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The following article by Dr Devini appeared on womenshealth.com.au during Endometriosis Awareness Month. 

Endometriosis Awareness Month is an ideal time to shine a light on an often painful condition that affects around 10 percent of reproductive aged women. Most prevalent in women aged 25 to 35, but also reported in premenarcheal girls and in two to five percent of postmenopausal women, endometriosis occurs when the lining of the uterus lies outside of the uterine cavity.

As well as pain with menstruation or intercourse and abnormal bleeding, endometriosis can contribute to infertility. Particularly if left untreated. While its cause is not well understood, genetic factors, immunological factors and retrograde (reverse) menstruation have been implicated.

To empower you take charge of your reproductive health this month (and always), here are five things you should know about endometriosis. Some of them might surprise you.

1. Severity doesn’t always correlate with symptoms

Women can have severe endometriosis as judged by surgery or physical findings, whilst experiencing minimal or even no symptoms. This is sometimes called silent endometriosis and may only be diagnosed as a result of unexplained infertility, or incidentally during surgery for a different issue. On the other hand, some women can have significant symptoms, such as severe pain with menstruation, yet have milder forms of the disease.

2. Endometriosis doesn’t have to be diagnosed from a scan or through surgery

Scans such as ultrasounds are not always a foolproof diagnosis method as they may not detect early stage or low-grade endometriosis. Neither is it always necessary to have surgery, such as a laparoscopy, if you are suspected to have endometriosis.

If your Gynaecologist or GP has investigated your symptoms, excluded other pathology and suspects you may have endometriosis, they may treat you with medical or hormonal treatments first to see whether your symptoms improve. There are many different treatments, and one treatment may be right for some women, but not others.

3. Pregnancy doesn’t ‘cure’ endometriosis

It is an old wives’ tale that pregnancy cures endometriosis. While your symptoms may change or reduce in severity during pregnancy, being pregnant will not ‘cure’ the condition or take the pathology away.

4. Endometriosis can be found in many different sites in those affected

Endometrial tissue is most commonly found on the ovaries and pelvic side-walls, but can also migrate and affect other areas including the bowels and bladder. Endometriosis can even be found on caesarean section scars or the abdominal wall, and – in rare cases – the diaphragm and other organs.

5. Up to half of women who are infertile will have endometriosis

The extent to which endometriosis affects fertility cannot be quantified. However, if we did a laparoscopy on everyone who presents with infertility, some studies show that 30-50% of women will have surgical evidence of endometriosis.

What we do know is that endometriosis can affect how the egg is released from the ovary, the quality of eggs, the ability of the embryo to implant onto the uterus, and may also increase the incidence of miscarriage.

Early detection helps to prevent pain from increasing and the condition progressing so that more difficult surgery is required. It is therefore important to seek the advice of your GP or Gynaecologist if you are experiencing any symptoms of endometriosis, or notice any change to your cycle or an increase in pain.

The above article by Dr Devini Ameratunga was published on womenshealth.com.au on 6 March, 2020.