What Is Endometriosis?
Endometriosis is a chronic inflammatory condition in which tissue similar to the uterine lining (endometrium) grows outside the uterus — on the ovaries, fallopian tubes, bowel, bladder, and peritoneum. Like the uterine lining, this tissue responds to the menstrual cycle — swelling and bleeding with each cycle — but with nowhere to go, it causes inflammation, scarring, and adhesions.
It affects approximately 1 in 10 women in Singapore and is a leading cause of chronic pelvic pain and infertility. Despite this, the average diagnostic delay in Singapore is 5–7 years from symptom onset.
Stages of Endometriosis
| Stage | Description | Management |
|---|---|---|
| Stage I (Minimal) | Few superficial implants; no significant adhesions | Medical management; laparoscopic excision if symptomatic |
| Stage II (Mild) | More implants, some deeper; minimal adhesions | Laparoscopic excision; medical suppression |
| Stage III (Moderate) | Multiple implants; endometriomas; mild-moderate adhesions | Laparoscopic excision; fertility evaluation |
| Stage IV (Severe) | Extensive implants; large endometriomas; dense adhesions; may involve bowel/bladder | Excision surgery by specialist; fertility treatment |
Medical vs Surgical Treatment
Medical (Hormone Suppression)
Suppresses oestrogen to prevent endometriotic lesion activity. Does not remove existing disease but provides symptom relief.
- Combined OCP (especially continuous cycling) — $20–$50/month
- Dienogest (Visanne) — highly effective progestogen; $80–$150/month
- GnRH agonists (Zoladex, Lupron) — temporary menopause; add-back therapy needed; $200–$400/month
- GnRH antagonist (elagolix/Orilissa) — newer, oral; awaiting broader availability in Singapore
- Levonorgestrel IUD (Mirena) — reduces dysmenorrhoea
Surgical (Laparoscopic Excision)
The only treatment that removes endometriotic lesions. Excision (cutting out) is superior to ablation (burning) for disease control and fertility outcomes. Performed laparoscopically in experienced hands with minimal recovery time (1–2 days hospitalisation; 1–2 weeks return to work).
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View the shortlist →Classic symptoms include painful periods (dysmenorrhoea) — pain severe enough to interfere with daily life, not just normal period discomfort; deep pelvic pain during or after intercourse (dyspareunia); painful bowel movements or urination around menstruation; heavy or irregular periods; and infertility. Notably, symptom severity does not correlate with disease stage — some women with severe endometriosis have minimal pain, while others with mild disease are debilitated.
Yes. Endometriosis affects fertility through multiple mechanisms: distorted pelvic anatomy from adhesions, impaired egg quality, altered endometrial receptivity, and toxic peritoneal fluid affecting sperm and egg function. Approximately 30–50% of women with endometriosis experience subfertility. Surgical removal of endometriotic deposits (laparoscopic excision) and endometriomas (ovarian cysts) can improve fertility outcomes, particularly in conjunction with IVF where needed.
Definitive diagnosis requires laparoscopy with biopsy — endometriosis cannot be reliably diagnosed from ultrasound alone. Ultrasound can detect endometriomas (ovarian chocolate cysts) and deep infiltrating endometriosis affecting the rectovaginal space, but small peritoneal deposits are invisible on imaging. MRI can map disease extent pre-operatively. CA-125 blood test is non-specific. Many women wait 7–10 years from symptom onset to diagnosis — if you have typical symptoms, push for specialist evaluation.
Not reliably. Endometriosis can persist and recur even after hysterectomy if endometriotic tissue outside the uterus is not fully excised. Definitive treatment is total hysterectomy + bilateral salpingo-oophorectomy (removing ovaries) + complete excision of all visible disease — but this induces surgical menopause and is reserved for women who have completed their family. For most patients, conservative laparoscopic excision with hormone suppression is preferred.
Laparoscopic excision of endometriosis at a private hospital: $10,000–$25,000 depending on disease complexity, operative time, and surgeon. Endometrioma (ovarian cyst) removal (laparoscopic cystectomy): $8,000–$18,000. Horticultural hormone treatment (GnRH agonist, dienogest): $100–$400/month. All surgeries are Medisave and MediShield Life claimable.