38 talkingwomen clinical review 

Endometriosis explained
these conditions co-existing. endometrium of
Dr Elizabeth A study to establish the typ- women with endo-
Farrell ical menstrual experience of metriosis confir­
MBBS, teenagers using the Menstrual med on laparos-
FRANZCOG, Disorders of Teenagers question- copy but not in
FRCOG naire was undertaken, including the endometrium
1051 women aged 16-18 years of women with-
Director, the Jean Hailes in the ACT. out endometriosis.
Foundation for Women’s About 70% felt their periods This may become
Health, President of the Asia were normal, but 25% had sig- a way of diagnos-
Pacific Menopause Federation nificant menstrual disturbance ing endometrio-
for the triennium 2007-10, including severe pain, school sis or targeting
and President-Elect of the absence, concern about their which women to
Australasian Menopause personal menstrual experience laparoscope.
Society. and visits to the GP.
MANAGEMENT
THE 10th World Congress on DIAGNOSIS There is debate
Endometriosis took place in The mean time from onset about the use of
Melbourne in March, with more of symptoms to diagnosis of empirical treat-
than 1000 delegates attending endometriosis is seven to 12 ment to suppress
from all over the world. years and even longer if the ovulation as first-
endometriosis has infiltrated into line management

Photolibrary
CLINICAL PRESENTATION deep tissues such as the uterosac- rather than oper-
Endometriosis is thought to ral ligaments, bowel, bladder, ative laparoscopy
occur in 10% of women but the ureter or rectovaginal septum. with excision.
prevalence may be lower. The diagnosis of endometrio- Suppressing
A study using data from the sis by investigations other than ovulation reduces endometrial endometriotic plaques is the
UK General Practice Research laparoscopy is not available. tissue growth and may be con- most widely used treatment.
Database showed the specific Ultrasound – transvaginal and sidered first-line in young teen-
symptoms of dysmenorrhoea, rectal – may have a limited place age women. CONCLUSION
menorrhagia and abdominal and in diagnosis of endometriomas Various therapies have been Endometriosis is a heterogenous
pelvic pain were significantly and deep infiltrative disease. prescribed for ovarian suppres- disorder. Symptoms may range
associated with endometriosis. At the congress, many stud- sion, including the combined oral from minimal to none, through
In the year prior to diagnosis, ies were presented that were contraceptive pill continuously, to severe and crippling.
about 10 per cent of the women investigating markers that could long-acting progestins such as The degree of disease varies
had multiple visits to their doc- possibly be developed as a less Implanon, and the Mirena IUD. and is classified according to its
tors to seek help and were twice invasive test for endometriosis. When symptoms persist clinical staging at laparoscopy.
as likely to take time off work Inflammatory markers includ- despite suppression of ovulation, Especially in women in their
because of the symptoms. ing macrophages, cytokines, operative laparoscopy with exci- teenage years, endometriosis may
There is a greater risk of growth factors and prostaglan- sion would be appropriate as a appear differently. The endome-
being misdiagnosed with irri- dins are being studied. second-line treatment. triotic plaques visible at laparos-
table bowel syndrome or pel- Sensory C nerve fibres have Operative laparoscopy with copy may appear as clear areas  worth
vic inflammatory disease, or of been shown to occur in the excision and/or diathermy of rather than the classical dark $1499
brown or red implants.
Recommendations for GPs There is concern about young
women undergoing multiple sur-
1. Dysmenorrhoea, menorrhagia and diagnosis of endometriosis. gical, mainly laparoscopic, pro-
abdominopelvic pain in a woman of any age 4. Management remains controversial. In young cedures with excision of tissue
who regularly has to take time off school or teenage women, an initial trial of ovarian and its consequence on long-
work, leading to visits to her doctor, should be suppression may be appropriate. term fertility. 
investigated for endometriosis. 5. Endometriosis is chronic and long-term
2. The time taken to diagnose endometriosis is follow-up is necessary. Post-operative ovarian The Jean Hailes Foundation for
too long in most cases. The condition should be suppression may be necessary. Women’s Health is a national,
part of the differential diagnosis of any woman, 6. When symptoms persist, refer to either non-profit health organisation
regardless of age, presenting with the complex a specialist endometriosis clinic or a focusing on clinical care,
of menstrual symptoms, including menstrual gynaecologist with advanced skills in innovative research and
pain, which impede normal function. laparoscopic surgery or a special interest in practical education opportunities
3. Laparoscopy remains the gold standard for endometriosis management. for health professionals
and women.