Endometriosis is a common disease affecting around one in 10 women during their reproductive years and is a major cause of infertility and pelvic pain.

The aetiology is unknown, but because it appears in some families, genetics are thought to be involved. In some women, the disease can be mild, but in others it can be severe with extensive involvement of the pelvic organs and tissues. It is not known why this variation in disease occurs.

Authors Prof David Healy PhD, FRANZCOG, FRCOG. Founding board member, the Jean Hailes Foundation for Women’s Health; Chairman, Department of Obstetrics & Gynaecology, Monash University Professor Peter Rogers BSc (Hons), PhD Founding board member, Jean Hailes Foundation for Women’s Health; Director, Centre for Women’s Health Research, and NHMRC Principal Research Fellow, Department of Obstetrics & Gynaecology, Monash University Dr Elizabeth Farrell AM MBBS, FRANZCOG, FRCOG Founding board member, the Jean Hailes Foundation for Women’s Health; Head, Menopause Unit, Monash Medical Centre; President, Australasian Menopause Society

Women with endometriosis often present on several occasions with severe dysmenorrhoea over an average of seven years before a diagnosis is made. Any woman who presents with dysmenorrhoea that impacts on her quality of life - requiring her to take time off work, study or school - should be investigated for endometriosis.  

Endometriosis is diagnosed in about a third of women presenting with infertility. Transvaginal ultrasound may detect ovarian endometriomas but is unable to detect peritoneal lesions. Referral to a gynaecologist with an interest in endometriosis and expertise in operative laparoscopy is appropriate.

The diagnosis can only be made visually at laparoscopy, but many researchers are working towards a non-invasive test. Sometimes a trial of the oral contraceptive pill in young women may differentiate between primary or secondary dysmenorrhoea.

Recommendations for priorities in endometriosis research were recently established at a World Endometriosis Research Foundation consensus workshop held following the 10th World Congress on Endometriosis in Melbourne in March 2008.

One of the recognised priorities was the need for a multidisciplinary approach to research in all aspects of endometriosis. From a research perspective, endometriosis is particularly challenging. Reasons include a lack of good experimental models and similarities between eutopic and ectopic endometrium that make it difficult to target ectopic tissues medically without damaging the eutopic endometrium.

Another cause of difficulty is the complex interplay between what are thought to be multiple currently unidentified genes and unknown environmental factors that lead to lesion formation.

One of the highest priorities for endometriosis researchers is the discovery of a non-invasive means of diagnosis that can detect early and mild disease. In addition to the obvious clinical importance of such a diagnostic test, identification of women at early stages of disease would greatly facilitate research aimed at understanding causative factors, epidemiology, disease mechanisms and, ultimately, new treatment options.

Recently published double-blind Australian studies suggest a new technique for diagnosis that involves sampling the endometrium via an endometrial biopsy and testing for the presence of nerve fibres in the tissue. These nerve fibres are increased in the endometrium of women with endometriosis.

It may be that laparoscopy will become a thing of the past for diagnosis of endometriosis, and perhaps all women presenting with fertility issues will have a simple biopsy without any need for anaesthesia and laparoscopy.

It could be postulated that any woman at the time of their Pap smear, especially those women with symptoms of dysmenorrhoea, menorrhagia and pelvic pain, could undergo a simple biopsy and test so that early treatment of endometriosis could prevent infertility and reduce the risk of severe disease.

Recent studies have shown endometriosis care should not stop once the woman becomes pregnant. It has shown that endometriosis is a risk factor for preterm birth, with a greater chance of antepartum haemorrhage, preeclampsia and delivery by caesarean section. In women with ovarian endometriomas requiring assisted reproductive technologies, there is a greater risk of preterm birth and small-for-gestational-age babies.

Ovarian endometriosis can be easily diagnosed because it has a characteristic appearance on obstetric ultrasound. If the ovarian endometrioma ultrasound appearance is seen in a pregnant woman, even if there is no diagnosis of endometriosis, the woman should be triaged into high-risk obstetric care.  

 Talking women endometriosis and infertility 235.84 Kb

References

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Content Updated October 30, 2009