• Early onset of first menstruation

• Short menstrual cycle

•  Prolonged/heavy menstrual flow

•  Delay of first birth

•  Reduced number of pregnancies

•  Family history

Endometriosis may vary with ethnicity, with more prevalence amongst Asian women. These ethnic variations indicate the significance of genetic and environmental risk factors.

Presence of endometrial tissue outside the uterine cavity is likely the end point of a combination of several aberrant biological processes. There are several different theories to try to explain this condition.

Sampson’s retrograde transplantation theory suggests endometrial cells are driven through the fallopian tubes, via reflux action during menstruation, and are deposited in the pelvis where they invade peritoneal (lining of abdominal cavity) surfaces. While we know that up to 90% of women can have retrograde menstruation, only 15% of women with retrograde flow actually have endometriosis.

Another theory suggests endometriosis develops from transformation of cells lining the abdominal wall into endometrium.

The latest theory suggests the basis of endometriosis is by way of alteration of genital tract structures during the time of embryo development.

The gold standard to confirm endometriosis is a diagnostic laparoscopy. This should be performed systematically, inspecting the surface of peritoneum, uterus, ovaries, tubes, other pelvic and abdominal organs.

There are no clinically useful serum markers to diagnose or monitor disease activity in . While CA125 can be raised in severe disease, it lacks sensitivity and is not routinely used.

Transvaginal ultrasound scan is the primary imaging technique for evaluating endometriosis. This may detect the presence of an endometrioma (endometriosis cyst in the ovary).

Other imaging techniques such as MRI or CT scan may be useful for specific cases.

Dr Sem has a lot of  experience in identifying this condition. His approach is both meticulous and systematic, to ensure that the endometriosis won’t be missed.

Endometriosis can be managed with medical/ hormonal treatment and surgically.

The rationale of medical management is use of hormones to achieve a state of amenorrhoea, thereby providing pain relief. However medical management is less effective for deep infiltrating endometriosis, as it does not remove adhesion or scar tissue leading to persistence of pain and bowel symptoms.

Surgical excision is the most effective long term management for endometriosis. There is much evidence that surgery reduces pain associated with endometriosis in all stages of the disease.

Diagnostic procedures
and diathermy treatment to endometriosis is ineffective. Minor
treatment to superficial disease is likely to offer short-term symptom management only, leading to the potential for repeated diagnostic procedures, and increased risk of adhesions.
Minor treatment to deep infiltrating endometriosis is an ineffective measure.

Keyhole (laparoscopic/ robotic) surgery provides a minimally invasive approach, superior visualisation of tissues through magnification, greater access to the pelvis/pelvic sidewall, microsurgical accuracy during excision of lesions and reduced incidence of scarring. There is also reduced length of hospital admission and greater patient satisfaction compared to laparotomy (open surgery).

Definitive surgery is hysterectomy combined with excision of endometriotic lesions. This often most suitable for those who have completed their families, have had limited benefit from medical and conservative surgical treatments or in those with suspected adenomyosis.

Dr Sem has extensive experience in treating this condition, avoiding unnecessary and repeated procedures. As an advanced laparoscopic surgeon, he has the necessary skills to facilitate complete clearance of endometriosis lesions. Dr Sem is also fully aware of the reproductive impact of this condition and its treatment, and will do everything possible to treat endometriosis while minimising reduction to future fertility.