The “Malignant” Benign Disease: Endometriosis

August 28, 2024 / Patient Education

What is Endometriosis?

Endometriosis is a disease whereby tissue of the inner lining of the womb (Endometrium) is located at an unusual site (outside the womb). There are many theories and studies on Endometriosis, but it’s pathology and exact causation remains a difficult question to answer. One of the more popular theories is the back flow of menstrual blood into the abdomen via the communication between fallopian tube and inner abdomen, causing inflammation and disruption of tissues.

Theory of how Endometriosis happen.

What does it cause?

Patients may experience different kinds of symptoms from cyclical severe menstrual pain, vague abdominal pain, discomfort to the more severe symptoms like pain or blood during passing of urine or stools or pain during intimate relations with partner. Some patients experience difficulty in conceiving. Pain related to endometriosis can be complicated and non-typical.
A lot of women suffer in silence.

Is it a cancer?

On its own, Endometriosis is not considered a cancer. But the disease has a very aggressive and unpredictable course, much like cancer (behaves like a cancer). It invades tissues and surrounding areas causing sever inflammation, tissue thickening (fibrosis), bleeding. It also commonly affects the bowels, bladder, ureters, making surgery and excision extremely difficult. Hence it is also called the “malignant” benign disease by experts. It usually presents as Cyst (swelling/tumour) in one or both of the ovaries.

Certain types of cancers of the female reproductive organ is also associated with endometriosis, for example clear cell carcinoma or serous cell carcinoma of the ovaries. It is rare, but possible. There is also a risk of recurrence after initial treatment, making management prolonged and long-term commitments necessary.

Right sided Ovarian Cyst (Endometrioma or Chocolate Cyst) with Endometriosis involving bowel and uterus.
Severe adhesion/ Plastering of bowel to the back of the womb.

Are there any other problems due to this disease?

Due to inflammation and tissue disruption, there are frequently adhesions (plastering of tissues together) in the abdomen. This can cause pain, as well as problems of fertility in patients. There is also possibility that a varying amount of inflammatory mediator/modulator changes alter the internal environment of the reproductive organs, thus making it unfavourable for pregnancy or implantation.

Can it be treated?

There are varying options of treatment for endometriosis. Including medications to control pain/inflammation, medications to regulate menstrual cycles, other medications to control menstruation, surgical excision and restoring normal tissue anatomy/orientation, as well as application of more advanced technologies like High Intensity Focused Ultrasound that is still in research stages.