Dr Roger McMaster-Fay

Gynaecologist and Endoscopic Surgeon - Clinical Lecturer, Sydney University

A brief overview of Endometriosis

Endometriosis is the ectopic growth of endometrium outside the uterine cavity. The endometrium is the lining of the uterine cavity into which the fertilized egg implants. This lining changes throughout the female (menstrual) cycle and is shed at the end of the cycle as a menstrual period. The changes in the endometrium during the cycle are ‘orchestrated’ by the female hormones oestrogen and progesterone, which are produced by the ovaries.

When a woman menstruates, most of the blood and endometrium pass out of the uterus, through the cervix and into the vagina. But some of this fluid also spills out though the fallopian tubes and into the abdominal (peritoneal) cavity. In some women, the endometrial glands and stromal cells attach to the peritoneum and start to grow, setting up ectopic colonies of endometrium: endometriosis.

Endometriosis causes two symptoms, pain and infertility. The pain is usually related to the menstrual cycle and most commonly is worse during the period. This is medically called dysmenorrhoea. Fertility problems caused by endometriosis are most commonly overcome by removing the disease affected tissue surgically. The surgery is performed laparoscopically.

The dysmenorrhoea in established disease is best treated by a combination of surgery and hormone therapy. If treated early enough, the dysmenorrhoea can be commonly controlled with simple hormone therapy such as the contraceptive ‘pill’.

As with all diseases, there are varying degrees of severity, from minimal disease to deep infiltrative disease.

A variant of the disease is secondary to a benign tumour of the ovary called an endometrioid cyst adenoma or ‘endometrioma’, also known as 'chocolate cyst'. It is now recognized that these benign tumours almost certainly have a malignant potential; that is, if left untreated they can turn into cancer.

I maintain the most up-to-date clinical and surgical standards in the management of this complex disease. Severe endometriosis can be the ultimate surgical challenge for the Gynaecologist. Being an Advanced Gynaecological Endoscopic surgeon equips me with the knowledge and skills to manage these difficult cases.

The 10th World Congress of Endometriosis was held in Melbourne in March 2008. I presented a paper at this meeting on our research into advances in tissue diagnosis of the disease by detecting a tissue specific antigen: CD10. Read a copy of my abstract and a copy of the actual poster presentation in PDF format.

Conclusion: Anyone concerned about the possibility of endometriosis should seek an expert opinion.