What is endometriosis?

Endometriosis is a condition where inner lining of the uterus (endometrium) grows elsewhere in the body, most often in the pelvis. Uterus (Adenomyosis), ovaries (chocolate cysts) , and the pelvis are common sites for endometriosis. Endometrial tissue may sometimes be found outside the pelvic organs, bladder, bowel and sometimes even in the lungs. It is a dynamic condition. As long as a woman has periods, she sheds endometrium into the pelvis.

How common is it?

6-10% women have endometriosis in their reproductive years. However, it’s much more common in infertile women. About 25 to 30% women with infertility have endometriosis. About 30 to 40% women with endometriosis have infertility.

What happens in endometriosis?

This endometrial lining found outside of the uterus also responds to hormonal changes during monthly cycle. This displaced endometrial tissue thickens, breaks down, and sheds with each menstrual cycle of the woman. But as the undesired endometrial implants have nowhere to go, these often lead to cysts in the ovaries called endometriomas or chocolate cysts. Also, as the surrounding tissues are irritated, there is a high probability of the formation of scar tissues and adhesions. Severity of endometriosis depends on size, location, and depth of the endometrial implants. Endometriosis is known to get worse with time.

What are the symptoms of endometriosis?

Some women do not have any symptoms at all. Others have minimal or debilitating symptoms, which include

1. Pain during periods
2. Pain during intercourse
3. Heavy periods
4. Chronic pain in the lower abdomen
5. Painful bowel movements
6. Pain during urination
7. Infertility
8. Constipation and bloating
9. Fatigue, diarrhoea, and nausea

The severity of pelvic pain in endometriosis is not an indicator of the severity of the medical disorder. A woman can have mild endometriosis with severe pain or severe endometriosis with little or no pain. Also, the intensity of pain can even vary from month to month.

What causes endometriosis?

The exact cause of endometriosis is not known. It may be backflow of the blood from the uterus during periods or it may just appear in pelvis

How is endometriosis diagnosed?

Medical history and examination can give a big clue to the diagnosis of endometriosis. A physical examination of the pelvic region will also aid further in diagnosis. A transvaginal scan will diagnose endometriosis in the wall of the uterus (adenomyosis), ovaries (chocolate cysts) And even in the bowel. However, gold-standard for accurate diagnosis is by laparoscopy (Key Hole Surgery). This procedure involves making a key-hole size incision near the belly button. A camera is inserted through this small cut that helps examine the pelvic region and confirm or rule-out endometriosis. Treatment can also be offered at the same time

Treatment

Endometriosis per se does not need treatment. It’s the symptoms that need treatment. Symptoms can be treated and managed with the right medicines and lifestyle. Sometimes surgery is necessary. Here goes the list of various treatment options available

1. Anti-Inflammatory Drugs – Pain-killers are usually advised to offer relief from pelvic pain and period pain in endometriosis.
2. Oral Contraceptives – Oral contraceptives are recommended for women with excessive menstrual bleeding. They can be given back-to-back for 3 months without a break. Pills stop the periods and the pain too. However, this is reversible.
3. Progesterone – This hormone can be given in the form of tablets (daily), injections (once in 3 months) or intrauterine system IUS (5 years)
4. GnRH injections – GnRH refers to gonadotropin-releasing hormones. The GnRH drugs help achieve temporary artificial menopause and suppress the cyclical female hormones. There can be side-effects (vaginal dryness and hot flushes) with GnRH injections which can be corrected with hormone replacement therapy HRT.
5. Surgery – This is the most effective treatment for endometriosis. Removal of the endometriotic tissue will cure the symptoms but again, as the situation is dynamic, kit will regrow. Surgery is particularly helpful in women with infertility, to plan treatment soon after the surgery.
6. Complimentary approaches to treat endometriosis include dietary changes, forming an exercise routine that includes moderate exercises along with basic stretching, herbal medicines, and acupuncture. These are also beneficial for women with endometriosis.

When will endometriosis be completed cured?

When the woman stops her period or when she undergoes hysterectomy