The FIVE common misconceptions and diagnosis explained

Endometriosis is a benign gynaecological condition affecting up to 10% of women of reproductive age causing pain and/or infertility. Tissue similar to the lining inside the uterus (“the endometrium”) implants and grows inside the abdomen and pelvis causing inflammation and scarring. In Ireland, it is estimated that 155,000 women are affected by the condition. Endometriosis is a chronic inflammatory disease which causes significant morbidity interfering with many aspects of a woman’s life and can have a major impact on quality of life. Dr Anne Marie Coady, Gynaecological Radiologist at Blackrock Health Hermitage Clinic who operates an ultrasound clinic for the diagnosis and assessment of endometriosis, is tackling some common misconceptions about the condition as part of Endometriosis Awareness Month.

ENDOMETRIOSIS can manifest in many ways making it challenging for people to receive a correct diagnosis. International figures show that it takes a mean of eight years to receive a diagnosis from first presentation, meaning that women are often left suffering for far longer than they need to.

There are a variety of reason for this, including the varied nature of symptoms and misconception around diagnosis. During this awareness month, it’s important to tackle ‘myths’ head on and to ensure we can educate people about the nature of this condition and what steps can be taken to confirm or exclude the diagnosis.

Here, five common misconceptions associated with endometriosis and its diagnosis are explained.

1 ENDOMETRIOSIS ONLY AFFECTS THE REPRODUCTIVE ORGANS

It’s a common misconception that endometriosis only affects the reproductive organs. With this condition, tissue similar to the lining of the uterus grows in other areas leading to inflammation and scar tissue developing in areas quite distant from the pelvis including the liver and lungs in addition to the bladder and ureters, as well as the bowel including the appendix.

2. YOU NEED TO GET A LAPAROSCOPY TO DIAGNOSE ENDOMETRIOSIS

There is a common misconception that a laparoscopy (keyhole surgery) is required to diagnose this disease. However, ultrasound is an effective method for diagnosing potential endometriosis which can also detect causes for pain not due to endometriosis. A pelvic ultrasound, performed by a specialised radiologist in the area, is a highly effective method of diagnosing this disease. If endometriosis is detected on an ultrasound scan, then that same scan should assess and stage the disease appropriately facilitating referral for the optimum treatment option. Diagnosis is the gateway to treatment.

3 YOU NEED TO HAVE A FULL BLADDER FOR A PELVIC ULTRASOUND SCAN

There is a myth that patients attending for a pelvic ultrasound need to have a full bladder. However the diagnostic scan for endometriosis and other pathological conditions is a transvaginal scan with an empty bladder required. In most cases, its recommended patients attend with an empty bladder as a transvaginal scan is required. This also makes the experience more comfortable for patients.

4 ENDOMETRIOSIS CAN BE DIAGNOSED AT ANY STAGE IN THE DISEASE

Early-stage endometriosis will not be detected by an imaging modality neither transvaginal ultrasound nor MRI scan. Earlystage disease does not require surgery however but rather approparite hormonal manipulation and pain relief. The transvaginal scan may detect other possible causes for symptoms.

5 PELVIC PAIN IS THE ONLY SYMPTOM OF ENDOMETRIOSIS

There are a number of different symptoms of endometriosis, these include (but are not limited to):

– Pain in your lower abdomen or back (pelvic pain) in the lead up to the onset of menstruation, progressing during your period. The pain would be considered worse than ‘normal’ period cramps and may not respond to basic pain medication.

– Period pain that stops you from doing normal activities, causes you to miss social events or happens at other times of the month when you are not menstruating (such as halfway through your cycle).

– Heavy bleeding during your period – you might notice this by needing to use a lot of sanitary products, or bleeding through your clothes.

– Pain during or after intercourse.

– Pain when going to the toilet to urinate or for a bowel movement that is worse during the time of your period.

– Experiencing nausea, constipation, diarrhoea, or blood in your urine or in your bowel motions during your period.

– Experiencing difficulty getting pregnant.

Not all pelvic pain is endometriosis, but if you are experiencing any of the symptoms listed above, you should contact your GP. Your GP can assess your symptoms and refer you to a specialist for further investigations if required.

Dr Anne Marie Coady operates an ultrasound clinic at Blackrock Health Hermitage Clinic specialising in diagnosing gynaecological conditions. A GP referral is required for a patient to see her. Visit https://www. blackrockhealth.com/ consultants/dr-anne-mariecoady for more information.