Endometriosis and Pelvic Pain

Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus in the abdominal cavity. This leads to inflammation, scarring, and pain

The pain is often related to the menstrual cycle but can also be chronic, affecting fertility, daily activities and quality of life

There are many ways that endometriosis is “staged”, however the most common is from the American Society for Reproductive Medicine (ASRM). They developed a staging system for endometriosis, ranging from Stage I (minimal) to Stage IV (severe), which assesses the extent, depth, and location of endometrial implants, as well as the presence of adhesions and ovarian cysts, to guide treatment and predict potential impacts on fertility.

The complex nature of endometriosis requires not just a diagnosis but a strategic approach to treatment that often involves advanced surgical intervention. This is where specialised expertise is crucial. As an experienced laparoscopic and robotic surgeon, Dr. Mikhail Sarofim is skilled in minimally invasive techniques that precisely target and remove endometrial lesions while preserving healthy tissue. This approach not only alleviates symptoms but also reduces the risk of complications or unnecessary procedures.

Endometriosis symptoms can vary, but common signs include:

1. Pelvic Pain: Often linked to your menstrual cycle, but can also be chronic.
2. Painful Periods: Intense cramping and lower abdominal pain during menstruation.
3. Pain During Sex: Discomfort during or after intercourse.
4. Pain with Bowel Movements or Urination: Especially during your period.
5. Heavy or Irregular Bleeding: Including heavy periods or spotting between periods.
6. Infertility: Difficulty conceiving is sometimes related to endometriosis.

Other symptoms can include fatigue, bloating, and digestive issues, especially during your period

It is important to know that symptoms do not correlate with how much endometriosis you have and even the early or superficial endometriosis can cause severe symptoms

Endometriosis is typically diagnosed through a combination of a detailed medical history, pelvic examination, imaging techniques like ultrasound, and, in some cases, a minimally invasive surgery called laparoscopy, which allows direct visualisation of the pelvic organs.

It is important to note that the only way to confirm the presence of endometriosis is with a tissue diagnosis, which requires surgery

It is also important to remember that everyone is different and everybody’s on a different journey. At Eden Women’s Health each person will have a personalised approach to their pelvic pain

Pelvic Pain is a complex condition and at Eden Women’s Health we work with a team of specialists and allied health providers to provide support and treatment for women suffering from this condition.

Often, women will have multiple conditions concurrently. Other common causes of pelvic pain include:

• Irritable Bowel Syndrome (IBS): A chronic condition affecting the digestive system, causing abdominal pain, bloating, and changes in bowel habits.
• Uterine Fibroids: Noncancerous growths in the uterus that can cause heavy menstrual bleeding, pelvic pain, and pressure.
• Interstitial Cystitis: A chronic bladder condition causing pelvic pain, frequent urination, and discomfort during intercourse.
• Adenomyosis: A condition where the inner lining of the uterus breaks through the muscle wall, leading to heavy periods and pelvic pain.
• Pelvic Floor Dysfunction: Pelvic floor dysfunction is a common cause of pelvic pain, especially with intercourse
• Pelvic Inflammatory Disease (PID): An infection of the female reproductive organs, often caused by sexually transmitted infections, leading to pain, fever, and unusual discharge.
• Ovarian Cysts: Fluid-filled sacs on the ovary that can cause sharp or dull pain, particularly if they rupture or twist

The difference between ablation and excision in the treatment of endometriosis lies in the approach and effectiveness of each method.

Ablation involves burning or destroying the surface of the endometriosis lesions, typically using techniques such as diathermy, laser, or thermal energy. While this method can provide temporary relief, it often leaves the deeper parts of the lesions untreated, which can lead to recurrence of symptoms. Ablation may be quicker and less technically demanding but is generally less effective in achieving long-term results.

Excision, on the other hand, involves surgically removing the endometriosis tissue in its entirety. This approach allows for the removal of both superficial and deep lesions, reducing the likelihood of recurrence and providing more sustained relief from symptoms. Excisional surgery is technically more complex and requires specialized training, but studies have shown it to be superior to ablation in terms of long-term outcomes, particularly in cases of deep infiltrating endometriosis.

Dr Mikhail Sarofim, as an excisional surgeon with advanced training in endometriosis surgery, strongly believes in the importance of a comprehensive understanding of this complex condition. His extensive experience and specialized training, including an AGES fellowship, position him as an excellent choice for women and girls suffering from endometriosis. Excisional surgery, when performed by a specialist like Dr Sarofim, offers a higher chance of effectively managing the condition and improving the quality of life for patients.