Endometriosis
Endometriosis Symptoms, Diagnosis and Treatment in Toowoomba
Endometriosis can affect more than your period. It can cause pelvic pain, painful sex, bowel or bladder symptoms, heavy bleeding, fatigue, bloating or fertility issues. Symptoms may be mild for some and severe for others, and the severity of pain does not always reflect the extent of endometriosis.
At Toowoomba Obstetrics and Gynaecology (TOAG), Dr Lanziz Homar provides assessment and management for women with suspected or diagnosed endometriosis.
If your symptoms are affecting your daily life, download our Endometriosis Symptom Checklist and ask your GP about a referral to Dr Homar.
What Is Endometriosis?
Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus. It may be found on the ovaries, fallopian tubes, pelvic lining, bowel, bladder or other structures within the pelvis.
Like the lining of the uterus, this tissue can respond to hormones. It can become inflamed and irritated, contributing to pain, scar tissue and adhesions. Adhesions are bands of scar-like tissue that can cause organs or tissues to stick together.
Endometriosis is a chronic condition. There is currently no cure, but treatment can help manage symptoms, support fertility planning and improve day-to-day function for many women.
Why Endometriosis Can Take Years to Diagnose
Endometriosis is common, but it is often missed or diagnosed late. Australian data show that the average time between the first symptoms and diagnosis is around six to eight years.
There are several reasons for this. Period pain is often normalised, and symptoms can also overlap with other conditions, including irritable bowel syndrome, bladder pain, pelvic floor dysfunction, adenomyosis, fibroids and ovarian cysts. Some women may have symptoms despite clear imaging, which can make next steps less obvious.
Pain that stops you from working, studying, exercising, going to school, having sex or managing everyday activities should not be dismissed as “just a bad period”.
Types of Endometriosis
Endometriosis can be described by where it is found and how deeply it affects the surrounding tissue. The main types include:
Superficial Peritoneal Endometriosis
This is endometriosis on the surface of the pelvic lining, called the peritoneum. The lesions may be small but they can still cause pain and other symptoms.
Ovarian Endometrioma
An endometrioma is a cyst on or within the ovary that contains old blood, sometimes called “chocolate cysts”. Endometriomas can be identified during a pelvic ultrasound and may cause significant pelvic pain or fertility concerns.
Deep Infiltrating Endometriosis
Deep infiltrating endometriosis grows more deeply into the tissue, which may involve areas such as the bowel, bladder, ligaments behind the uterus, vagina or the space between the vagina and rectum. This type can be more complex and may require genealogical surgery and detailed surgical planning.
Stages of Endometriosis
Endometriosis may be classified from Stage I to Stage IV. These stages are generally based on what is seen during surgery, including the location and extent of lesions, adhesions and ovarian involvement.
Stage I: Minimal Endometriosis
There may be a small number of superficial lesions.
Stage II: Mild Endometriosis
There may be more superficial lesions throughout the pelvis.
Stage III: Moderate Endometriosis
There may be deeper areas of disease, ovarian endometriomas or scar tissue.
Stage IV: Severe Endometriosis
There may be more extensive disease, adhesions and changes to the pelvic anatomy.
The stage does not always predict pain levels. A woman with Stage I endometriosis may experience severe pain, while another woman with Stage IV endometriosis may have fewer symptoms.
Treatment should be guided by your symptoms, examination, imaging, fertility plans and personal priorities.
Endometriosis Symptoms
Endometriosis symptoms vary from person to person. Women can experience symptoms from their first periods or notice them later on, like after stopping hormonal contraception or when trying to conceive. Common symptoms reported can include:
- Painful periods
- Pelvic pain before, during or after a period
- Pain during ovulation
- Pain during or after sex
- Pain when opening your bowels or passing urine
- Heavy periods or clotting
- Irregular bleeding
- Bloating, nausea or bowel changes
- Constipation or diarrhoea, particularly around a period
- Fatigue
- Lower back, hip or leg pain
- Difficulty falling pregnant
Some women describe endometriosis pain as cramping, stabbing, burning, dragging, deep aching or pressure. Pain may come and go with the menstrual cycle, but it can also become more constant.
If you are unsure how to describe your symptoms, our checklist may help you organise what you are experiencing before speaking with your GP.
What Causes Endometriosis?
The exact cause of endometriosis is not fully understood. It is likely to involve a combination of genetic, hormonal, immune and inflammatory factors. Possible contributors include:
- A family history of endometriosis
- Retrograde menstruation, where menstrual blood flows backwards through the fallopian tubes into the pelvis
- Immune system differences
- Hormonal influences, including oestrogen
- Inflammation
- Previous pelvic surgery in some cases
Having a family history does not mean you will develop endometriosis, and having no family history does not rule it out.
When to See a Women’s Specialist
Speak with your GP about referral to Dr Homar if you’re experiencing:
- Period pain that stops you from completing normal activities
- Pelvic pain that keeps returning
- Pain during or after sex
- Bowel or bladder pain around your period
- Heavy or irregular bleeding
- Difficulty falling pregnant
- Symptoms that are worsening over time
- Pain that is not improving with your usual period pain measures
Seek urgent medical attention if you experience sudden, severe pelvic pain, fainting, heavy bleeding, fever, vomiting, shoulder-tip pain or pain with a positive pregnancy test.
How Endometriosis Is Diagnosed
Diagnosis usually begins with a detailed discussion about your symptoms, menstrual cycle, medical and family history, fertility plans and previous treatments.
Dr Homar will likely also ask about bowel or bladder symptoms, pain during sex, bleeding patterns and the effect your symptoms have on daily life. Assessment may involve:
Endometriosis Treatment Options
There is no single treatment that suits everyone. Your treatment plan will be based on your symptoms, age, medical history, fertility plans, previous treatments, examination findings and imaging results. Treatment may involve one or more of the following options.
Endometriosis and Fertility
Endometriosis can affect fertility in different ways, and can affect the ovaries, fallopian tubes, egg quality, inflammation within the pelvis, pelvic anatomy or the ability of the egg and sperm to meet.
Having endometriosis does not mean that you cannot have a baby. Many women still conceive naturally and others may need treatment, surgery or fertility support.
If you have known or suspected endometriosis and have been trying to conceive, it is worth discussing this early with your GP or gynaecologist. Earlier assessment may help guide the next steps, especially if you are older than 35, have irregular menstrual cycles, have an endometrioma, experience severe pain or have been trying to conceive for six to 12 months without success
Endometriosis Care at TOAG
Dr Lanziz Homar is an Australian-trained specialist obstetrician and gynaecologist with extensive training in laparoscopy and vaginal surgery. He provides gynaecology consultations and procedural care for women in Toowoomba and surrounding regional areas.
You do not need to manage significant period or pelvic pain alone. If symptoms are affecting your work, study, relationships, fertility or daily life, speak with your GP about referral to Dr Homar.
Frequently Asked Questions about Endo
Book an Endometriosis Consultation at TOAG
If you have symptoms of endometriosis or ongoing pelvic pain, speak with your GP about a referral to Dr Lanziz Homar at Toowoomba Obstetrics and Gynaecology.
A: Suite 8/9 Scott Street, East Toowoomba QLD 4350
P: (07) 4592 8350
F: (07) 4592 8351
Resources and Support for Endometriosis
Endometriosis Australia. https://endometriosisaustralia.org/
QENDO. https://www.qendo.org.au/downloadable-resources
Jean Hailes for Women’s Health. Endometriosis Fact Sheet.