What is Deep Infiltrating Endometriosis?

While endometriosis itself is common, affecting an estimated 1-in-10 women, Deep Infiltrating Endometriosis is less so, affecting approximately one percent of women who are of reproductive age. 

The majority of cases of endometriosis consist of superficial lesions on the lining of your pelvic tissues or within your ovaries. While these can cause painful cysts, heavy bleeding and chronic pain, they may also cause mild symptoms, or no symptoms at all. They might not require treatment but should still be monitored with regular pelvic ultrasound. Deeply Infiltrating Endometriosis is more aggressive and severe, invading (or infiltrating) areas such as your pelvic organs, cervix and vaginal tissue, causing obstructions and much more pronounced symptoms. If you have been diagnosed with endometriosis previously, or suspect your symptoms to be unusually painful, enquire with your health professional about receiving a Deep Endometriosis Scan. You may also opt to have this scan pre-emptively, to know what to expect prior to a laparoscopy or infertility treatment.


What is the Deep Infiltrative Endometriosis Scan, and What Should You Expect?

After endometriosis is first confirmed, often through a laparoscopy or similar procedure, you may require further examination if the cell clumps appear unusually large, embedded, or destructive— a commonly seen sign is adhesion, or stickiness, between pelvic organs where the clumps have grown. You will be required to prepare your bowels and bladder in the days leading up to your examination, taking mild laxatives while ensuring your diet is high in fibre and low in residue. On the day of your examination, you will be asked to empty your bladder.

The ultrasound scan will most likely be a transvaginal one, where a slender transducer probe is inserted into the vagina to emit soundwaves, capture the reflections, and translate them to images. The examination is interpreted and documented in real-time by your specialist, who will analyse the uterus and ovaries, before assessing the pouch of Douglas, the bowel, the ligaments (uterosacral) and so on. The bowel preparation allows a much deeper look at the loops of the bowel, which would otherwise be very difficult if faecal residue were degrading the ultrasound beam. While not explicitly painful, the examination may cause discomfort due to extra pressure on the bowel, and you may take simple anti-inflammatory painkillers beforehand if you are concerned. If your endometriosis is diagnosed as Deep Infiltrative Endometriosis, you can begin to discuss treatments or management with your health professionals.

It is most convenient if this scan is scheduled in the weeks leading up to your expected period, preferably in the third week of the menstrual cycle, as patients with endometriosis often have the least amount of pelvic pain during this time. Scans can be made at any time, though they are likely to be more painful.


What Happens After a Deep Endometriosis Ultrasound?

Should you be diagnosed with unusually severe or infiltrating endometriosis, you can begin to discuss treatment options with your gynaecologist or doctor. It is important to note, however, that endometriosis is a chronic health condition, and as such cannot be totally ‘cured’— you may have to manage your expectations somewhat. Treatment will usually focus on managing, lessening, or temporarily relieving symptoms through medicines, hormone-based treatments, or surgery.

It is also important to note that many effective treatments for endometriosis are also contraceptive in nature, and may affect your ability to get pregnant.

Medication can include pain relief medicines or analgesics, such as Naprosyn or Ponstan. These can be in the form of oral tablets or injections.

You may also be treated with hormone-based options, such as:

A more difficult or time-consuming method of treatment can be surgery. The type of surgery depends on present symptoms and the location of the endometriosis but most often takes the form of a laparoscopy, where your surgeon will locate growths with a tiny telescope and cut or burn them off. This can be simple or very complex, depending on the severity of the infiltration, and if you consider this option, it is vital to have a clear understanding of the nature and purpose of any planned surgery.

It is normal to feel deflated or unhappy when suffering from Deep Infiltrating Endometriosis, but you are not without help. Even severe symptoms can be managed, and you do not have to suffer unduly. If your pain is unusually severe, or your growths particularly pronounced, there are always options to discuss with your health professionals, and many women who have gone through the same and developed their own methods for coping. For more information on chronic pain, or managing endometriosis, see the linked articles.


If you are experiencing the symptoms of Deep Infiltrating Endometriosis, make an appointment with Dr.Nicole Stamatopoulos here.