Endometriosis

What is endometriosis?

Endometriosis is a very common condition where cells of the lining of the uterus (endometrium) are found elsewhere, usually in the pelvic cavity, bowel, ovaries and fallopian tubes. It’s a condition of reproductive years.

What are the symptoms of endometriosis?

The main symptoms of endometriosis are:

  • painful periods (dysmenorrhoea)
  • Some women may have heavy periods(menorrhagia)
  • pain during or after sexual intercourse (dyspareunia)
  • lower abdominal pain
  • pelvic pain
  • difficulty in getting pregnant
  • pain related to the bowels and bladder

Occasionally women may have no symptoms.

What causes endometriosis?

During the menstrual cycle, under the influence of the female hormones estrogen and progesterone, the lining (endometrium) of the uterus thickens and prepares itself for the implantation of the fertilized egg. If there is no pregnancy, the lining sheds as a period.

Endometriosis occurs when the cells of the lining of the uterus are found in other parts of the body, usually the pelvis. Each month this tissue thickens and bleeds in the same way as the lining of the uterus. This internal bleeding into the pelvis has no way of leaving the body. This causes inflammation, pain and damage to the reproductive organs and the normal anatomy of the pelvis.

Reproductive areas where endometriosis can be found

What are the different sites of endometriosis?

It can be found:

  • on the ovaries where it can form cysts (often referred to as ‘chocolate cysts’)
  • in or on the fallopian tubes
  • almost anywhere on, behind or around the uterus
  • in the peritoneum.
  • the bowel and bladder
  • deep within the muscle wall of the uterus (adenomyosis).

Why does endometriosis occur?

The cause is not known but many theories are present. The most commonly accepted theory is- “retrograde Menstruation”- during a period, light ‘backward’ bleeding carries tissue from the uterus through the fallopian tubes to the different places in the pelvic cavity.

How can it be diagnosed?

There is no simple test for endometriosis. Ultrasounds can identify chocolate cysts but not rule out endometriosis.

Definitive diagnosis is formed by Laparoscopy.

What is the treatment of endometriosis?

The treatment depends on various factors. They are:

  • age
  • degree of pain
  • menstrual problem
  • severity of endometriosis
  • desirous of pregnancy

The options for treatment may be:

Pain relief

Pain-relieving drugs reduce inflammation and help to ease the pain. Also pain relieving anesthesia is an option

Hormone treatments

There is a range of hormone treatments which allow the endometriosis to shrink or disappear.

  • The combined oral contraceptive (COC) pill or patch contain the hormones estrogen and progesterone and work by preventing ovulation and also pregnancy .the added advantages are light, shorter and less painful.
  • The intrauterine system (IUS)-MIRENA : this is a small T-shaped device which releases the hormone progestogen. This helps to reduce the pain and makes periods lighter. Some women get no periods at all.
  • progesterones or testosterone derivatives
  • GnRH agonists – these drugs prevent estrogen being produced by the ovaries and cause a temporary and reversible menopause or the pseudomenopause.

Surgery

Surgical treatment depends on the site and the extent of endometriosis.

It ranges from simple ablation of the endometriotic spots, cyst fulgaration or excision, hysterectomy.

It can be done either by laparoscopy or as an open surgery(laparotomy)

What are the treatment options if I want pregnancy?

Getting pregnant can be a problem for some women with endometriosis.

If the endometriosis is mild then one can conceive normally or with little help in the form of ovulation induction with timed intercourse or IUI

Moderate to severe endometriosis may require assistance. The options are ovulation induction followed by IUI or IVF.

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