23 February 2021


Endometriosis is a typical condition affecting up to 22% of women worldwide. It is more prevalent today because of better socioeconomic standing, fewer pregnancies and delayed childbearing.

Endometriosis is neither infectious nor malignant. It develops a few years after the start of menstruation, primarily affecting women during their reproductive times. It is one of the primary causes of infertility for women in Singapore. 

What Is Endometriosis?

Endometriosis is a painful disorder where tissues similar to the uterus lining’s tissue grow outside a woman’s uterine cavity. The uterus lining is known as the endometrium. This condition happens when endometrial tissue develops on the ovaries, bowel and tissue lining the pelvis. Endometrial tissue rarely grows outside the pelvic region. If the tissue spread beyond the uterus, it is called an endometrial implant.

Women’s hormonal changes during a menstrual cycle impact the misplaced endometrial tissue, resulting in a painful and inflamed area. Thus, the tissue will develop, thicken and break down. Broken tissues which are stuck in the area will be trapped in the pelvic over time. These trapped tissues can lead to irritation, scar formation, fertility issues, severe pain during menstruation and adhesions, wherein tissue binds the pelvic organs together.

Women who have a history of endometriosis in their family or have a medical condition which prevents them from having normal menstrual flow are at a higher risk of developing endometriosis. Other risk factors for endometriosis include the following:

  • Never go through childbirth before
  • Have anatomical abnormalities, such as an imperforate hymen or blocked vagina which prevents normal menstrual flow passage
  • Being white or Asian

What Causes Endometriosis?

Endometriosis’s exact cause is unknown. Still, there are various theories about its causes, even though no one theory is scientifically proven.

One of the oldest beliefs is that the condition happens because of a process known as retrograde menstruation. This situation occurs when menstrual blood flows back via the fallopian tubes into the pelvic cavity rather than leaving the body via the vagina.

Others believe endometriosis might happen if small areas of the abdomen transform into endometrial tissues. This situation occurs when the abdomen cells develop from embryonic cells, which can alter shapes and function like endometrial cells.

Another theory suggested that the endometrial cells are carried out of the uterus via the lymphatic system. Nevertheless, another theory proposes it might be because of a flawed immune system which does not eliminate errant endometrial cells.

What Are the Potential Complications of Endometriosis?

One serious complication of endometriosis is fertility problems. Around 30% to 40% of women diagnosed with endometriosis have difficulty to conceive. Women with milder endometriosis might be able to get pregnant and deliver a healthy baby. Endometriosis may result in infertility if the inflammation blocks the fallopian tubes.

Moreover, medications do not improve fertility. Some women have a chance to become pregnant by surgically removing the endometrial tissue. If this method fails, they may need to consider fertility treatments or IVF to increase their likelihoods of having a baby.

Women with endometriosis should consider having a baby sooner than later since the symptoms may worsen over time and make it harder for them to conceive naturally. The doctor needs to assess them before and during pregnancy.

Although fertility is not a concern, managing the condition’s chronic pain can be challenging. Anxiety, depression and other mental problems are not rare. Women should visit a gynae clinic to get advice on the best ways to manage these side effects.

Another potential condition is endometriosis-associated cancers, typically ovarian cancer. Women with endometriosis could have a higher risk of ovarian cancer by two to three times.

What Are the Treatments Available for Endometriosis?

Untreated endometriosis may disrupt the patients’ life. While the condition has no cure, its symptoms are manageable. Surgical and medical options are available to decrease the symptoms and deal with any potential complications. However, the doctors may want to attempt conservative treatments first. They might recommend surgery if the patients’ conditions do not improve.

Since each patient reacts differently to the treatment options, patients need to talk with their doctor to get advice on the treatment type, which works best. Below are the treatment options available for endometriosis:

  • Pain medications: Patients can try taking over-the-counter pain medications like ibuprofen. Nevertheless, they may not be effective in all cases.
  • Hormone therapy: Sometimes, supplemental hormones can alleviate pain and stop endometriosis progression. Hormone therapy helps the body regulate its monthly hormonal changes which promote tissue growth which happens with endometriosis.
  • Hormonal contraceptives: Patches, birth control pills and vaginal rings can decrease or even eliminate the pain in less serious condition. Depo-Provera injection can also be effective to stop menstruation and the endometrial implants’ growth and alleviate pain and other symptoms.
  • Conservative surgery: Women who experience severe pain or want to conceive can undergo this surgery to destroy or remove endometrial growths without harming their reproductive organs. Laparoscopic surgery is a minimally invasive surgery utilised to visualise and diagnose endometriosis and remove endometrial tissues.


Endometriosis is a painful condition where cells from the womb’s lining grow beyond the womb, typically around areas like fallopian tubes, ovaries and tissue lining the pelvis. If left undiagnosed and untreated, it may disrupt life and lead to infertility. Currently, the cause for this condition remains unknown.