Endometriosis is a condition in which tissue similar to the lining of the uterus (endometrium) grows outside the uterus, where it should not normally exist. These misplaced tissues undergo the same cycle of thickening, breakdown, and bleeding as the uterine lining, leading to chronic inflammation and pain.

Ectopic endometrial tissue can develop in the ovaries, fallopian tubes, pelvic peritoneum, bowel, bladder, and other areas, causing inflammation and adhesions. When it occurs in the ovaries, it may form “chocolate cysts” (endometriomas), which in advanced cases can rupture or lead to ovarian torsion, causing sudden severe abdominal pain that requires emergency medical care.

Causes of Endometriosis (Pathogenesis)

The exact cause of endometriosis is not yet fully understood, but several theories and contributing factors are recognised:

1. Retrograde Menstruation Theory (Sampson’s Theory)
   • Menstrual blood flows backward through the fallopian tubes into the pelvic cavity, allowing endometrial cells to implant and grow.
   • Since retrograde menstruation occurs in many women but not all develop endometriosis, other factors such as immunity and genetics are believed to play a role.
2. Coelomic Metaplasia Theory
   • Cells lining the pelvic cavity (peritoneum) transform into endometrial-like tissue under certain stimuli or hormonal influences.
3. Lymphatic and Hematogenous Spread Theory
   • Endometrial cells spread via lymphatic channels or blood vessels, leading to lesions in distant sites. Rare cases of endometriosis in the lungs or brain may be explained by this.
4. Genetic Factors
   • Endometriosis tends to run in families, suggesting a hereditary component.
5. Environmental and Hormonal Factors
   • As an oestrogen-dependent disease, excess oestrogen may promote lesion growth.

In summary, endometriosis is understood to be a multifactorial disease, arising from a combination of menstrual backflow, immune dysfunction, genetic predisposition, and hormonal environment.

Endometriosis is a very common yet often overlooked chronic condition. In Australia, it is estimated that 1 in 9 women (or people assigned female at birth) will be diagnosed with the condition by the age of 44. Globally, at least 10% of women of reproductive age—around 190 million people—are thought to suffer from endometriosis. In Australia, more than 830,000 people are currently living with this condition.

Despite its prevalence, diagnosis is often significantly delayed. On average, it can take 6–8 years from the onset of symptoms to a confirmed diagnosis. This delay is due to the fact that its symptoms often resemble other conditions such as irritable bowel syndrome (IBS) or pelvic inflammatory disease, and also because of cultural beliefs that “menstrual pain is normal.”

The impact of endometriosis is profound. It can cause chronic pelvic pain, infertility, reduced productivity, and emotional distress. In Australia, the economic cost is estimated to exceed $9.7 billion annually, most of which stems from lost productivity at work and school. Advanced cases may result in cyst formation, such as “ovarian chocolate cysts,” and in some cases can lead to acute complications such as cyst rupture or ovarian torsion. These can cause sudden severe abdominal pain and may require emergency medical care.

At SkyArch Medical Clinic Brisbane, we place great importance on raising awareness of this condition, supporting early diagnosis, evidence-based treatment, and compassionate care. We aim to create a safe environment where patients can openly discuss menstrual and health concerns, helping to reduce diagnostic delays and improve quality of life. When necessary, we can also provide referrals to trusted gynaecologists in Brisbane.

Main Symptoms

The hallmark symptoms of endometriosis are severe period pain and pelvic pain. Pain may occur not only during menstruation but also throughout the cycle. Other common symptoms include:

• Pain during sex, bowel movements, or urination
• Heavy menstrual bleeding or irregular bleeding
• Chronic fatigue, bloating, and lower back pain
• Infertility (associated with up to 40% of patients)

The severity of symptoms varies widely. Some people experience little impact on daily life, while others face significant limitations due to pain. In some cases, the condition is discovered only during infertility investigations, without any prior symptoms.

Why It Is Often Missed

One major reason for delayed diagnosis is that symptoms are often mistaken for IBS, urinary disorders, or other conditions. Additionally, cultural beliefs such as “period pain must be endured” can prevent people from seeking medical care promptly. As a result, many patients visit multiple doctors over several years before finally receiving the correct diagnosis.

Diagnosis

The first step involves taking a detailed history and conducting a gynaecological examination. In some cases, a transvaginal ultrasound may detect ovarian cysts or scar tissue, but small lesions often remain invisible.

The most reliable diagnostic method is laparoscopy, where a small camera is inserted into the abdomen to directly observe and biopsy lesions, allowing a definitive diagnosis of endometriosis.

Treatment

There is currently no cure, but several treatments can reduce symptoms and improve quality of life:

1. For Pain Relief
   • NSAIDs (e.g. ibuprofen, naproxen) are often prescribed to reduce inflammation and pain.
   • Analgesics are usually used alongside other treatments.
2. Hormone Therapy
   • Since hormonal fluctuations worsen endometriosis, suppressing hormones can help.
   • Continuous use of low-dose contraceptive pills or vaginal rings to suppress menstruation
   • Progestogen therapy (oral, injection, or intrauterine device such as Mirena®)
3. Surgical Treatment
   • Laparoscopic surgery to remove lesions, adhesions, or ovarian cysts (chocolate cysts)
   • Surgery can improve pain and infertility but recurrence is possible, so it is often combined with medication.
4. Infertility Treatment
   • Surgical removal of lesions may increase the chances of pregnancy.
   • Assisted reproductive technologies such as IVF are also options.
   • Early consultation with a doctor is important for those who wish to conceive.
5. Supportive Therapies
   • Physiotherapy (pelvic floor rehabilitation), psychological support, and dietary guidance may help improve symptoms.
   • Exercise, anti-inflammatory diets, and stress management can also be beneficial.

Our Clinic’s Approach

At SkyArch Medical Clinic Brisbane, care is provided by a Japanese doctor experienced in both Japan and Australia, with a deep understanding of the cultural differences in healthcare. We provide a supportive environment where Japanese patients can speak freely in their native language about sensitive issues. When needed, we can refer patients to trusted gynaecologists in Brisbane.

If you have concerns about endometriosis, please feel free to consult SkyArch Medical Clinic Brisbane.

Japanese Doctor: Tatsuo Nagashima

References

• Australian Government – Department of Health and Aged Care: https://www.health.gov.au/topics/endometriosis
• Jean Hailes Foundation – Endometriosis: https://www.jeanhailes.org.au/conditions/endometriosis
• Endometriosis Australia: https://endometriosisaustralia.org