Endometriosis

Endometriosis is a painful condition where the tissue that normally lines your uterus grows outside the uterine cavity. This abnormal growth results in chronic inflammation and complications such as adhesions, pelvic pain, and subfertility. Endometriotic implants most commonly involve pelvic structures such as the ovaries, fallopian tubes and peritoneum, but can also spread to the intestines, urinary tract and structures outside the pelvic cavity. 

What is the prevalence of endometriosis?

​The main risk factor is a positive family history (having a family member affected by endometriosis).

​Your doctor will speak to you about the symptoms that you experience and also do a physical examination. This typically includes a pelvic exam to look for the presence of endometriotic cysts and/or evidence of scar tissue. An advanced ultrasound scan and/or MRI imaging may be ordered. In some cases, your doctor may recommend a diagnostic laparoscopy, which will allow direct visual inspection and biopsy of suspicious areas.

The approach that you and your doctor choose will depend on factors such as the severity of your symptoms, the extent of the endometriotic deposits and whether you hope to become pregnant. 

Conservative management involves treatment of pain using analgesics such as nonsteroidal anti-inflammatory agents.  

Hormone treatment aims to slow down the growth and progression of endometriotic deposits. These include oral contraceptive pills and progestins such as dienogest. These medicines typically need to be taken long-term, as stopping them may lead to recurrence of symptoms. 

Surgery is often required in patients with significant pain and/or infertility, and allows for the excision of endometriotic cysts and deposits. It is typically performed laparoscopically, though traditional abdominal surgery may be performed for patients with more severe cases.  Medical treatment may be recommended by your doctor after surgery to prevent the growth of new areas of endometriosis. 

Robot-assisted laparoscopic surgery is available in Singapore General Hospital, along with traditional laparoscopy and abdominal surgery methods. Your doctor will be able to advise you on the approach most suitable for your condition.