One-stop centre for women's problems Singapore health

July and Aug 2011

One-stop centre for women's problems Singapore health

A multidisciplinary team comes under one roof to serve endometriosis patients at KKH

By Thava Rani

Thirty-three year old Andrea Lim (not her real name) went to KK Women’s and Children’s Hospital (KKH) with severe menstrual cramps and bowel problems. After assessing her condition, the gynaecologist referred her to the colorectal surgeon, who did a colonoscopy.

With the results of their combined experience, the doctors discussed the options with her. She chose to undergo surgery, where scar tissue distorting her uterus and large bowel, was removed. After the operation, she received counselling from the nurse coordinator, and also completed a questionnaire which helped the team better understand the impact the condition had on her daily life.

Andrea is one of an increasing number of women in Singapore suffering from endometriosis, a gynaecological condition that affects up to one in 10 women. KKH alone saw 1,200 women who underwent surgery related to endometriosis last year.

This and the severe impact the condition has on the lives of women, plus the high chance of recurrence, prompted the hospital to set up the ne-stop KK Endometriosis Centre that offers a comprehensive range of services and adopts a patient-centred approach.

“As the combination of symptoms, severity and specific needs of these patients is diverse, we felt that the availability of a multidisciplinary team of doctors and medical support staff will be optimal to provide holistic care to such patients,” said Dr Cynthia Kew, Associate Consultant, Minimally Invasive Surgery Unit, Department of Obstetrics and Gynaecology, KKH.

About endometriosis

Dr Cynthia Kew, Associate Consultant, Minimally invasive Surgery Unit, Department of Obstetrics and gynaecology, KK Women’s and Children’s Hospital, answers some typical questions patients have about endometriosis.

What is endometriosis?

A condition where the lining of the uterus, or the endometrium, is found outside the uterus, such as in the ovaries, fallopian tubes, pelvis or lower abdominal cavity

What are the symptoms?

• Severe menstrual pain, chronic pain in the lower abdomen or pelvic region, painful sexual intercourse, infertility
• Other symptoms unrelated to periods or none at all

What types of surgery can help?

• Ablating (burning off) or excising (removing) endometriosis lesions
• Ovarian cystectomy (removal of a cyst from the ovary)
• Complete removal of the uterus and ovaries, which means immediate menopause. Therefore, it is reserved for women nearing menopausal age or with very severe symptoms
• The above are usually accomplished through laparoscopic (keyhole) surgery

Are there non-surgical methods of treating the pain?

• Painkillers
• Hormonal therapies
  • First line (fewer side effects): oral contraceptives, progestogens
  • Second line (more side effects): GnRH analogue, danazol
  • Levonorgestrel intrauterine system
• Other alternative therapies: counselling, thiamine, vitamin E, high frequency transcutaneous nerve stimulation, local heat and herbal remedies

Can endometriosis affect me chance of pregnancy?

• Yes, about 25 to 50 percent of subfertile women have endometriosis, making it a significant cause of subfertility
• Besides surgery, assisted reproduction like intrauterine insemination (IUI) and in-vitro fertilisation (IVF) may help