ENDOMETRIOSIS

What is endometriosis?

Endometriosis is a common gynaecological problem affecting women of reproductive age. It occurs when endometrium (tissue lining the inside of the uterus) starts growing on surfaces of other organs in the pelvis such as the ovaries, fallopian tubes, outer surface of the uterus, pelvic cavity, vagina, cervix, vulva, bladder or rectum.

What symptoms do patients with endometriosis experience?

Areas of endometriosis irritate the surrounding structures leading to pain during menstrual flow or intercourse, and scar-formation (adhesions). Patients may experience painful cramps in the lower abdomen, back or in the pelvis, heavy menstrual bleeding, painful bowel movements or urination and infertility.

What causes endometriosis?

The exact cause for the endometriosis is not known, but it is thought to be inherited through genes that run in families. Defects in the immune system, hormonal imbalances, or complications of surgery may cause women to develop endometriosis. One theory suggests that when endometrial tissue gets discharged during menstrual flow, some of the cells remain and get attached to organs outside the uterus.

How does endometriosis affect fertility?

Endometriosis may be a cause of infertility in women. The reason for this link is unclear but may be attributed to certain physical (scar tissue) and chemical (substances released by the endometriosis) hindrances to the release and fertilization of the egg and sperm, and its effect on the quality of the eggs and sperm present in the woman’s reproductive tract.

How is endometriosis diagnosed?

Your gynaecologist will ask you about your general health, your symptoms and perform a pelvic examination to feel for the presence of large cysts or scars. An ultrasound scan may also be performed to look for ovarian cysts. To confirm the diagnosis your doctor may recommend a laparoscopic examination with biopsy.

Diagnosis of endometriosis is important, not only to determine the cause of pelvic pain, but to also stage the condition (Stage 1 to 4) according to severity, which helps determine a woman’s risk for infertility. Women with stage 4 endometriosis may have damaged ovaries and blocked tubes, facing the highest level of infertility and requiring advanced fertility treatment

What are the treatments for endometriosis?

There are several treatment options available to minimize the pain as well as control heavy bleeding.

Pain Medication: Over the counter pain relievers may be helpful for mild pain. Nonsteroidal anti-inflammatory medications will be prescribed by your doctor in cases of severe pain.

Hormone Treatment: Hormone treatment is recommended if there is a small growth and mild pain. Hormonal preparations can be taken in the form of pills, shots, and nasal sprays. Birth control pills help to decrease the amount of menstrual bleeding.

Surgery: Surgery is an option for women having multiple growths, severe pain, or fertility problems. Options include:

• Laparoscopy: During this surgery, growths and scar tissue are removed or cauterized. This is a minimally invasive technique and does not harm the healthy tissues around the growth.
• Laparotomy or major abdominal surgery: This involves a larger cut in the abdomen which allows the doctor to reach and remove the endometriosis growth.
• Hysterectomy: It is a surgery that involves removal of the uterus. This procedure is done when there is severe damage to the uterus and only if patient does not want to become pregnant in the future.

How is fertility enhanced for women with endometriosis?

There are many approaches to treating infertility associated with endometriosis. Laparoscopic surgery to remove scar tissue and other obstructions may result in success for conception in women suffering from mild-to-moderate endometriosis. It reinstates the normal structure of the reproductive tract and allows the organs to function better. Controlled ovarian stimulation (COS) along with intrauterine insemination (IUI), where egg release is stimulated and healthy sperm are injected into the uterus, is another option that can enhance fertility. More aggressive treatment with in-vitro fertilization (IVF) may be indicated in older women trying to conceive with endometriosis. Treatment is highly individualized and is based on many factors such as stage of disease, age of woman and duration of infertility.