Senior Consultant Obstetrician & Gynaecologist
Medical Director & Clinical Governance Officer (CGO) of Monash IVF Singapore
Medical Director of Health & Fertility Centre for Women
What is Endometriosis?
Endometriosis is a condition where the lining of the womb (called endometrium) occurs outside its usual location e.g., at the back of the uterus and around the ovaries. The tissue induces an inflammatory reaction, causing menstrual pain and infertility. Around 1 in 10 women suffer from endometriosis during their reproductive years. With time, endometriosis will have an adverse impact on a woman’s physical and social well-being, leading to the formation of ovarian endometriotic cysts, severely painful periods, pain during or after sex, and infertility.
Occasionally, endometriotic cysts may be found incidentally on an ultrasound scan. Cysts caused by endometriosis contain old blood and are often referred to as 'chocolate cysts'.
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How Common is Endometriosis in Singapore?
Endometriosis is a common gynaecological condition that affects 1 out of 10 women of reproductive age globally. Approximately 10% of women of childbearing age have endometriosis in Singapore, and around one-third of them are unable to conceive. These rates may be higher as many women tend to ignore the symptoms until they undergo a fertility examination.
What are the Common Symptoms of Endometriosis?
Endometriosis is most commonly characterised by pelvic pain. Women with this condition exhibit menstrual pain that is more severe than normal, to the point of significantly interfering with daily activities. Other signs and symptoms of endometriosis include:
Painful periods (dysmenorrhea)
Intense pain during sex
Menstruation problems
Abnormal bowel movements or urination
Severe bleeding
Fertility issues
Bloating or nausea
Constipation
Fatigue
What are the Main Causes of Endometriosis?
Endometriosis does not have a definitive cause; however, certain factors may contribute to the development of this condition, including:
Genetic predisposition:
Endometriosis occurs more frequently in women with a family history of the disease, indicating a possible genetic influence.Retrograde Menstruation:
It is thought that this occurs when blood containing endometrial cells travels backwards through the fallopian tubes into the pelvic cavity instead of naturally leaving the body. Endometrial cells are attached to the pelvic walls and inside the pelvic organs, where they expand, become thicker, and cause bleeding during each menstrual period.Having no children or few children later in life may also cause an increase in risk of endometriosis.
How to Test for Endometriosis in Singapore?
For the diagnosis of endometriosis, the doctor will take the patient's symptoms and family history into account. Additionally, the doctor may perform the following tests to determine an effective endometriosis treatment in Singapore:
Pelvic exam
In this diagnostic test, the doctor palpates the pelvic/lower abdominal region to detect signs of abnormality, for instance, cysts on the reproductive organs or uterine scarring.
Ultrasound
To identify cysts related to endometriosis, this test involves acoustic sound waves that create detailed images of the body using a probe, either placed against the abdomen (abdominal ultrasound) or inserted into the vagina (transvaginal ultrasound).
Magnetic Resonance Imaging (MRI)
This test utilises a powerful magnetic field and radio waves to check for signs of endometrial implants. MRIs are also beneficial in serious cases that require endometriosis surgery.
Laparoscopy
This type of endometriosis surgery in Singapore involves making a tiny incision in the abdomen and inserting a laparoscope to assess the extent and severity of endometrial tissue outside the uterus. The procedure may also involve a biopsy to conduct further examination of the abnormal tissues.
How are Treatments for Endometriosis and Endometriotic Cysts Determined?
The decision on which is the best treatment option depends on a variety of factors. These include:
The nature of the symptoms e.g., severity of pain due to endometriosis
The desire for fertility (usually done to prepare for IVF treatment)
The size of the endometriotic cysts
The risk of cancerous changes in the endometriotic cysts
What are the Treatments for Endometriosis and Endometriotic Cysts?
Medication and hormonal treatment for endometriosis
Medication such as painkillers may be prescribed by your gynaecologist for menstrual pain. Often, hormonal suppression of the menstrual cycle with birth control pills or injections may be recommended. Unfortunately, endometriosis is a condition which tends to worsen with time.Endometriosis Surgery including endometriotic cysts
Cystectomy for endometriotic cysts and ablation of endometriosis
Surgery can be very effective for removing endometriotic lesions, cysts and scar tissue. Surgery can help enable the cyst to be sent for biopsy and confirm if the cyst is non-cancerous or not. Such surgery is usually performed by laparoscopy (minimally invasive or keyhole method). Surgery is best performed before fertility treatment to increase pregnancy success rates. As endometriosis tends to recur easily, for women keen on fertility, they should try to conceive as early as possible. For those who are not keen on fertility, hormone medication can help to control endometriosis.Oophorectomy for endometriotic cysts and endometriosis
Surgery to remove the ovary is the permanent solution for endometriotic cysts, but the ovary is an important source of hormones. If early menopause occurs, hormone replacement therapy may be needed.
Dr Kelly Loi
Medical Director
BMBCh (Oxford), FRCOG (UK), FAMS (Singapore)
Dr Kelly Loi is the Medical Director of Health & Fertility Centre for Women and Monash IVF Singapore. She is known for her work in fertility and women’s health, with a focus on providing personalised and evidence-based care for women at different stages of their reproductive journey.
Dr Loi’s clinical interests include fertility, gynaecology, obstetrics, as well as minimally invasive laparoscopic and hysteroscopic surgery. She supports women through a wide range of reproductive and gynaecological concerns, including endometriosis.
She has also completed clinical attachments at internationally recognised institutions including Johns Hopkins Hospital and Massachusetts General Hospital, Harvard Medical School, further deepening her experience in fertility care and reproductive medicine.
Gynaecology Services We Provide
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