Dr Novikova and her assistant in scrubs in the surgery room.


Endometriosis is a condition when the tissue that is part of the lining of the womb grows outside of the womb in the tummy, on the ovaries, and other areas which leads to women experiencing pain, especially during their menstrual cycle. It is a very common condition with 1 in 10 women experiencing it but often goes undiagnosed as women believe that a very painful period is normal.

Women in a reproductive age suffer from endometriosis, from teenagers to women in their 40s and it usually comes with painful and heavy periods. It can be also be genetic. If the pain is severe to a point of it interfering with your daily activities or requires you to take painkillers excessively, it is not normal and could be endometriosis.

Endometriosis is usually diagnosed on laparoscopy (operation looking with the camera inside of the tummy) and treated with hormones or surgery. It most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. During Endometriosis, the displaced endometrial cells stick to your pelvic walls and the surfaces of your pelvic organs, such as your bladder, ovaries, and rectum. They continue to grow, thicken and bleed over the course of your menstrual cycle.

Although the exact cause of endometriosis unknown, some possible explanations include:
– Menstrual flow problems
– Fetal development
– Embryonic cell growth
– Surgical scar
– Genetics
– Hormones

The symptoms of endometriosis can vary from very mild to very severe, although the severity of your pain doesn’t always indicate the degree of the condition.

The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Women with endometriosis typically describe the menstrual pain that’s far worse than normal. Other common signs may include:

– Pain with urination

– Pain with intercourse

– Infertility

– Excessive bleeding

– Pain passing stool

Symptoms are likely to be cyclical as it is a chronic condition. Beyond the physical, it can also interfere with psychological wellbeing.

Endometriosis is usually diagnosed by laparoscopy (operation looking with the camera inside of the tummy) and treated with hormones or surgery. The approach to treatment will depend on women’s age, her immediate and long-term wishes for family planning, the severity and type of her symptoms.
A number of girls/women experience extremely painful menstrual periods and think that is normal and do not seek help for years. It is very important to see a specialist to assess the problem and management of it.

Dr Novikova is a highly experienced gynaecologist in Cape Town who treats all conditions associated with Endometriosis and is specialised in minimally invasive laparoscopic or keyhole surgery.

Treatment will vary from woman to woman and is often determined by the patient’s priorities. For instance, if a woman is planning to try and become pregnant soon, none of the hormonal treatments are suitable as they either act as a contraceptive or halt the menstrual cycle.

The type of treatment should be decided in partnership between the patient and the healthcare professional. The decision should depend on several factors:

    • The age of the woman
    • The severity of her symptoms
    • The desire to have children, and when
    • The severity of the disease
    • Previous treatment
    • The woman’s priorities – pain relief or fertility
    • Side effects of drugs
    • Risks
    • Intended duration of treatment

We do not recommend any particular treatment for endometriosis, but support patients seeking treatment options appropriate to their individual circumstances. The options are:

  • Surgery
  • Hormone treatment
  • Pain management

These are treatments that are used to act on the endometriosis and stop its growth. They either put the woman into a pseudo-pregnancy or pseudo-menopause. (Pseudo means simulated or artificial – both states are reversed when the patient has stopped taking the hormones.)

In addition, testosterone derivatives are occasionally used to mimic the male hormonal state; these drugs are generally synthetic hormones. While not all of the hormonal drugs used to treat endometriosis are licensed as a contraceptive, they all have a contraceptive effect, so are not used if the patient is trying to become pregnant. Please note: only the oral contraceptive pill and the Mirena IUS are licensed as contraceptives, so barrier methods of contraception (e.g. condoms) should be used if using other treatments as an extra precaution.

All of the hormonal drugs carry side effects and are equally effective as treatments for endometriosis, so it’s often the side effects that will dictate the choice of drug.

Drugs used that mimic pregnancy:

  • Combined oral contraceptive pill
  • Progestagens
  • Mirena IUS ®

Pregnancy is characterised by higher levels of progesterone, thus taking progestagens (the synthetic form of progesterone) mimics the state of pregnancy. During pregnancy the endometrium is thin and also inactive.

Drugs that mimic menopause:

  • GnRH analogues

GnRH analogues are a form of the naturally occurring GnRH, which is produced in a part of the brain called the hypothalamus. GnRH analogues stop the production of the hormones FSH and LH. The ovaries switch off and temporarily stop producing eggs and the hormone oestrogen.

Male hormone drugs – testosterone derivatives:

  • Danazol and Gestrinone

Danazol and Gestrinone are a derivatives of the male hormone, testosterone. They lower oestrogen levels which directly switches off the growth of the endometrium (lining of the womb).

COCPs are tablets containing synthetic oestrogen and progestagen (female hormones). The combination of these hormones in the pill is similar to that in pregnancy, causing the menstrual cycle to stop, hence the symptoms of endometriosis being reduced.
The pill is commonly used to treat endometriosis prior to a definite diagnosis as most women who take it do not suffer from side effects. It can also be taken safely for many years. The pill can be taken continuously (without a monthly break) to avoid bleeding.

Although there is limited data on its use to treat endometriosis, there are a few studies that have assessed the pill’s effectiveness. One particular review compared the use of the pill to Zoladex over a six month period. The Zoladex relieved dysmenorrhoea (painful menstruation) more effectively because it stops periods, but there were no differences between the two treatments for dypareunia (painful sex) and non-menstrual pain. Based on the side effects of each treatment it was concluded that the pill may be preferable as a treatment overall and has the advantage that it can be safely continued long-term until the menopause in fit and healthy, non-smoking women.

The female sex hormone progesterone stops the endometrium (womb lining) from growing. If the endometrium is exposed to progesterone for a prolonged amount of time it will become thin and inactive. This is also the effect the hormone has on endometriosis.
Progestagens are synthetic progesterone hormones, which are used to recreate this effect on the endometrium and endometriosis. The dose of the drug is usually adjusted until periods stop.

As a treatment for endometriosis, surgery can be used to alleviate pain by removing the endometriosis, dividing adhesions or removing cysts. Surgery is also used to diagnose the disease and can be used to improve fertility.

Read more about endometriosis here