When the endometriosis tissue bleeds in the abdomen, it causes inflammation and irritation, creating pain. In some cases, the scar tissue developed from the endometriosis can also contribute to the pain experienced. When endometriosis tissue grows in abnormal areas such as the fallopian tubes, it can affect fertility, leading to infertility.

The exact cause for endometriosis is unknown; however, research shows its origin is multifactorial. The following factors do, however, increase your risk for developing endometriosis:

• Having never given birth
• Starting menstruation at a young age
• Becoming menopausal at an older age
• Those with shorter menstrual cycles
• Those with heavy menstrual periods
• Low body mass index
• Those with higher levels of oestrogen
• A history of endometriosis in the family
• Abnormalities in the reproductive organs

Since knowledge of the cause and pathological process of endometriosis remains poorly understood and fragmented, the approach to treatment is vital to ensure management of this condition and offer patients a better quality of life.

Endometriosis can cause many symptoms or none at all. However, women with endometriosis commonly report chronic pelvic pain. Women suffering from endometriosis display the following types of pelvic pain:

• Severe pelvic pain with menstruation
• Non-menstrual pelvic pain
• Pelvic pain during or after sex
• Pelvic pain with urination
• Pelvic pain bowel movements

The intensity of the pain varies each month. Other symptoms include:

• Heavy menstrual bleeding
• Abnormal menstrual bleeding
• Irregular menstrual cycles
• Debilitating menstrual cramps and period pain
• Anaemia
• Infertility or problems with fertility

The symptoms are often “cyclical” meaning that the pain is worse right before or during the period, and then improves. These symptoms are also not exclusively related to endometriosis as they can be a sign of various other conditions including abnormal uterine bleeding, irritable bowel syndrome, polycystic ovary syndrome, pelvic inflammatory disease (PID), fibroids and even bladder infections. This is what makes endometriosis so tricky to diagnose.

To diagnose endometriosis and rule out the presence of other conditions that can cause pelvic pain, Dr Benecke will begin by discussing your symptoms and do a physical exam. Ultrasounds and MRIs may also be useful in making a diagnosis, but endometriosis presents itself in different ways in different individuals. For this reason, endometriosis can only be accurately diagnosed through the detection of this tissue during laparoscopy. During laparoscopic surgery Dr Benecke would use a laparoscope, which is a thin tube-like tool fitted with a camera, to look inside the abdomen for endometriosis lesions or cysts and if found, take a biopsy of it.

Dr Benecke is meticulous in the laparoscopic investigation of symptoms, understanding that an endometriosis diagnosis can only be made with substantial evidence. With a proper diagnosis, a comprehensive treatment plan can be made to ensure a better quality of life.

Presently, there is no cure for endometriosis and while treatment of this condition can be very complicated, having a gynaecologist who is particularly passionate about the treatment of endometriosis makes all the difference.

The most effective way to treat endometriosis is through excision surgery; however, the approach for treatment will depend on the depth and severity of the endometriosis lesions as well as whether or not you plan to fall pregnant.

In conservative cases, non-steroidal anti-inflammatory medications may help with pain and inflammation. Oral contraceptive pills and gonadotropin-releasing hormone (GnRH) agonists may also be useful in alleviating the pain of endometriosis by slowing the tissue growth and preventing new implants. Hormonal supplementation may suppress symptoms; however, it will not treat endometriosis.

In most cases, surgery is done to remove the endometriosis as this is effective for managing symptoms. Here the approach is taken, skills and tools used are all essential. In suitable cases, Dr Benecke uses minimally invasive laparoscopic surgery to carefully remove as much of the endometriosis tissue as possible while preserving your uterus and ovaries. Through small incisions in the abdomen, a slender tube-like instrument with a camera fitted at the end may be inserted into the abdomen. This will allow your gynaecologist to view the inside of the abdomen and locate the lesions. Through more tiny incisions, surgical tools can be inserted to remove the endometriosis tissue from the reproductive organs thoroughly. If endometriosis lesions are found on the bowels, Dr Benecke may have a specialist bowel surgeon join him in surgery to remove these growths.

In select cases where patients do not have child-bearing concerns, a hysterectomy with removal of the ovaries may be considered; however, this approach is highly contested due to the nature of its complications.

Surgical excision of the endometriosis may alleviate pain caused and assist those wishing to fall pregnant; however, sadly, endometriosis may return. At this point, with little understanding of the cause for this disease, surgical excision of endometriosis tissue remains the gold standard. When surgical removal is combined with alternative therapies such as physical therapy, hormone therapy and counselling as well as other complementary treatments, diet and nutrition associated symptoms can be managed to ensure patients quality of life.

It is clear that beyond the physical aspects, the symptoms and complications of endometriosis can have psychological effects. For this reason, the multidisciplinary team of specialists that are involved at The Endometriosis Clinic can ensure that your treatment is managed holistically. In addition, those dealing with endometriosis, its symptoms and complications for fertility, Dr Benecke suggests joining a support group for women with endometriosis or fertility issues such as the Endowarriors. The latter can relate to your feelings and experiences.