THE classic triad of endometriosis is:

1) Severe period pains which get progressively worse as time goes by.

2) Cyclical pain before, during and sometimes right after the period.

3) Painful sex — a herald sign to see the doctor.

However, endometriosis, which is ectopic tissue found outside the uterus, is more than just painful periods. What is often not stressed enough is the impact of endometriosis on the ovaries, eggs and ultimately fertility. Endometriosis, an inflammatory condition that worsens with time, leads to scarring of surrounding tissues and sometimes blocked tubes. This inflammation also adversely affects egg and sperm quality, leading to poor fertilisation, miscarriages, and infertility.

Diagnosis

The gold standard is diagnostic laparoscopy, a minimally invasive surgery where a telescope with a camera is inserted into the abdomen to look for endometriotic tissues.

While ultrasound is useful to detect endometriomas (chocolate cysts) and nodules, a normal ultrasound does not rule out endometriosis.

If you have severe, debilitating period pains, you have endometriosis until proven otherwise, but there is always hope.

Treatment options:

There is currently no cure, but the condition can be managed effectively, especially if the diagnosis in made early.

Options include:

•Hormonal therapies: Progesterone pills or injections, hormonal IUCD, GnRH analogues

•Minimally invasive surgery

•Pelvic floor physiotherapy

•Lifestyle modifications

•IVF

•Psychological support

The choice of treatment depends on the age of the patient, the severity of the symptoms, the stage of the disease, the location of the endometriosis, and the desire for fertility.

Dr Michelle Bailey is a fertility specialist, gynaecologist and laparoscopic surgeon.

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