Dr Roger Perkins
Endometriosis Perth
What is endometriosis?
Endometriosis explained
Endometriosis is essentially abnormal endometrial tissue growth outside the lining of the uterus. Your (normal) endometrial tissue creates a lining inside your uterus. This type of tissue is important at the start of pregnancy when an embryo needs a place in the uterus to attach. This exact same type of tissue can also grow outside your uterus. That is what leads to a diagnosis of endometriosis.
In that situation, abnormal tissue growth may be found on your ovaries, on the sidewall of your pelvis or between your uterus and your rectum. In other situations, endometrial tissue is found in surgical wounds and other places.
"Endometriosis is a common condition in women’s health. It is associated with infertility, pain during intercourse, and excessive period pain. The symptoms may be felt stronger before or during your period because the endometrial tissue grows during your menstrual cycle. The cells in this tissue respond to hormones."
Scientists and gynaecologists are still working hard to find more data on the exact causes of endometriosis.
The benefit of seeing a specialist for your endometriosis diagnosis is that you get access to my experience, both in general gynaecology and women’s health and in fertility treatment.
Endometriosis symptoms
Symptoms you should look out for
One or more of the typical symptoms may cause your GP to refer you to my practice:
- Heavy periods and painful periods
- Pelvic pain before and during your period
- Pain during intercourse
- Pain when you empty your bowels or your bladder
- Delay in conceiving and infertility
- Changes in your bowel or bladder function when you have your period
It is important to know that endometriosis shows up with different symptoms in different people. Some women are diagnosed with it and yet they don’t have any symptoms. This is what we call a variable disease.
"The tissue nodules that we are looking for, can be very small or they can grow larger (between 1 mm and 4 cm). That will influence the symptoms you experience. This is why it takes the expertise of an experienced gynaecologist to give you a clear diagnosis."
Endometriosis diagnosis
How is it diagnosed?
Endometriosis may be difficult to diagnose without direct visualisation of the pelvic structures. It is usually not visible with Ultrasound or MRI. The gold standard approach to diagnose endometriosis is laparoscopic appraisal surgery. Laparoscopy also provides the opportunity to surgically remove the tissue at the time without the need for further surgery. Often samples are sent for testing in the lab and confirm your diagnosis.
Part of the process involves mapping your medical history and any symptoms that you may have been experiencing in the past.
We use the information supplied by preoperative ultrasound to visualise any larger tissue deposits.
"I will look at each person's individual circumstances to work out the best solution. It is important to have an in-depth consultation to look at your symptoms, your history, and the visual information from your ultrasounds. "
Endometriosis treatment Perth
Can it be treated?
You will hear gynaecologists talk about the management of endometriosis. What we do is combine the expertise and the findings of the most recent research, to create your personalised endometriosis treatment plan.
Specific treatment is broadly divided between medical and surgical.
The standard approach is to surgically remove the tissue that causes the symptoms. The excision also allows me to normalise the anatomy of the areas that were affected by endometrial tissue.
In the context of subfertility, it is important to concentrate on all means to achieve pregnancy. This usually involves laparoscopic appraisal and removal of endometriosis. At the same time, a tubal assessment is done to ensure normal tubal patency. This way, you should be able to keep trying naturally knowing that the condition is managed and that the Fallopian tubes are not blocked.
Sometimes, it will be necessary to undertake IVF treatment, particularly if the endometriosis is severe and associated with a lot of pelvic scarring.
If your main reason to see me has been the pain caused by endometriosis, then our first focus will be to reduce your pain after assessing the extent of the endometriosis. Here is where medical management has a great role to play. Treatments such as analgesia, the Contraceptive pill, Mirena device, and GnRH analogs can reduce pain by slowing down the progression of endometriosis.
Using these medical methods in the context of subfertility will reduce pain, but are associated with delaying fertility because of their contraceptive effect.
In these situations, we suppress the hormonal triggers that cause the tissue to grow when you have your period: it means that we use medication to halt follicle development, hormone production and ovulation, which stimulates endometriosis.
This is why a conversation about your medical history and your fertility history is relevant. If fertility is no longer a priority, then we may have a conversation about removing your uterus, tubes or even your ovaries.
It is good to bear in mind that endometriosis symptoms are generally reduced significantly once you reach menopause. The natural evolution means that your oestrogen hormone levels will be lower and that reduces the symptoms without surgery.
Endometriosis infertility
Can I be infertile because of endometriosis?
Endometriosis and infertility are commonly associated. There is a clear association between the stage of endometriosis and infertility. Some women may only have mild disease. Hence many women with endometriosis will still fall pregnant and not experience any difficulties. Severe endometriosis is much more likely to affect fertility. We know that by the age of 45, about one in nine women have endometriosis at some level.
Laparoscopic treatment of endometriosis can improve fertility, particularly in milder cases. The assessment as to whether surgery is indicated will depend on multiple factors including the man's fertility.
Endometriosis typically gets worse with age, and that is also when your fertility as a woman declines. This may be one of the reasons why endometriosis is often discussed in the context of increasing your chances of falling pregnant.
Endometriosis surgeon Perth
Gynaecologist in Perth available to help me with endometriosis
You can count on my experience to assess your symptoms in detail and to aim for a clear diagnosis. My patients in Perth tell me that they appreciate my unrushed consultation style. Together, we look at the best possible and most suitable treatment plan, depending on your circumstances and the information we obtain from routine tests.
If you have any questions about endometriosis, please contact my practice. We look forward to helping you.
More about Dr Roger Perkins
Painful periods
It is often hard for women to know whether their cycle is abnormal. After all, how do you compare yourself with others? A woman’s menstrual cycle is very individual and private, and so learning what may be different from others can be difficult.
Hysterectomy
In case of ongoing women’s health issues, your gynaecologist may recommend a hysterectomy, a procedure to remove your uterus. The decision to have a hysterectomy is one you should not make lightly and my role as your gynaecologist is to inform you adequately and to carefully inspect the reasons to perform a hysterectomy.
"My aim is to make you feel comfortable at all times. My consultation style is unrushed and I respect your schedule by minimising waiting times. You’re a unique person and I make it my goal to truly get to know you."
