Endometriosis

Endometriosis is a painful and chronic condition that affects 2-4% of all women (of child-bearing age).  

During child-bearing age, one or more eggs mature in the ovaries every 28 days or so. While the egg is maturing, a mucous lining will be developing in the uterus. It’s in this lining that a fertilized egg can burrow itself. But if no egg is fertilized that month, the lining simply perishes. It’s then expelled along with the egg as menstrual bleeding. 

In women who have endometriosis, there’s tissue outside the uterus similar to the tissue inside the uterus. For instance on the ovaries, fallopian tubes, the ligaments that keep the uterus in place, bladder, bowels, or in the area between vagina and rectum. When the egg matures, this tissue will grow just like the tissue in the lining of the uterus. But unlike this lining, which is expelled during your period, the blood from the tissue outside the uterus (endometriosis) cannot be expelled. So instead it bleeds into your abdomen. And that can cause scarring and adhesions in the reproductive organs.

Symptoms

The most common symptoms include: 

  • Painful periods
  • Pain at ovulation
  • Pain during or after sex
  • Heavy and irregular periods
  • Painful bowel movements or urination during periods
  • Infertility
Treatment

To find out if you’ve got endometriosis, we’ll perform a keyhole examination of the pelvis (a laparoscopy). This enables the specialist to spot any endometriosis on the lining of the abdominal wall, ovaries and fallopian tubes. Using a keyhole examination of the bladder (a cystoscopy), we can see if there’s any endometriosis in your bladder. During the examination we’ll take some samples of tissue, which will be sent to the Aarhus University Department of Histopathology for further analysis. You’ll get the results of the tests about 14 days later. 

If your symptoms are fairly mild, taking some painkillers (e.g. paracetamol) during your period may be enough. 

In some cases you could benefit from hormone treatment, e.g. the Pill. This treatment works by preventing ovulation. 

If you have cysts, scar tissue or adhesions in your ovaries or fallopian tubes, or if there’s endometriosis in the abdominal wall or the wall between vagina and rectum, an operation may be the best solution.  

Below you can read more about what happens during the operation.

Before the operation

Endometriosis is treated through a keyhole surgery of the pelvis (laparoscopy).

Removing endometriosis is usually a small procedure, which means you can go home the same day. But because there may be some side-effects of the anaesthetic, you must have somebody to come and pick you up at the clinic and stay with you for the next 24 hours.

Before the procedure, it’s important that you tell the specialist about any drugs or medicine you take because some of them may be dangerous in combination with the anaesthetc. If you can, it’s also a good idea to stop smoking before the procedure, because smoking slows down the healing process. That goes for the period after the operation as well.  

Fasting:

  • You are not allowed to eat anything during the last 6 hours before your operation
  • You are allowed to drink water and juice until 2 hours before your operation
The operation

You’ll have a general anaesthetic for the operation.  We’ll put an IV line in the back of your hand and give you the anaesthetic through it. The operation is usually performed using a thin tube with a microscope (laparoscope). Usually a contrast substance will be injected via the uterus into the fallopian tubes to check that the passage is unblocked. Via the laparoscope, we can assess the spread and size of the endometriosis. Then we cut 1-2 small holes in your abdomen to insert various other instruments and, in case of milder forms of endometriosis, to remove it. 

This procedure will often relieve the pain, and it may also make it easier to become pregnant.

After the operation

After the operation you should take it easy for the rest of the day. During the operation you’ll have had a catheter inserted into your bladder, which has to be removed a couple of hours later. The day after the operation, our nurse will call you at home to check if you’re OK.

Post-operative checkup

Once the keyhole surgery is over, we close the incisions with soluble thread inside and special tape on your skin. This means that you don’t have to have the threads removed. But you should come in for a checkup 1 month after the operation. 

The operation is often supplemented with hormone treatment. For instance birth control pills, gestagen, GnRH-agonists like Synarela, Zoladex and Decapeptyl.

Good to know

Pain:It’s normal to experience pain after the operation. Your tummy may also feel bloated, and occasionally there’ll be pain in the right shoulder. However, the pain and discomfort should pass in a day or two.

Hygiene:You can take a shower after 24 hours. Take off any bandages first, and afterwards gently dab the wounds with a towel. The wounds heal better if they are left unbandaged. But if there’s a bit of oozing from the wounds, you should put on a clean bandage. 

Activity:Following the keyhole operation, you should be off sick for 1-2 weeks. If you’ve had large incisions, we recommend you take sick leave for 3-4 weeks. After keyhole surgery, there’re no special restrictions on lifting or activity afterwards. But you should never push yourself beyond your pain threshold. If you’ve had major incisions, however, you shouldn’t lift heavy objects (more than 10 kg) or perform any physically demanding exercises such as badminton, tennis or similar activities for 4 weeks after the operation. You can start running, riding your bike, taking walks etc. as soon as you feel up to it. You can take up swimming again about 14 days after the wounds have healed.

Side-effects and complications

If you have severe pain, a fever or other symptoms of an infection, you must contact the clinic at +45 8612 6121 or +45 2320 4221.