Painful Periods, Endometriosis & Adenomyosis
Endometriosis is the most common cause of painful periods.
Endometriosis is a condition where menstruation happens outside the womb. This happens because menstruating tissue (called endometrium) is found outside the womb. When endometriosis affects the ovary, it commonly forms ovarian blood cyst called endometrioma. When endometriosis affects the womb, it is referred to adenomyosis.
Most women with endometriosis have a history of menstrual cramps starting in their teens. A study by Janssen (Human Repro Update 2018) found that up to 62% of teenagers with menstrual camps have endometriosis diagnosed at surgery. Many studies also show endometriosis diagnosis can be delayed by up to 9 years because many people assume teenage menstrual cramps are normal.
Endometriosis is a condition that is linked to menstruation. Depending on various factors, each menstruation may or may not excite endometriosis further. Endometriosis will only go away when menstruation stops, like during pregnancy, breastfeeding and in the menopause. Hormonal medication that stops or reduce menstruation will also make endometriosis go away.
Symptoms Of Endometriosis
The most common symptom is pain.
❖ Pain during menstruation often on the left side
❖ Pain at sexual activity
❖ Chronic pelvic pain
Other symptoms of endometriosis include:-
❖ Heavy and/or irregular menstruation
❖ Pre-menstruation or post-menstruation spotting
❖ Difficulties getting pregnant
❖ Irritable bowel symptoms
❖ Fatigue, lethargy, low moods
Diagnosis Of Endometriosis
Endometriosis can be suspected based on
❖ Ultrasound or MRI findings of endometriotic ovarian cysts / Adenomyosis of the uterus
❖ Raised CA125 levels in the blood.
To confirm the diagnosis of endometriosis, Laparoscopic Keyhole Surgery is the gold standard.
Treatment of Endometriosis
The aim of endometriosis treatment is to achieve a good Quality of Life (QoL).
We can either treat just the symptoms or we can treat endometriosis itself to be rid of its symptoms.
To treat Endometriosis Symptoms :-
❖ Pain : Pain killers like Panadol, Nurofen, Ponstan, Arcoxia, Tramadol
❖ Bleeding : Tranexemic Acid to reduce heavy menstruation
❖ Other symptoms : Medicines for bloating and irritable bowel symptoms
To treat Endometriosis Itself :-
❖ Visanne (Dienogest), a hormone specially formulated for endometriosis
❖ Mirena Intrauterine System
❖ Birth control pills
❖ Contraceptive injection (DepoProvera)
❖ Menopausal injection (Lurin, Diphereline, Decapeptyl)
Visanne (Dienogest) reduces inflammation and oxidative process of endometriosis.
Visanne (Dienogest) brings about persistent pain relief because of its anti-inflammatory effects.
Visanne (Dienogest) can reduce ovarian cyst over 53 weeks of treatment.
Visanne (Dienogest) reduces postop cyst and pain recurrence.
Many women with endometriosis find their symptoms and Quality of Life improve with regular exercise and keeping to the Endometriosis Diet.
Surgery for Endometriosis
Surgery for endometriosis is now reserved for women with
❖ severe symptoms despite medical treatment
❖ large ovarian cyst of > 6cm
❖ problems trying to get pregnant
Endometriosis surgery is best done by laparoscopic keyhole surgery because the vision and access to the deeper pelvis is far superior than conventional open surgery.
Laparoscopic keyhole surgery also causes less pain, less infection and less adhesion formation, resulting in faster recovery and better fertility outcome.