What is endometriosis?
Endometriosis occurs when tissue similar to the inner lining of uterus (womb) is found elsewhere in the body- usually around uterus, ovaries and fallopian tubes, peritoneum. It can be found on other parts of body- scars after surgery, belly button or chest.
How common is it?
It affects an estimated 10% (190 million) of reproductive age women worldwide.
How to detect endometriosis?
It is not easy to diagnose it as there is no blood test, doesn’t always show up on scans and symptoms overlap with other conditions.
Some tests that may help
- Transvaginal scan- may show cysts on ovaries or other evidence of endometriosis
- MRI- can show when there is extensive endometriosis involving bladder or bowel
- Laparoscopy- A key hole diagnostic surgery to directly see the pelvic as well as abdominal organs to see traces of endometriosis. Used to treat and diagnose endometriosis.
A normal ultrasound or MRI doesn’t rule out endometriosis but can help guide treatment options
How to prevent endometriosis?
At present, there is no known way to prevent endometriosis. Enhanced awareness, early diagnosis and quality health care may slow or halt the progression of the disease and reduce long-term symptoms, including possibly the risk of central nervous system pain sensitization. Currently there is no cure
What are the treatment options?
Treatment depends on:
- Type and severity of symptoms
- How much endometriosis, where it is present
- Whether planning a pregnancy
- Whether wanting a contraception
- Personal preferences
Pain relieving medicines
Range from over-the-counter medicines (like paracetamol or ibuprofen) to prescription medicines.
Hormone treatment
Hormone treatment help control symptoms, reduce bleeding and pain by stopping the periods. They include
- Combined pill with or without a break (preferred)- makes flow lighter and reduces pain
- Hormonal intrauterine device (e.g. Mirena) acts locally on uterus and stops periods
- Progesterone based - mini pills, injections
- GnRH analogues- Temporary stop the ovaries to produce estrogen and progesterone causing temporary menopause. Often given for short periods- when above medicines do not work or prior to surgery
Surgery
The type of surgery offered depends on individual situation. Most women can be treated by laparoscopy (key hole surgery) which requires very small cuts.
Depending upon the situation- sometimes a hysterectomy (removal of uterus) with or without removal of ovaries may be offered- this may not necessarily cure endometriosis but helps with other symptoms
Fertility treatment
Many women with endometriosis do conceive naturally, but some may require help.
Will it be cured completely?
There is currently no cure for endometriosis; access to early diagnosis and effective treatment of endometriosis is limited in many settings and treatment aims to control symptoms and limit long-term impacts.
About Endometriosis and Adenomyosis
We, at Rejoice Hospital, treat Endometriosis which is a complex disease of the female genital tract. It affects ovaries mostly forming ovarian cysts (Endometriotic cysts or chocolate cyst) but with disease progress it affects the uterus and other pelvic organs including the rectosigmoid (Intestines) and the urinary system (ureters and urinary bladder). The symptoms of endometriosis varies widely. Many milder forms of diseases may present with no to severe symptoms while some of the severe form of the diseases may be without symptoms. Involvement of the uterine wall is called adenomyosis. Adenomyosis can increase the size of the uterus to a great extent.
Pain Abdomen and pain during menstrual cycle
Pain lower abdomen during the menstrual cycles (dysmenorrhoea) are the initial symptoms of endometriosis. The severity of pain increases over time to cause very severe dysmenorrhoea needing injectable pain killers. Gradually the duration of pain increases to involve days without menses and leads to chronic pain abdomen.
Subfertility or Infertility
Many cases of endometriosis conceive naturally without any difficulty. Difficulty in conceiving is found in some cases of endometriosis. It affects the tubal motility, the oocyte release and activation and the sperm as well. If you have endometriosis you should not delay the process of conception and pregnancy. If you fail to conceive naturally, you should consult your gynaecologist early and seek for treatment. Starting the treatment early is always better and gives good results. Laparoscopic clearance of the endometriosis is always a better option and it helps you in natural pregnancy. In severe cases assisted reproduction may be required for pregnancy.
Increased bleeding during periods
Endometriosis and adenomyosis can increase your bleeding during menses. The bleeding may be more with passage of clots or may be for more number of days. These are mostly associated with painful cycles.
Pain during Intercourse (Dyspareunia)
Pain during intercourse is a common feature in patients with endometriosis. This happens when the endometriosis involves the rectouterine pouch (space between the rectum and the vagina). Many patients unable perform intercourse properly and that leads to infertility. You should tell your doctor if you are experiencing pain during intercourse.
Uncommon Symptoms
Bleeding from rectum and anal canal and bleeding from the urinary tract are seen rarely in patients with severe endometriosis. They should be treated by trained laparoscopic gynae surgeons with experience in handling endometriosis. Not all gynaecologists can handle this. Obstruction of the urinary tract leading to hydroureteronephrosis (dilatation of the urinary system) is an extremely serious and dangerous condition. This can lead to permanent damage to your kidneys. You should seek treatment on an emergency basis if there is any back pressure on the kidney and ureter.
Treatment of Endometriosis:
There are medical and surgical treatments of endometriosis.
Medical treatment is reserved for young patients with mild endometriosis who are not desirous of pregnancy or in unmarried patients. Medical treatments is temporary and your doctor will guide you what treatment is best for you.
Surgical treatment is more definite and involves a lot of challenging steps and should be done by the most experienced gynae laparoscopic surgeons with a great experience in endometriosis surgery. The first surgery is always the best surgery so never get operated at a place where the surgeon has less experience in endometriosis surgery.
Our experience with endometriosis surgery
We, at REJOICE HOSPITAL New Delhi, are routinely doing difficult endometriosis surgery for a long time. We always say the first surgery is the best surgery. We have a vast experience in treating severe endometriosis cases involving the bowel and bladder. We always try near complete removal of endometriosis. Many of our patients conceived naturally after the surgery and the others with the help of IVF. Our experience with the fertility preserving endometriosis surgery is unparalleled and second to none. We always try to preserve the ovarian reserve and at the same time remove the diseased parts. Restoring the anatomy and patency of the fallopian tubes are our primary focus in fertility enhancing endometriosis surgeries. We have operated many redo surgeries where other surgeons could not do the surgeries and abandoned the procedures and all of them were successfully completed without any complications. If you have any questions related to endometriosis please contact us for a better treatment.
Visit Rejoice Hospital to learn more.
