We spoke to obstetrician gynecologist Dr. Selina Pang 彭敏華醫生 about the symptoms, causes, and treatments for endometriosis.
What is endometriosis?
Endometriosis is a disease that affects women’s reproductive organs. It occurs when cells very similar to the endometrial cells that grow inside the uterus grow elsewhere inside the abdominal lining. Endometrial cells make up the lining of the uterus and are either shed every month during menstruation or are where a pregnancy implants. For women with endometriosis, these extra cells still respond to a woman’s hormones and bleed during menstruation, however they cannot be shed so remain inside the body. This monthly bleeding causes inflammation and pain and, over time, scar tissue, usually causing pain and infertility. As scar tissue grows inside the abdominal lining, it may begin to stick the uterus, bowel, fallopian tubes and ovaries together.
There are multiple ways to classify the severity of endometriosis, depending on the amount of scarring, inflammation and potential impact on fertility. The amount of pain is not defined by the stage of endometriosis – some women can have debilitating pain with stage I endometriosis, while others may have few pain symptoms with stage IV.
Below is one classification framework (keep in mind your physician may use another framework), from the Women’s Health & Research Institute of Australia:
- Stage I: Minor amounts of endometrial deposits, minimal scarring, and usually fertility is not affected.
- Stage II: Endometrial deposits are bigger but not affecting other organ functioning.
- Stage III: Endometrial deposits are larger, affect your ovaries and are likely to cause pain and affect fertility.
- Stage IV: Endometrial deposits are bigger and widespread, cysts are present on ovaries, and other organs may be affected.
- Stage V: Endometrial deposits are throughout the abdomen and affect multiple organs. Stage V endometriosis is very rare.
Causes and risk factors
Scientists aren’t entirely sure what causes endometriosis but existing research suggests a number of potential causes and risk factors:
- Genetics – Many women who develop endometriosis have a close family history of the disease in either a mother or sister.
- Retrograde menstruation occurs when some of the menstrual blood gets ‘backed up’ into the open-ended fallopian tubes rather than exiting the body. Scientists posit that the endometrial cells in that menstrual material may stick to whatever it lands on when leaving the fallopian tubes.
- Family history of endometriosis.
- Early menarche (first period), periods of less than 27 days, heavy or very painful periods, and long periods (more than a week.)
- Exposure to toxins – there is some research to suggest that long term exposure to dioxin may be associated with developing endometriosis.
Signs and symptoms
- Painful and heavy periods
- Reduced fertility
- Pelvic pain
- Pain during sex
- Pain during bowel movements and/or urination
- Ovulation pain
- Pain in the lower back and/or thighs
- Nausea and lethargy
As you can see, endometriosis usually comes with a lot of pain – sometimes only at the time of menstruation, sometimes the pain is constant. The pain and discomfort can be so bad for some women, it prevents them from daily activities such as going to school and work. If you have painful periods, it’s important to visit your doctor.
How is endometriosis diagnosed?
If you have painful periods, it can be helpful to keep a diary of your period and any symptoms you experience before you go to the doctor. The process of diagnosing endometriosis starts with understanding your symptoms and then is often confirmed with either medical imaging, a laparoscopy and/or a biopsy.
Treatment options for endometriosis
Note: as always, every patient’s case is different. If you’re seeking treatment for endometriosis, it’s important to be in close consultation with your physician.
Treatment options will depend on the stage of endometriosis, where the deposits are, whether they affect other organs, the level of pain, and the quality of life of the woman affected.
We’ve divided the treatment options based on how the woman is affected:
Endometriosis with no pain and no fertility problems
If a woman isn’t experiencing pain or fertility issues, some physicians may suggest a ‘wait and see’ approach and keep tabs on its development with regular check-ups.
In a small number of cases, women with ovarian endometriosis will go on to develop ovarian cancer. In those cases, sonographic observation will be essential to monitor whether cancerous cells develop.
Endometriosis with pain and no fertility problems
Women who experience painful endometriosis but have no fertility concerns have a range of treatment options available, depending on preference, severity of pain, and physician’s advice.
- Physiotherapy with a women’s health or pelvic physiotherapist can help with endometriosis pain by providing scar tissue and adhesion release, relief of muscle tightness and spasms, and restoring the correct alignment of pelvic and abdominal organs, bones, and soft tissues.
- Certain medication can help alleviate the pain you experience with endometriosis.
- If endometriosis is affecting your quality of life, there are numerous surgical options ranging from key-hole surgery to a hysterectomy.
Endometriosis with no pain and fertility problems
If fertility is an issue as a result of your endometriosis, treatment will focus on ensuring the fallopian tubes remain open and ovaries stay as intact as possible.
Endometriosis with pain and fertility problems
If your endometriosis is causing pain and fertility problems, treatment will be aimed at both. Depending on every patient’s situation, medication and/or physiotherapy is recommended for pain, and surgery with a focus on preserving reproductive organs and assisted reproduction is recommended to assist with fertility.
Endometriosis doctors in Hong Kong
If you’re experiencing heavy and painful periods, it’s important to consult your doctor. If you’re going through the public health system, you’ll need to speak first to your GP in order to be referred to a gynecologist. If you’re using private care, you can refer yourself to a gynecologist. A list of registered gynecologists in Hong Kong is available on the specialist registry list.
Support for endometriosis
The pain and fertility issues of endometriosis can take a significant toll on your mental health, relationships and work. It can help to reach out to a community of people suffering from a similar disease to talk about your own experience. While we have not found any specific support group in Hong Kong, there are several general Facebook endometriosis groups you can join. Endometriosis.org is one of the leading global online platforms that deliver reliable and up to date information about endometriosis.