What Are Endometriosis & Endometrioma?

Endometriosis happens when tissue that is normally found inside the lining of the womb(uterus) grows outside its normal location.  Endometriosis can affect many organs, be it in the local vicinity (ovaries, external uterine wall, abdominal wall, fallopian tubes, bladder, bowel and even diaphragm, upper abdomen and thoracic regions). There were case reports of central nervous system affliction as well. Other less common sies include surgical wound endometriosis, causing the patient to bleed from such wounds, related to her menstrual cycles.

When the tissue grows on an Ovary(female gonad) it gives rise to cyst-like structure called “Endometrioma”. This cyst usually contains chocolate/dark coloured fluid or blood hence often referred to as “chocolate cyst”.

The exact cause of endometriosis remains unknown. The most accepted theory is the retrograde menstruation theory by Sampson. During menstruation, parts of the inner lining of the uterus move towards the abdominal cavity through the fallopian tubes and stick to various organs of the abdomen,pelvis or to the ovaries. These “endometrial implants” become “endometriotic lesions”. The hormone oestrogen maybe crucial in this process as it is one of the key hormones controlling the menstrual cycle, researches have however remain in debate as there is still no direct causative link. Genetic, environmental and immune factors may also play an important role in the development of endometrioma.

Investigations are tailored based on patient symptoms and the stage of the disease. In patients with infertility, further investigations may be required to evaluate the extent of the disease especially if it affects the fallopian tubes. Serum Anti-Mullerian Hormone can be done to check the ovarian reserve prior to surgery and if warranted, egg or embryo preservation can be offered to patient before laparoscopic surgery. For patients with significant pain, attention would be to remove disease based on anatomical regions involved. In endometrioma, one of the major concerns is to differentiate endometriosis from a malignant condition since endometriosis patients have an average 4 times increased risk of ovarian cancer. In such cases, imaging and tumour marker levels may not reflect the true extent of underlying disease and very often clinical judgement can only be made intraoperatively especially with the help of Frozen Section Histopathology.

Long-term prognosis depends on the extent of the disease and size of the endometrioma. Recurrence is common, and life-long follow up is warranted. This is more so when most patients present in their early reproductive years at the age of less than 40. Treatment strategies will be to relieve pain by medical or surgical means and most importantly to improve the patient’s quality of life as this debilitating disease often causes relationship distress and disrupts activities of daily living for the patient.