Endometriosis

About Endometriosis 

Over 830,000 people live with endometriosis in Australia. That’s about 1 in 7 people assigned female at birth and tens of thousands of hospitalisations every year. With a 7-year delay in diagnosis on average, endometriosis is a widely misunderstood, underdiagnosed, and underfunded condition. 

What is Endometriosis?

Endometriosis isn’t just awful pelvic pains or chronic fatigue—it’s a complex, inflammatory condition that’s affected by hormones (but not caused by them).

Endometriosis (also known as endo) is a progressive, inflammatory disease that is affected by hormones, but not caused by hormones. On top of the debilitating pelvic pain, infertility, bloating, and back pain, endo can also cause serious fatigue and seriously disrupt your daily life. It’s been shown to affect people’s physical, mental, and social wellbeing, and can even impact a person’s ability to work or go to school.  

When you have endometriosis, cells similar to the uterine lining (endometrium) grow outside the uterus, mainly in the pelvis. Normally, the endometrial cells shed each month during your period, but with endo, the cells outside the uterus don’t shed.

Instead, these cells build up over time, causing pain, inflammation, scarring, cysts, and sometimes adhesions, where organs stick together. Endometriosis is often described as a “full-body” condition because it involves a complex interaction of misplaced cells, hormones, and the immune system.

Symptoms and Stages of Endometriosis 

Endometriosis can be a real pain—both literally and figuratively. The symptoms of endometriosis vary widely from person to person and can often overlap with those of conditions like PCOS, adenomyosis, IBS, fibroids, or STIs.

This overlap is why it’s so important for medical professionals to take their time with each patient, ensuring a thorough evaluation to avoid delayed or incorrect diagnoses and receive endometriosis medical treatment as soon as possible. 

Some of the most common symptoms of endometriosis include:  

• Lower back pain 
• Nerve pain
• Abnormally heavy bleeding during menstruation 
• Fatigue 
• Abdominal bloating (aka endo belly) 
• Severe cramps 
• Severe pelvic pain 
• Painful sex (aka dyspareunia) 
• Mood changes 
• Painful bowel movements 
• Pain when emptying the bladder 
• Infertility and difficulty conceiving 
• Digestive issues (including nausea, constipation, and diarrhoea) 

If you're experiencing these symptoms, it's a good idea to book an appointment with your doctor or a women's health specialist. The sooner you consult an expert, the sooner you can get the support you need.

Endometriosis is also classified into four stages, and understanding these stages can give you more insight into the severity of the condition:

• Stage 1 (Minimal): In this early stage, there’s a small amount of endometrial tissue outside the uterus, typically found on the ovaries or peritoneum (a membrane that lines the abdominal cavity). Symptoms might still be mild, but even minimal tissue can cause discomfort or pain.
  
  
• Stage 2 (Mild): Here, the tissue has grown a bit more, affecting areas like the ovaries and the peritoneum. Symptoms can be more noticeable, with pelvic pain or heavier periods becoming common.
  
  
• Stage 3 (Moderate): At this point, the tissue has spread more extensively and can involve the ovaries, fallopian tubes, and cause adhesions (scar tissue). This stage often brings more intense pain and can affect fertility.
  
  
• Stage 4 (Severe): The tissue is widespread and may involve other organs like the bladder and bowel. Symptoms can be severe, causing chronic pain, heavy menstrual bleeding, and a higher likelihood of infertility.

It’s important to note that the stage doesn’t always match up with the severity of symptoms. Some people with Stage 4 endometriosis may have fewer symptoms than someone with Stage 2. So, while the stage helps doctors understand the condition's progression, your experience is unique, and your treatment plan should be tailored to you (like we do at Hazel).

Causes of Endometriosis?

Unfortunately, the exact cause of endometriosis is still unknown, there are several factors that may contribute to the development of the condition. Some common causes of endometriosis may include: 

• Genetics: A family history of endometriosis increases your risk.
• Hormones: Oestrogen may promote endometriosis growth, especially with higher-than-average levels.
• Retrograde menstruation: Menstrual blood flows back into the pelvis instead of exiting the body, possibly spreading endometrial cells.
• Prior surgeries: Endometrial cells can attach to surgical scars, such as after a C-section.

While it’s typically more common in those who have been assigned female at birth, endometriosis has also been found in the genitourinary tracts (the urinary and reproductive system) of men. While fewer than 20 cases have been reported in men — compared to the 190 million women currently living with it worldwide — it is still possible. 

Reducing Your Risk of Endometriosis 

While there's no known way to prevent endometriosis, recognising its signs is key. Being aware of the symptoms can lead to earlier diagnosis and management. Early intervention, along with your clinical team, can help slow the disease's progression and reduce long-term effects.

Getting a Diagnosis For Endometriosis 

At the time of writing, the only definitive way to obtain an official diagnosis of endometriosis is through laparoscopic surgery.

This procedure involves inserting a small, thin camera called a laparoscope through a tiny incision in your abdomen. The laparoscope allows doctors to directly view your reproductive organs, such as the ovaries, fallopian tubes, and uterus, and it may be used to take tissue samples (biopsies) for further analysis.

While ultrasound is often used in the early stages of diagnosing endometriosis, it’s not a foolproof method of diagnosis. Ultrasounds are helpful in detecting endometriomas (ovarian cysts filled with old blood) but can miss smaller, deeper tissue implants or adhesions that are characteristic of the condition.

In fact, the growths that cause endometriosis may be too small or hidden to show up clearly on an ultrasound scan. This is why laparoscopy is considered the gold standard for diagnosis, as it provides a much more accurate and detailed view of the condition.

Is Endometriosis treatable?

Wondering how to treat endometriosis? You’re not alone. If a doctor or medical team has ever made you feel like treating endometriosis is impossible, rest assured—there are things you can do.

There are many endometriosis treatments in Australia including pain management, hormone therapies, surgical options, and lifestyle strategies to ease symptoms. With the guidance of an endometriosis specialist, like our doctors at Hazel, you can find the right combination of treatments to help manage your symptoms and improve your quality of life.

Treatments for Endometriosis

While there is currently no cure for endometriosis, there are treatment options available to help you manage your endometriosis and provide you with pain relief. Treatment for endometriosis may involve one of the options below, or a combination of a few, depending on your treatment plan: 

• Medical treatments (including NSAIDs and other medications)
• Surgical treatments (including endometriosis surgery such as laparoscopic surgery)
• Hormonal treatments (including hormone therapy, like oral contraceptive pills
• Combined treatments (including a mix of conventional and natural treatments)

Medications for Endometriosis 

• NSAIDs for endometriosis
  Many people living with endo turn to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) for temporary pain relief from the symptoms of endometriosis.
  
  NSAIDs, such as naproxen, ibuprofen, aspirin, and naproxen, block the production of prostaglandin within the body, helping to effectively manage pain and inflammation.
  
  
• Medicinal cannabis for endometriosis pain
  For those looking for a natural alternative for endometriosis treatment, medicinal cannabis offers a promising alternative.
  
  Research suggests that medicinal cannabis may help slow the growth of endometrial tissue, potentially managing the progression of the condition. In addition to this, it can alleviate chronic pelvic pain, improve sleep, and provide relief from gastrointestinal issues. This plant-based therapy offers a holistic approach to managing endometriosis symptoms and improving overall well-being

Surgical Treatments for Endometriosis

‍When it comes to treating endometriosis, surgery might be suggested if other treatments like medications haven’t worked or if a more clear diagnosis is needed. Surgical treatments involve removing or destroying the endometrial tissue that’s growing outside the uterus. The type of surgery will depend on how severe the endometriosis is and where the tissue is located.

There are different kinds of surgeries available for endometriosis, from less invasive options to more complex ones, including a hysterectomy (removal of the uterus) in cases where symptoms are severe and other treatments haven’t provided relief. However, a hysterectomy is usually considered only for those who don’t wish to maintain fertility and may be more suitable — though still extreme options — for postmenopausal women. 

What’s chosen will depend on your unique situation and needs — like whether you're hoping to keep your fertility or just want to manage the symptoms better. Surgery, just like any other treatment, has its pros and cons, and it’s important to be aware of things like recovery time, costs, and potential side effects. For some, these factors can make surgery feel like a big step, but it’s worth discussing with your doctor to find the best option for you.

Laparoscopic Endometriosis Treatment

Laparoscopic surgery is one of the most common ways to both diagnose and treat endometriosis.

During this procedure, the surgeon uses a tiny camera (called a laparoscope) that’s inserted through a small incision in your abdomen. This lets them see your reproductive organs and check for any endometriosis tissue. If they find it, they can remove or treat it during the same procedure.

One positive about laparoscopic surgery is that it gives both a diagnosis and treatment in one go. But while it’s the only way to definitively confirm endometriosis, it doesn’t always get rid of all the tissue, and sometimes the endometriosis can come back, meaning you might need further treatments or surgeries down the line. 

Hormone Therapy for Endometriosis 

The reality is, Laparoscopic treatment for endometriosis can be highly effective in diagnosing and removing endometrial tissue, but it’s not always necessary, or wanted, for every patient.

Hormone treatments are another common approach to endometriosis management and work to: 

• Reduce the frequency of menstruation:
  Reducing the frequency of menstruation (or stopping menstruation altogether) can help alleviate endometriosis pain and other symptoms associated with the condition.
  
  
• Lower oestrogen levels within the body:
  Higher than-average oestrogen levels have been linked to the growth of endometrial tissue. Decreasing the oestrogen levels within the body can help regulate hormones and decrease a person’s risk of developing endometriosis

Some of the most popular hormonal therapy treatments for endometriosis include: 

• Hormonal Contraceptives – including oral contraceptives (aka The Pill), vaginal rings and patches 
• Gonadotropin Releasing Hormone Agonists (aka GnRH)
• Progestin Therapy – including IUDs, progestin-only pills, and injections 

If you choose to centre your endometriosis treatment plan around hormone therapy, the medication you receive will depend on several factors, including the severity of your symptoms, your age, and if you have any reproductive plans.

What is the best hormone treatment for endometriosis​?

An expert in women’s health and endometriosis can help you determine the most effective method of hormone therapy for you and your lifestyle.

As mentioned above, there are several hormone therapy options available for managing endometriosis, and the best one for you depends on various factors, like your age, the severity of your symptoms, whether you're planning to have children, and how your body responds to treatment.

Your doctor will work with you to find the most effective option based on your personal needs and lifestyle.‍

Alternative Endometriosis Treatments

Whether you want an alternative for laparoscopic surgery, explore non hormonal endometriosis treatment options, or just want to know what else is out there, many alternative therapies exist to help you manage your endo in a way that aligns with your needs.

Some natural options that can help to manage the symptoms of endometriosis include: 

• Supplements
  Omega-3 fatty acids are known for their anti-inflammatory properties and are commonly used to support overall wellness, including reducing inflammation. Some studies suggest that Omega-3s may help alleviate endometriosis-related pain by reducing inflammation in the body, though evidence is still emerging.
  
  
• Naturopathic Treatment for Endometriosis Pain
  Naturopathic treatment for endometriosis pain typically involves a holistic, natural approach to healing, with a focus on using herbal medicines to alleviate pain.
  
  
• ‍Diet and Exercise
  Along with getting enough rest, and staying on top of hydration levels, moving our bodies and fuelling them with the right foods can have more of an impact on endometriosis management than you might think.
  
  Anti-inflammatory foods like whole grains, legumes, omega-3 and olive oil help to balance intestinal bacteria, lower levels of inflammation, and manage the symptoms of endometriosis.
  
  
• Acupuncture
  Emerging research has found that acupuncture can play a role in the effective management of endometriosis symptoms. Acupuncture has been shown to ease pelvic pain and improve the wellbeing and quality of life in women and folks assigned female at birth who live with endometriosis pain. 

Endometriosis Stage 1 Treatment

In Stage 1, endometriosis is typically mild, with small patches of tissue found on the ovaries or pelvic lining.

Treatment usually focuses on easing symptoms. Common options include pain relievers like ibuprofen, birth control pills to regulate periods, and hormonal treatments like progesterone to manage growth.

If you're trying to get pregnant, doctors may recommend fertility treatments. In some cases, a small surgery (laparoscopy) may be done to remove the tissue.

Endometriosis Stage 2 Treatment

Stage 2 involves a bit more tissue growth and some adhesions (scar tissue). Treatment might include hormonal therapies, like the birth control pill, GnRH agonists to lower oestrogen levels, or progestins to slow tissue growth.

Surgery may be needed to remove or shrink the endometrial tissue, especially if you're having trouble with fertility. Pain relief options like NSAIDs or physical therapy may also help manage discomfort.

Endometriosis Stage 3 Treatment

At Stage 3, the condition is more severe, with deep tissue growth and adhesions that can affect fertility. Surgery is often the first step to remove as much of the tissue and scar tissue as possible.

After surgery, hormonal treatments are used to prevent the tissue from growing back. You might be prescribed GnRH agonists, birth control, or progestin treatments. If you're struggling to get pregnant, IVF or other fertility treatments might be an option. Pain management and therapies like acupuncture or physical therapy may also help you feel better.

Endometriosis Stage 4 Treatment

Stage 4 is the most severe stage of endometriosis, characterised by extensive tissue growth, deep adhesions, and large cysts on one or both ovaries. This level of endometriosis can cause significant pain and may greatly impact fertility.

Treatment at this stage often involves comprehensive surgery to remove as much endometrial tissue and scar tissue as possible, which can help improve symptoms and enhance fertility outcomes. After surgery, hormonal therapies, like GnRH agonists or progestin treatments, may be prescribed to prevent the return of endometrial growth.

Pain management is also a key part of Stage 4 treatment, and complementary therapies such as acupuncture, physical therapy, and dietary adjustments may provide additional support for managing symptoms.

Combined Treatment for Endometriosis 

Forget everything you may have heard about a one-size-fits-all approach to treating endometriosis (and healthcare in general, for that matter).  

‍The best treatment for endometriosis is the treatment plan that works for you. Because the symptoms are so varied and manifest themselves differently in each person, endometriosis treatments that work for one person may not necessarily work for another. 

‍A combined approach to treatment involving a range of different treatment and management options (such as hormone treatments for endometriosis, alternative endometriosis treatments, medications, and laparoscopic treatment for endometriosis​) can help effectively manage the symptoms of endometriosis and improve the quality of life. 

If you suspect you might have endometriosis, we recommend booking a time to talk to your doctor or an expert in women’s health to determine the most effective treatment plan for you and your unique situation.

Endometriosis Infertility Treatment

Endometriosis can make it more difficult to get pregnant, and for some, it’s one of the hardest parts of the condition. About 30-50% of women with endometriosis experience infertility. But don’t lose hope! There are options and treatments available that can help.

First, let’s talk about how endometriosis can impact fertility. The tissue that grows outside the uterus can cause inflammation, scarring, and adhesions, which can block or damage the fallopian tubes, ovaries, and other reproductive organs. This can make it harder for the egg and sperm to meet, or for a fertilised egg to implant properly. The extent of infertility depends on the severity of the endometriosis, but even mild endometriosis can sometimes cause challenges when trying to conceive.

Some of the treatment options that can help you on your endometriosis fertility journey:

Medications‍

In some cases, medications can help improve fertility by addressing issues like pain, inflammation, or hormone imbalances. However, they’re not typically used as fertility treatments on their own, though they can be helpful in managing the symptoms while you try to conceive.

Surgery for Endometriosis infertility

If your endometriosis is more severe, surgery may be necessary. Laparoscopic surgery can improve your chances of pregnancy by improving the function of your reproductive organs. After surgery, many women experience improved fertility, although there’s always a chance that the endometriosis could return over time.

Intrauterine Insemination (IUI)

For some women with endometriosis, especially those with mild to moderate cases, IUI can be an effective fertility treatment. IUI involves placing sperm directly into the uterus, which increases the chances of sperm meeting the egg. Often, IUI is combined with ovulation-stimulating medications like Clomid to boost the number of eggs released.

In Vitro Fertilisation (IVF) for Endometriosis 

If other treatments aren’t successful, IVF might be recommended. IVF involves stimulating the ovaries to produce multiple eggs, which are then retrieved, fertilised in the lab, and implanted into the uterus. IVF has been shown to be successful for many women with endometriosis, even those with more advanced stages, because it bypasses some of the obstacles caused by endometrial tissue.

Egg Freezing for Endometriosis 

For women who may not be ready to try for a baby but are concerned about the impact of endometriosis on their fertility down the road, egg freezing is an option. This involves retrieving and freezing your eggs while they are still healthy and viable, so you have the option of using them later on if necessary.

If you’ve been struggling with fertility and suspect endometriosis might be the cause, it’s a good idea to consult with a fertility specialist or a gynaecologist who has experience in treating endometriosis. They can assess your unique situation, talk through your options, and help guide you toward the right treatment plan.

Endometriosis in a nutshell:

‍Endometriosis is a complex and often misunderstood condition affecting a significant number of women across Australia. While there is no one-size-fits-all solution, a comprehensive, personalised treatment plan that combines medical, hormonal, natural, and surgical approaches can help manage symptoms and improve quality of life. 

By understanding the diverse symptoms and risk factors, seeking early diagnosis, and working closely with healthcare professionals, like our caring team at hazel, individuals with endometriosis can find relief and take control of their health. If you suspect you may have endometriosis, don't hesitate to get diagnosed and explore the best treatment options for you.

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Endometriosis FAQs

‍Can you live with endometriosis without surgery?
Yes, many people manage endometriosis without surgery. Options like hormone therapy, lifestyle changes, and pain management can help control symptoms, but it’s essential to work with a doctor to find what works best for you.

What happens if endometriosis is left untreated?
Untreated endometriosis can lead to ongoing pain, scar tissue, and potential fertility issues. While it’s not life-threatening, untreated symptoms may worsen over time, making it important to explore treatment options if symptoms are affecting your quality of life.

Can I live a normal life with endometriosis?
With the right treatment and support, many people can live their best lives despite endometriosis. Managing symptoms may require a combination of medical care, lifestyle changes, and emotional support to help you thrive!

How do I manage my endometriosis?
Endometriosis can be managed with medications (like hormone therapy), pain relief, physical therapy, and dietary adjustments. Some people also find relief through alternative therapies. A doctor, like one of our Hazel specialists, can guide you in finding a treatment plan that suits your needs.

Does endometriosis get worse with age?
Endometriosis symptoms can change over time and may get worse if left untreated, though this is unique from person to person. Hormonal shifts, like those during menopause, can sometimes reduce symptoms, but everyone’s experience is different.

Can endometriosis cause weight gain?
While endometriosis itself doesn’t directly cause weight gain, symptoms like bloating, hormonal treatments, and pain-related inactivity may contribute to weight fluctuations in some people.

Can endometriosis go away?
Endometriosis is a chronic condition, so it typically doesn’t go away completely, even with treatment. Treatments, including hormonal therapies and surgery, can help manage symptoms, reduce pain, and slow the growth of endometrial tissue, but they don’t eliminate the condition entirely.

For some people, symptoms may improve naturally after menopause, as hormonal changes reduce the activity of endometrial tissue. While treatment can often bring significant relief, endometriosis doesn’t have a permanent cure at this time. However, ongoing treatment and symptom management can make a big difference!