Endometriosis in Singapore

What is endometriosis? 

Endometriosis is a condition where tissue from the uterine lining (endometrium) is found outside the uterus. 

Endometriosis may occur on your bowel, fallopian tubes, ovaries, and tissues that line your pelvis. It is also possible for endometriosis to occur outside of your pelvis, but that is uncommon.

In endometriosis, these tissues act just the same way your regular uterine lining does during your menstrual periods; they also thicken, break down and bleed during menstruation. However, this blood remains trapped inside your body, which may lead to swelling, inflammation and eventual scarring of the surrounding areas. 

If these tissues grow on your ovaries, you may develop ovarian cysts known as endometriomas, or “chocolate” cysts.

What causes Endometriosis?

The real cause of endometriosis isn’t clear. But possible theories and explanations include: 

Retrograde menstruation

In retrograde menstruation, menstrual blood flows backwards through the fallopian tubes into the pelvic cavity instead of naturally exiting your body via the vagina. As a result, cells from your uterine lining stick to your pelvic organs and walls, where they grow and thicken over the course of your menstrual cycles in response to your hormones.

Transformation of cells (metaplasia)

The second theory has it that the hormonal or immunological factors transform cells outside of your uterus into endometrial cells, leading to the development of endometriosis in a process known as metaplasia.

Surgical scar implantation

There is a possibility of endometrial cells leeching onto a surgical incision after surgery, like C-section or episiotomy.

Immune system disorder

Due to a faulty immune system, the body may not be able to recognize and destroy endometrial-like tissue living outside the uterus. 

Endometrial cell transport

Another theory has it that endometriosis could be caused by your endometrial cells being transported outside of your uterus via the lymphatic or vascular system. 

Mullerian theory

According to this theory, you may develop endometriosis right from your fetal period. In this case, misplaced cell tissues would begin to respond to your puberty hormones, which explain why endometriosis affects women of child-bearing age.

How do I know if I have endometriosis?

While endometriosis is a common disease, not many understand what it really is. In many cases, you may only know of your endometriosis after a complete medical assessment by a gynaecologist with experience treating this condition. Symptoms of endometriosis may include: 

Painful Periods

Cramping during periods can be normal. However, you should be concerned if you get severe cramps that start before and last throughout your periods which affect your ability to function and require regular painkillers. In severe cases, this may morph into chronic pelvic pain, whereby you experience pelvic pain throughout the month. 

Painful Intercourse

Pain during or after intercourse is a symptom that you shouldn’t ignore as it may indicate severe symptoms. If you have endometriosis, chances are that you may experience pain on deep penetration during sex. 

Infertility

Endometriosis is one of the major causes of infertility. Often, endometriosis is first diagnosed among female patients who seek infertility treatments at our clinic.

Painful/ abnormal urination or bowel habits

If you have deep infiltrating endometriosis involving your bladder or colon, you may experience painful urination/defecation, feeling of incomplete emptying, or constipation during your periods.

Endometriosis can be treated.

Speak to our Obstetrics and Gynaecology Specialists today!

Is endometriosis always painful?

Some women with endometriosis have no symptoms while some women suffer from severe symptoms of endometriosis; every woman is different. The severity of pain may not correlate with the severity of endometriosis – this means that someone with severe endometriosis may experience only mild or no pain, while someone with mild endometriosis may experience debilitating pain. As mentioned earlier, many of our patients only discover that they have endometriosis upon seeking fertility treatment with us. 

Who is prone to endometriosis, and can it be treated?

Any woman in the reproductive age group can get endometriosis. In fact, endometriosis affects 1 in 10 women. You may be at higher risk of getting endometriosis if you have a family history. 

If you suspect that you have endometriosis, it is important to visit a gynaecologist with experience in endometriosis, as not all gynaecologists are well-versed in diagnosing and treating this condition. He/she will need to take a detailed medical history and do a pelvic examination for you. A transvaginal ultrasound scan will be performed to check for the presence of endometriotic cysts in the ovaries. In severe cases requiring surgery, an MRI scan is sometimes required to check for extent of scarring and bowel involvement. 

Endometriosis is a lifelong, chronic condition and there is no single treatment that ensures long-term cure, although your symptoms will abate when you reach menopause. However, you can achieve good suppression of this condition by working closely with your gynaecologist. Treatment options vary and depend on the severity of your symptoms, stage of endometriosis, and your plans for fertility. The main aim of treatment is to achieve surgical clearance (if required) at the most appropriate time, with hormonal medicines before and after that to suppress endometriosis. 

Bedsides hormonal medications and surgery, some women have found the following helpful in managing their endometriosis symptoms:

  • Exercise
  • Diet changes: avoid dairy, wheat products. Aim for a diet rich in anti-oxidants.
  • Psychological counselling
  • Traditional Chinese medicine, acupuncture, reflexology