What is Endometriosis?
Endometriosis occurs when tissue similar to the lining of the uterus (the endometrium) grows outside the uterus. This tissue can grow anywhere in the body but most commonly affects the ovaries, fallopian tubes, the outer surface of the uterus, the ligaments of the pelvis and the other pelvic organs (bladder and bowel). Each menstrual cycle, in response to hormonal changes, this tissue responds in the same way as it would inside the uterus – it thickens, breaks down, and sheds. However, because the blood has nowhere to go, it can cause inflammation, pain, and formation of scar tissue (adhesions).
Symptoms of endometriosis can vary and include:
Chronic pelvic pain, which may be especially severe during menstruation
Heavy menstrual bleeding or irregular bleeding
Pain during intercourse
Painful bowel movements or urination, particularly during menstruation
Infertility (in about 30-40% of women with endometriosis)
Endometriosis Diagnosis: New Stool Test
Usually, endometriosis diagnosis is made through a combination of medical history, physical exams, and imaging tests like ultrasound or MRI. However, the only way to definitively diagnose the condition is through laparoscopy (keyhole surgery). While this method is the “gold standard”, it is expensive, invasive, difficult to organise and not ideal for everyone.
A new stool test has been developed that may revolutionize how endometriosis is diagnosed.
Researchers have identified a specific set of biomarkers in stool samples that could indicate the presence of endometriosis. This non-invasive test can detect these biomarkers with a high degree of accuracy, offering a much-needed alternative to laparoscopy. While the test is still in its early stages, it holds great promise for more accessible and quicker diagnoses, sparing women the need for surgery in many cases. It is not yet available to the public but hopefully soon.
Treatment Options for Endometriosis
Current mainstream treatments for endometriosis include hormonal methods to try and suppress the endometriosis tissue to get to the root of the problem, simple pain relief for the symptoms, and lastly surgery (though surgery for endometriosis is long and not always successful).
Examples of these treatment options include:
Oral Contraceptive pills (combined pill or progestogen only pill)
Levonorgestral IUDs (Mirena® or Kyleena®)
Contraceptive Implant
Occasionally hormone blockers called GnRH agonists are used
Non Steroidal Anti-inflammatory Drugs
Laparoscopy (Key-hole) surgery to remove the endometriosis and scar tissue
Hysterectomy may be necessary in severe cases
New Advances in Medication Treatment
Visanne®
Visanne® was recently added to the Pharmaceutical Benefits Scheme (PBS) in Australia, making it more affordable. It is a hormone tablet, similar to the combined pill. It contains dienogest, a synthetic progestin that helps to suppress the growth of endometriosis tissue. By reducing the symptoms of endometriosis, such as pelvic pain, dienogest provides many endometriosis sufferers with relief. Its inclusion on the PBS means that Visanne ( dienogest) is a more accessible treatment option due to the reduced cost.
Reyqo®
Reyqo® is a new combination medication containing three medications; relugolix, estradiol, and norethisterone acetate and works by regulating the hormonal environment to reduce pain and slow the progression of endometriosis. Reyqo® is currently available only on private prescription in Australia.
If you suspect you have endometriosis or have been diagnosed with it, don’t hesitate to discuss treatment options with one of our doctors.
By Dr Karen Osborne
BSc (Hons), MBBS, MRCGP, DRCOG, DFSRH, FRACGP
General Practitioner Focussing on Reproductive & Sexual Health
February 2025
Reference: Identification of distinct stool metabolites in women with endometriosis for non-invasive diagnosis and potential for microbiota-based therapies published in Med October 11, 2024
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