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Endometriosis is defined as the growth of menstrual tissue (the tissue that comes out with each period) anywhere other than within the normal cavity of the uterus. This usually involves the tubes and ovaries (known as endometriomas – cystic swellings of endometriosis in the ovaries), inside the muscle of the uterus (adenomyosis) or cervix, in the ligaments behind the uterus (uterosacral ligaments), involving the bowel or bladder or indeed anywhere in the body.

With each menstrual cycle this tissue is stimulated to grow but being in the wrong location, can cause irritation to nerves and adhesions between the ovary and pelvic walls, the bowel and the back of the cervix etc. This can lead to the main presenting symptoms of endometriosis;

  • Painful periods
  • Pain with intercourse
  • Heavy menstrual bleeding
  • Bleeding between regular periods
  • Bleeding after or with intercourse
  • Pain passing a bowel motion during periods
  • Infertility – difficulty getting pregnant
  • Nausea or vomiting associated with menstrual cycles

In many cases, pain can be so severe that a young woman is unable to perform her normal work or studies during and leading up to a menstrual period. This not only causes physical pain every month, but can lead to depression and relationship issues.

The major advance in endometriosis over the last 20 years has been laparoscopy. Because diagnosis can be made using tiny incisions, even a young woman can have her endometriosis diagnosed and treated with a minimum of danger or time off from normal activities. BUT, there are a number of questions you should and indeed MUST ask your gynaecologist before you agree to allow them to perform a laparoscopy for suspected endometriosis;

  • Will you resect or simply burn away (diathermy) any disease you found – endometriosis can penetrate deeper into underlying structures and MUST be completely excised, not simply burnt away
  • If you find disease involving my ureter (tube from the kidney down to the bladder often involved with endometriosis) do you have the skills to remove it or will you wake me up to tell me I need another operation with someone more skilled, because of the danger
  • If you find disease involving my bowel do you have the skills to remove it or will you wake me up to tell me I need another operation with someone more skilled, because of the danger
  • How often do you perform surgery for Stage 3 and 4 endometriosis
  • Are you practiced in recognizing very subtle early stage disease

Many surgeons can insert a laparoscope for mild endometriosis, however when they find anything resembling more serious disease they need to stop. This is wise as they do not possess the skills to safely remove this disease, but why commence surgery in the first place? In more troubling instances, surgeons have told patients they are cured when they have left obvious disease. The young woman thus has continued pain despite thinking she has been fixed.

Our practice specializes in the diagnosis, treatment and management of endometriosis for pain and infertility. As part of the Sydney Women’s Endosurgery Centre, Dr Rosen has a close working relationships with specialist colorectal and urological surgeons  with a special interest in endometriosis as well as pain management and  fertility specialists also involved in the care of endometriosis related problems, and specialized pelvic floor physiotherapists trained in diagnosis and management of complex pelvic pain issues, to provide a holistic approach to the care and management of this enigmatic disease.

Each woman’s case is individually assessed and the risks and benefits of any treatment programme fully explained.

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