Dr I-Ferne Tan: Endometriosis Specialist Sydney

Endometriosis is a chronic condition where tissue similar to the lining of the uterus (the endometrium) grows outside the uterus. This tissue can be found on the ovaries, fallopian tubes, the wall of the uterus, and other organs in the pelvis.

In rare cases, it has even been found in organs outside the pelvis. This displaced tissue continues breaking down and bleeds with your period each month.

This leads to inflammation, pain, and the formation of scar tissue (adhesions).

Period pain is the most well-known symptom of endometriosis, but it doesn’t necessarily have to be excruciating pain.

Normal period pain is mild, only lasts 1-2 days, and resolves with Panadol or Nurofen. It should not distract you from everyday activities, work, or school.

Anything beyond this is suspicious, especially if you have any of these other symptoms:

• Irregular periods, particularly heavy periods.

• Pain during sex.

• Pain or blood with a poo or wee.

• Trouble falling pregnant.

• Feel abnormally fatigued during your period.

Diagnosis can be challenging. The “gold standard” is a laparoscopy (key-hole surgery through the belly button) and excision (removal) of endometriosis. This allows it to be sent to the lab for confirmation of the diagnosis. However, surgery comes with significant risks and diagnosis not always necessary.

Other methods that are less invasive, though less accurate for mild or superficial endometriosis:

Unfortunately, there is currently no cure for endometriosis. But we can help treat symptoms and manage this condition.

• Anti-inflammatory pain relief, such as Nurofen (ibuprofen), can lessen inflammation and pain.

• Hormone treatments can lighten menstrual flow and deter endometrial growth.

• Surgery can remove growths of endometriosis and adhesions and restore your pelvic organs to the right place. This is best achieved through laparoscopic (key-hole) excision surgery.

• Invitro Fertilisation (IVF) can help you have a little one by bypassing the inflammatory pelvic environment.

• Lifestyle changes and non-medical treatment can go a long way in easing the pain, psychological, and fertility consequences of endometriosis. Ideally, this is achieved through a multidisciplinary team of physiotherapists, psychologists, and dieticians.

Endometriosis and period pain disorders are commonly treated by GPs with hormones. If this is not working, it’s causing side effects, or you’re experiencing other unusual symptoms, you may want to consider seeing a gynecologist. A gynaecologist who has a special interest in endometriosis is best positioned to know what additional treatment can be offered, including surgery if appropriate. 

If you’re having difficulty falling pregnant, you may want to see a fertility specialist - ideally one with a special interest in endometriosis.

As endometriosis is known to impact fertility and is associated with early menopause, all women with endometriosis who want children in the future should consider freezing their eggs, especially before going in for any surgery.

1. What training do you have in endometriosis treatment and surgery?

2. Are you a fertility specialist too? What happens if I need fertility treatment/advice?

3. If they are recommending surgery, make sure you ask why this is being recommended over non-invasive treatment.

4. If in doubt, always get a second opinion.

Up to 50% of women with fertility issues have endometriosis.

Symptoms like inflammation, scar tissue formation, sticky pelvic organs, blockages to fallopian tubes, damage to egg quality, chronic pain and sexual dysfunction can all have a role.

It's also associated with early menopause.

But having a baby isn't out of the question - especially with expert support and treatment.