The latest in endometriosis diagnosis and care, according to a Specialist
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Endometriosis has become a hot topic recently, with public awareness slowly but surely being raised for this chronic condition that is estimated to affect 10% of women globally.
In 2022, the Australian Government announced a $58.3 million package to support women suffering with endometriosis and pelvic pain, including establishing 22 dedicated endometriosis and pelvic pain clinics across Australia – welcome news for those of us who live with this condition every day. But even if you have the disease yourself, it can be hard to keep up to date with the latest innovations, research and thinking about this complex condition.
As so many of us know, the internet can become the Wild West when it comes to medical advice. So we sat down with Genea Canberra’s Dr Sumi Saha – who has more than 15 years’ experience treating complex gynaecological conditions including endometriosis, is a fertility specialist, laparoscopic surgeon and now the ACT’s first female surgeon qualified to practice robotic surgery – to ask her all about the state of endometriosis in 2025.
Recently there’s been a lot of conversation about what endometriosis is and why it happens – can you share the current thinking?
Endometriosis is a chronic, inflammatory, estrogen-dependent disease that is caused by something called retrograde menstruation. The menstrual blood starts to go up the fallopian tubes – kind of like getting reflux.
Once the blood is in your pelvis, those cells start to grow their own systems, similar to a stem cell transplant. They have their own nerve system, blood system and hormone system, which start to cause ongoing inflammation and fibrosis. Pain can also develop because it’s impacting the nerve supply of the pelvis.
What are some of the current symptoms of endometriosis that people might not know?
Symptoms can be extremely variable and include such things as starting your menarche (first period) very young, painful periods, painful bowel movements, pain during sex, bloating, recurring thrush and pelvic pain. Endometriosis can also be silent and some patients may experience minimal to no symptoms, making diagnosis very difficult.
Laparoscopic/ Robotic surgery has often been used to diagnose and treat endometriosis – is that still the case?
Surgery is actually now considered to be the last resort. I send patients with suspected endometriosis for a “deep infiltrative endometriosis” ultrasound scan at a specialised clinic. This scan is pivotal for my surgical planning. Most importantly, the endometriosis diagnosis by this non-invasive ultrasound gives patients piece of mind as it validates their symptoms by giving a name to the pain that they have been experiencing.
Keyhole surgery (laparoscopic/ robotic assisted) is only needed if a patient continues to have symptoms despite adequate medical management via hormonal medication. However, surgery does not cure endometriosis. Surgery may provide temporary symptom relief with many women starting to have reemerging symptoms by 12 to 18 months post-surgery. If fertility is not the immediate treatment goal, patients should continue their medical management plan to minimise recurrence of the disease.
What about fertility preservation (egg freezing) for patients with endometriosis?
Endometriosis is well known to impact both the quality of eggs and the ovarian egg reserve. Patients with endometriosis may consider egg freezing ideally before their 31st birthday after consultation with their treating Doctor or a Fertility Specialist.
What do you wish more people understood about endometriosis?
There are two things that will assist patients to really understand endometriosis; that is a basic education of what endo is, and to also set themselves realistic expectations as to how us as clinicians can assist in managing it. I still have patients coming to me and only requesting surgery – they don’t want any hormone treatment. Endometriosis is a hormone mediated condition and if a doctor is offering surgery only, I would seek a second opinion.
I quite often see patients who have had multiple surgeries…but clearance surgery alone does nothing. Multiple surgeries do not improve patient’s quality of life. Ultimately, endometriosis is a chronic disease which impacts a patients’ daily life and needs to be managed as such.
To use a simple analogy, endometriosis is not simply garbage that you are clearing. People need to know that a single surgery cannot cure your endometriosis, and that surgery is the last resort. There is absolutely hope though. For a majority of people with endometriosis – with early diagnosis and treatment with the right hormone medication – they do respond incredibly well.
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