KEY INSIGHTS

• Endometriosis is a common but challenging chronic medical condition impacting 14% of Australian women. It occurs when endometrial tissue grows abnormally outside the uterine cavity.

• Endometriosis symptoms include chronic pelvic pain, heavy/painful periods, pain while going to the toilet or during sexual intercourse, and fertility issues.

• Treatment of endometriosis may include pain medication, hormonal contraceptives, hormone therapy, and/or surgery. The hormonal IUD can be a very effective option for a lot of women.

• Gynaecology Centres Australia is a top NSW private women’s health clinic offering IUD insertion under sedation. This procedure approach is the gold standard of care for IUD placement.

Endometriosis: What Is It and How to Manage It

Endometriosis (“endo”) is a common but complex and challenging chronic medical condition that can affect biological women. It involves tissue similar to the lining of the uterus (endometrial tissue) growing outside the uterine cavity. The abnormal growth can occur on the:

• Ovaries
• Fallopian tubes
• Bladder
• Bowel (intestines)
• Between the uterus and the rectum (Pouch of Douglas)
• Rarely, it can occur in other parts of the body, such as the joints, skin, lungs, and brain.

This tissue, despite being abnormally deposited, responds to hormones and behaves in the same way as it does in the uterus during the menstrual cycle: thickening, breaking down, and bleeding. As there is no exit route for it (unlike normal menstrual blood that exits the body monthly via the vagina), it leads to significant inflammation, pain, and scar tissue formation.

Endometriosis contributes to a significant burden on a woman’s health and well-being, including pain and infertility.

In Australia:

• As of 2024, almost one million women live with endometriosis – that’s 14% of Australian women – yet less than 1% of Australia’s health system expenditure in 2022-23 was attributable to this condition.

• 1 in 7 women born 1973-1978 were diagnosed by their late 40s

• More than 1 in 12 women born 1989-1995 were diagnosed by age 31

• More than 40,000 women were hospitalised for endometriosis in 2021-2022, with the rate doubling in the last decade for women aged 20-24

• 95% of hospitalisations for endometriosis involved at least one surgical procedure

Common Endometriosis Symptoms and Warning Signs

Signs and symptoms of endometriosis can vary from mild to debilitating. They include:

• Fatigue

• Painful menstruation – pelvic pain and cramping just before each period starts; this may last several days into the cycle.

• Excessive bleeding – heavy menstrual flow and/or bleeding between periods

• Chronic pelvic pain or discomfort between periods

• Pain in the lower back/upper legs

• Pain during urination or bowel movements, especially during menstruation; difficulty “holding on” when the bladder is full

• Pain during ovulation

• Pain during or after sexual intercourse

• Infertility

Health Impact and Endo Subtypes

The impact of endometriosis symptoms on a woman and her quality of life can be debilitating; it can disrupt normal participation in school, work, and social life. While it is not life-threatening, it certainly does limit one’s quality of life.

There are three main types of endometriosis:

• Superficial Endometriosis: occurs primarily on the mucous membrane that lines the pelvic cavity

• Deep Infiltrating Endometriosis: affects the outside of the uterus as well  as organs such as the bladder, bowel, and ovaries

• Endometriomas: blood-filled cysts that form on and in the ovaries.

Women with severe endometriosis are statistically at a heightened risk of developing ovarian cancer and a slightly higher risk of endometrial cancer.

Early diagnosis and proper management are crucial.

Diagnostic Challenges and Medical Gaslighting

This is a condition that typically has an unacceptable diagnosis delay of, on average, 6-8 years. It has traditionally been marked by significant medical gaslighting, whereby health providers have commonly trivialised, dismissed, or denied a woman’s experience of chronic pain and discomfort.

Many women first develop endometriosis in their teens and attribute its symptoms to “painful periods”. This is part of the reason why diagnosis can be so delayed – and many women do not receive an accurate diagnosis until, after many years of suffering, they experience difficulty getting pregnant and seek infertility treatment.

Countless women presenting with symptoms of chronic pelvic pain and heavy bleeding have been dismissively told, “it’s just period pain”; “it’s just growing pains”; “it’s normal”; “you’re just anxious”; “there’s nothing there”; “you’re too young for it to be serious”; “you’re fine”. This attitude (essentially suggesting that a woman is wasting her doctor’s time) not only ignores the physical suffering but also creates even more psychological distress and prevents women from seeking the care they need.

Fortunately, the tide seems to finally be turning, and endometriosis is getting more of the validation and wider recognition it requires.

How Is Endometriosis Diagnosed?

Early diagnosis is critical for appropriate intervention to address and manage the symptoms and possible complications of endometriosis. Diagnosing the condition may involve:

• Pelvic Examination – endometriosis tissue may be able to be felt by the doctor.

• Ultrasound – this imaging technique uses high-frequency sound waves (no radiation) to look at the uterus, ovaries, and fallopian tubes.

• MRI – magnetic resonance imaging (no radiation) is used to provide detailed insight into the size and location of endometrial tissue implants.

• Laparoscopy – this definitive diagnostic method is a day-only surgical procedure carried out by a gynaecologist, in a hospital, under a general anaesthetic. A small abdominal incision is made (usually in the belly button), and a thin “telescope” called a laparoscope is used to visually inspect the inside of the abdomen and pelvis for endometrial tissue located outside the uterus. Any tissue that looks like endometriosis is removed and sent for pathology testing to confirm the diagnosis.

Treatment and Management Options 

Doctors should aim to offer personalised treatment strategies to best suit each woman’s needs. Depending on the severity of symptoms, size and location of endometrial deposits, and factors such as a desire to become pregnant in the near future (or not), endo treatment options may include:

• Heat Packs – used with medication, these can offer some relief.

• Pain Medication – non-steroidal anti-inflammatory drugs (NSAIDs) provide some pain relief by reducing inflammation and cramping. These may be over-the-counter (e.g. Naproxen, Ibuprofen), or a stronger, prescription medicine (e.g. Ponstan).

• Hormonal Contraceptive – combined oral contraceptive pills, vaginal rings, or dermal patches: these can be effective for alleviating mild to moderate pain associated wth the condition, and may also help make the menstrual flow lighter. They can also help inhibit the growth of endometrial tissue.

• Hormonal IUD – progestin-releasing IUDs can be effective for managing endometriosis. They release the hormone directly into the uterus; this thins the lining, eases pain, and reduces heavy bleeding. They can remain in place for at least 5 years (often longer), and an IUD for endometriosis is frequently used after surgical excision of endometrial implants to help prevent a recurrence.

• Hormone Therapy – Provera is a hormonal therapy drug used to suppress the growth of endometrial tissue. It mimics progesterone, temporarily stops menstruation from occurring, and this reduces pain, bleeding, and shrinks endometrial implants. It is used for several months but does have some potential side effects (e.g. mood changes) which must be discussed with your doctor.

• Surgery – performed laparoscopically (or via laparotomy/open surgery for severe cases) to physically remove abnormal endometrial growths

It’s important to visit a doctor (GP/gynaecologist) whom you trust and feel comfortable with.

Women who face fertility challenges due to endometriosis may require treatments such as IVF to fall pregnant, but many women with endometriosis do indeed fall pregnant naturally.

Summing Up

• Endometriosis has no cure but can be effectively managed.
• Excision (surgery) can remove it, but it can recur.
• It is worsened by high oestrogen levels, chronic inflammation, and immune dysfunction.
• Endo progresses due to prolonged oestrogen exposure (early menarche, late menopause, never having children, obesity)
• Flare-ups can be triggered by alcohol, caffeine, an inflammatory diet, stress, and a lack of sleep.

IUD Insertion at Gynaecology Centres Australia

A hormonal IUD can play a major role in the long-term management of endometriosis.

GCA is an NSW women’s health provider offering IUD insertions using IV sedation. This is standard practice for all IUD procedures with us, and the sedation is provided at no extra cost. This distinctly sets us apart from other providers.

To have a chat about endo treatment options at GCA or to book a consultation with us, contact us online or phone us during business hours:

• Sydney 02 9585 9599

• Newcastle 02 4962 4999

• Gosford 02 4324 5176

• Wollongong 02 4227 4100