Endometriosis is a chronic condition that can have a significant impact on the lives of women who are affected. This condition occurs in women mostly in the prime of their lives, and can affect their ability to get pregnant as well. In India alone there are more than 25 million women suffering from Endometriosis.
The condition occurs when cells from the lining of the womb also known as endometrium begins to grow outside the uterus, the disease could spread beyond the pelvic region and affect other areas of the body. Unlike the cells that are shed in the uterus, the cells that tresspass stay in the body and do not shed when you have your period. However, these growths react to the hormones from your ovaries just like the cells in the uterus. The cells begin to grow and bleed during the period. Over time, the growths may add more tissue and blood. Endometriosis in the ovaries leads to the formation of cycts which are called endometrio mass or chocolate cycts. The augmentation of blood and tissue in the body leads to pain and other symptoms.
The onset of the condition probably starts when a woman begins having periods. The condition is predominantly seen in women who fall between the reproductive age group of 15 – 50 yrs hampering their chances of getting pregnant.
At Fortis, our team of specialists employ a multidisciplinary approach to get to the root of your condition. Every woman with Endometriosis deserves the best of care and our centre offers a range of state-of-the-art diagnosis and treatment options.
As a common menstural cycle, a woman’s uterus swells up every month when the ovaries produce hormones that tell the cell lining to do so. During the period, the woman’s uterus sheds these cells along with blood and tissue through the vagina.
When these cells grow outside the uterus and sometimes onto other parts of your body, endometriosis occurs. This tissue may attach on any of the following:
- Lining of your pelvic area
There are possibilities that it may grow onto other parts of the body as well.
Although endometriosis can happen in any girl or woman who has menstrual periods, it is more common in women between 20-40 years of age.
A woman is likely to develop endometriosis if she:
- Has a mother or sister with endometriosis
- Started periods at a relatively young age
- Hasn’t had children
- Has frequent periods, or they last for 7 or more days
- Has a closed hymen
- Could have genetic predisposition
- Certain types of immune environment within the abdomen/pelvic promotes the growth of endometriosis
The extent of symptoms are varied. Some women with severe endometriosis and are diagnosed incidentally experience no pain at all, while some women with milder condition experience severe pain.
In addition to pelvic pain some of the other symptoms of endometriosis are:
- Painful periods.
- Lower abdomen pain before and during your period.
- Dull to severe cramps for a week or 2 before and during the period.
- Pain during or following sexual intercourse.
- Pain with bowel movements.
- Lower back pain.
Most forms of endometriosis requires visual inspection of the pelvis using laparoscopy which is considered the ‘gold standard’ for investigation. Transvaginal scanning and MRI, pelvic examination is also employed to diagnose the disease.
Research shows that infertile women are 6 to 8 times more likely to have endometriosis than fertile women.
Although it is not entirely clear, the association between endometriosis and infertility could be associated with (but not limited to)
- pelvic adhesions and anatomic distortions,
- implants near the site of fertilization which may produce molecular messengers that impact on fertilization
- abnormal ovarian follicular development
A significant ratio of women with endometriosis are able to concieve. We recommend women diagnosed with endometriosis to avoid delaying having children as the condition worsens with time. Further, the symptoms of endometriosis, especially pain seems to disappear in women who are pregnant.
Medical management of endometriosis can be done through hormonal treatments or pain management.
- Oral contraceptives cause the endometriosis to stop growing.
- Progestogens like MPA, Dydrogesterone or Norethisterone can also be used to simulate a “pseudo” pregnancy state and temporarily calm the endometriosis tissue.
- GnRH analogue progesterone receptor modulators is an option which makes the endometrial implants to become inactive and degenerate.
- Analgesia is administered to inhibit pain.
Surgical management plays a prominent role in treatment of pain and infertility due to endometriosis. We do a careful pre-operative evaluation to determine the surgical approach for treatment.
The indications for surgical procedures could be:
- Ovarian cystectomy
- Adhesiolysis to restore anatomy
- Hysterectomy +/ – conservation of ovaries based on appearance of ovaries
- Excising nodules