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Endometriosis

Early menarche

What is Endometriosis?

Endometriosis is a condition in Singapore which endometrial tissue (similar to the one present in the uterine lining) grows or is found outside the uterine cavity (uterus). Endometriosis is a chronic gynaecological disease that can be severely debilitating and cause significant deterioration of one’s quality of life.

Endometriosis can be a complicated condition to diagnose despite its prevalence.  Fortunately in Singapore, a wave of endometriosis awareness has been taking place, empowering women to forgo tolerating extreme pain that impacts their quality of life.

  • It is estimated that 1 in 10 women of reproductive age, worldwide, suffer from endometriosis.
  • Of this, up to 50% of women have been linked to infertility.
  • On average, women take up to 5- 10 years to obtain an endometriosis diagnosis but Singapore fares better at 4 years on average.
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During menstruation, women shed uterine lining built in the uterus through the vagina. However, for women with endometriosis, endometrial tissues tend to grow outside the uterus, subsequently also thickening and bleeding during menstruation. As there is no channel of exit outside the uterus, the abnormal growth leads to inflammation, scar tissue formation (adhesion), and the growth of chocolate cysts (endometrioma) in the affected areas.

Below are the stages of endometriosis and their classifications:

  • Stage 1: few endometrial implants, wounds, and lesions. Little to no scar tissues are present but implants can be found in the abdomen and pelvic areas. At this stage, the endometrial spread is considered minimal.
  • Stage 2: small amounts of deeply implanted endometrial tissues. There are some noticeable scar tissues.
  • Stage 3: many deep endometrial implantations and cysts identified in one or both ovaries. Lesions and adhesions may be present.
  • Stage 4: widespread endometrial implantations that are deep with thick adhesions and lesions. Large cysts are found in one or both ovaries.

What are the common causes of Endometriosis in Singapore?

The cause of endometriosis is still unclear and definitive.

 Below are some popular theories about the formation of endometriosis:

  • Retrograde menstruation: menstruation blood sloughs back into the pelvic cavity through the fallopian tube. This theory holds for women with congenital genital tract as abnormal reproductive structures could obstruct menstrual flow. However, it does not explain deep endometriosis lesions that occur in organs outside the uterine cavity.
  • Haematogenous/lymphatic spread: this theory assumes that endometrial cells spread in the body through lymph-vessels and blood vessels subsequently attaching themselves to deep layers of organs. Some claim that endometrial cells exhibit cancer metastasis-like behaviour, whereby endometrial cells spread like tumour cells would. However, this theory has yet to be definitively proven.
  • Cellular metaplasia: an abnormal change in the nature of tissue and cells occurs leading to endometriosis.
Symptoms of endometriosis

As menstruation experiences differ for everyone, symptoms would also present themselves differently. Endometriosis can start even during the first menstrual cycle. It is important to be honest about your discomfort instead of pushing your body for tolerance.

Symptoms of endometriosis include:

  • Debilitating pain: women with endometriosis often have to rely on painkillers in order to be functional, they have difficulty conducting daily routines and mundane chores, often feel feverish during menstruation, and may even experience cold sweats during menstruation.
  • Menstrual problems: menstruation problems such as heavy menstrual flow, blood flow in the form of blood clots, soaking through pads, or needing to wear extra large pads to avoid leakage are characteristics of menstrual problems.
  • Pain during intercourse: sharp pain and discomfort during and after intercourse are symptoms of endometriosis.
  • Excretion issues: such as diarrhoea during menstruation, cramps when urinating and excreting, blood in urine and faecal matter are characteristics of endometriosis.
  • Bodily discomfort: women with endometriosis often experience bloating, nausea, dizziness, or fatigue.

If you notice any of the symptoms stated above, make an appointment today to get an accurate diagnosis and effective treatment.

Is Endometriosis painful?

Yes, endometriosis is generally a painful condition. However, 20-25% of women are asymptomatic. This means it is possible for one to have endometriosis without symptoms of pain. In such cases, these women typically discover their endometriosis diagnosis during attempts to conceive. We advise conducting preconception screening if you have suspicions of being asymptomatic or find difficulties conceiving.

Who is at risk of Endometriosis in Singapore?

Endometriosis risk factors include:

  • Family history: if a female family member (mother, sister, daughter) has been diagnosed with endometriosis, the likelihood of you being diagnosed with this condition increases.
  • Early menstruation: girls who had their first menstruation at the age of 10 and below (early menarche) are more likely to develop endometriosis.
  • Longer menstruation days than average: women with short monthly cycles (menstruating every 21 days or less) are at an increased risk of developing endometriosis.
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Who is at risk of Endometriosis in Singapore?

Endometriosis risk factors include:

  • Family history: if a female family member (mother, sister, daughter) has been diagnosed with endometriosis, the likelihood of you being diagnosed with this condition increases.
  • Early menstruation: girls who had their first menstruation at the age of 10 and below (early menarche) are more likely to develop endometriosis.
  • Longer menstruation days than average: women with short monthly cycles (menstruating every 21 days or less) are at an increased risk of developing endometriosis.

How is Endometriosis diagnosed in Singapore?

Obtaining a diagnosis for endometriosis is complex as no imaging test or physical examination can provide a definitive finding.

However, clues and hints can be obtained from:

  • Pelvic examination: your obstetrician/gynaecologist may attempt to physically feel if there are any cysts on the reproductive organ. Tenderness in the pelvic region would also provide clues of underlying issues.
  • Imaging tests: a transvaginal ultrasound or pelvic magnetic resonance imaging (MRI) limits the ability to provide accurate visualisation of endometriosis spread but it can provide hints by identifying cysts, lesions, and deeply infiltrating endometriosis.
  • Diagnostic laparoscopy: the only and surest way to identify endometrial growth in the abdominal cavity. It serves as a tool for diagnosis, and if necessary, subsequent treatment will be administered.

What are the treatment options available for Endometriosis in Singapore?

Treating endometriosis will provide much relief and improvement in your quality of life.

Treatments options include:

  • Surgery: laparoscopic surgery  is a common route of treatment employed to immediately remove endometrial growth, cysts, and lesions.
  • Oral medication: anti-inflammatory drugs are prescribed to alleviate pain. These, however, do not provide any improvement in endometriosis.
  • Hormone therapy and contraceptives: depending on your condition, appropriate hormone therapy would be suggested. Contraceptives may be prescribed to reduce menstruation frequency and flow. Whilst hormone therapy and contraceptives do not cure endometriosis, they can help in reducing the spread of endometriosis tissues and endometrial implants.

Frequently asked questions

What can I expect after laparoscopy for endometriosis?

Depending on the severity of your condition and healing capabilities, recovery rates may vary. There are situations where patients with chronic endometriosis recover within 2 weeks whilst patients with mild endometriosis feel lethargic for a longer period of time. Depending on your severity, your duration of stay in the hospital may also vary. Usually after a laparoscopy, symptoms of endometriosis reduce significantly and quality of life increases.

Can IUD help endometriosis?

IUD (Mirena) lessens period flow and pain, however, in cases where endometriosis is present outside the uterine cavity, an IUD is unable to remove or reverse endometriosis conditions.

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