Could I possibly have endometriosis?

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Q Lately I have been experiencing lower back pain, heavy and irregular menstrual periods and pain, particularly at a specific point inside the vagina, merely by touch. I also have burning sensations during urination after that specific point has been touched. I've had these symptoms for three to four years.

I have read about endometriosis and found some of the symptoms match that condition. Are there any other illnesses that have similar symptoms?

A: Endometriosis is a common condition affecting many women of child-bearing age. It is a progressive disease in which the lining of the womb (endometrium) is spilled into other parts of the reproductive organs including the fallopian tubes, ovaries, the back of the womb and large intestines. These abnormal and wayward endometrial tissues bleed every month during menstruation and subsequently form scars and adhesions in surrounding areas.

You do have some symptoms pertaining to endometriosis. However, other conditions may have to be considered. They include pelvic inflammatory disease, benign ovarian cyst, adenomyosis, and ovarian cancer.

What are the symptoms of endometriosis?

  • It is a painful disorder in which tissue that normally lines the inside of a woman's uterus grows outside of the organ.
  • Doctors believe that the condition may be caused by "retrograde menstrual flow" - the backflow of blood into the pelvis during menstruation.
  • Most women with endometriosis don't experience any symptoms at all. Having trouble getting pregnant may sometimes be the first sign.
  • Extremely painful or heavy periods
  • Irregular vaginal bleeding between periods
  • Pain during or after sexual intercourse
  • Pain when moving bowels
  • Chronic pelvic pain, including the lower back and pelvic areas
  • Chronic fatigue
  • Hormonal treatments can be used to reduce pain and correct heavy or irregular menstrual flow.
  • These include birth control pills, progesterone drugs and menopause-inducing injections.
  • If endometriosis is extensive, or if there is severe pain, surgery is usually recommended.
  • Although this is a rare condition, there have been several reports of women with endometriosis coughing up blood during menstruation in medical journals.
  • Some 30-40% of women with endometriosis are infertile, making it one of the top causes of female infertility.

Pelvic inflammatory disease refers to the infection of the womb, fallopian tubes and ovaries. It is usually a result of sexually-transmitted diseases (STDs) and forms swelling and adhesions in nearby tissues. There may be pus in the tube and ovary. Patients can experience abdominal cramps, back pain and irregular and heavy menses. Pain on urination and fever are common in the acute phase.

A benign ovarian cyst (fluid-filled sac that forms in the ovaries) may persist for months and bleeding from this cyst may produce pelvic pain. The physiological cyst is usually asymptomatic, but in some patients, it may be confused with endometriosis.

Similarly, adenomyosis may cause abnormal bleeding and pain. It is a condition in which the endometrium is abnormally present in the muscle layer of the womb (myometrium). The womb is usually uniformly enlarged and big or may be irregular in shape. Pain during sexual intercourse is usually present and the womb is tender when touched.

Ovarian cancer may cause irregular menstrual bleeding, lower backache and tenderness on vaginal examination.

From the above account, you can see that diagnosis of endometriosis is not easy. It requires careful clinical history, examination and interpretation of laboratory and imaging results by a gynaecologist.

DR PETER CHEW
Consultant obstetrician and gynaecologist, Gleneagles Hospital