What is Endometriosis?
Endometriosis is a chronic condition where tissue similar to the uterine lining (endometrium) grows outside the uterus — typically on the ovaries, fallopian tubes, pelvic peritoneum, and other pelvic structures. This tissue responds to hormonal changes each month, causing inflammation, pain, scarring, and in many cases, infertility.
Endometriosis affects approximately 10-15% of women of reproductive age and is found in up to 50% of women with infertility. Despite its prevalence, diagnosis is often delayed by 7-10 years due to normalisation of symptoms.
Stages of Endometriosis
Endometriosis is classified into four stages (revised ASRM classification):
- Stage I (Minimal) — Small, superficial implants on the peritoneum or ovarian surface
- Stage II (Mild) — More implants, deeper, possibly with some scarring
- Stage III (Moderate) — Deep implants, ovarian endometriomas (chocolate cysts), filmy adhesions
- Stage IV (Severe) — Large endometriomas, dense adhesions, deep infiltrating disease affecting organs
Important: The stage does not always correlate with symptoms. Some women with Stage I have severe pain, while others with Stage IV have minimal symptoms. Similarly, even mild endometriosis can significantly affect fertility.
Treatment Goals
Treatment of endometriosis focuses on three key goals:
1. Pain Management
Reducing chronic pelvic pain, painful periods (dysmenorrhoea), and pain during intercourse (dyspareunia). This may involve hormonal treatments (combined pill, progestogens, GnRH analogues), pain management strategies, or surgical excision of endometriotic lesions.
2. Preventing Disease Progression
Slowing or halting the growth of endometriotic tissue to prevent further damage to reproductive organs. Hormonal suppression can prevent new lesion formation, while surgical removal addresses existing disease.
3. Fertility Restoration/Preservation
Optimising fertility outcomes through surgical removal of disease (especially endometriomas), restoring normal anatomy, and proceeding to IVF when natural conception is unlikely. For younger women with endometriosis, fertility preservation (egg freezing) may be recommended to protect against progressive ovarian damage.
Medical vs Surgical Treatment
Medical Treatment
- Combined oral contraceptive pill (continuous use)
- Progestogen therapy (Dienogest/Visanne, Mirena IUS)
- GnRH agonists (Lucrin, Zoladex) — temporary menopause induction
- Pain management (NSAIDs, neuromodulators)
Note: Medical treatment suppresses endometriosis but does not cure it. It is not suitable for women actively trying to conceive.
Surgical Treatment
- Laparoscopic excision of endometriotic lesions
- Removal of ovarian endometriomas (cystectomy)
- Division of adhesions to restore normal anatomy
- Treatment of deep infiltrating endometriosis
Dr Volschenk has extensive training in minimally invasive endometriosis surgery, aiming to remove disease completely while preserving ovarian tissue and fertility potential.