Hello, I am Dr. Srisailesh Vithala. I am one of the infertility specialists in the city. Today I am going to talk about endometriosis. What is endometriosis? Endometriosis is nothing but line in the sense, lining the womb usually if they grow outside the uterus, then it will lead to the following problems like pain during the period, pain during love making which is intercourse and pain during passing the motion and they also have difficulty in getting pregnant. If these symptoms are there, then we call endometriosis. Where else the lining of the womb cells can grow? The common areas, where the lining of the womb cells grow are ovaries, bowel and anywhere else. Why does endometriosis occur? The ovaries of a woman produces a hormones, which will help the cells lining the womb to grow. These lining of the womb is important to facilitate the pregnancy but women do not get pregnant every month. Henceforth, the lining of the womb will shut down. The shutting of lining of womb comes out as a period. However, if these cells which lie in the womb, instead of shutting down goes and gets implanted outside the uterus like in ovaries, like in bowel or any other area, it will lead to endometriosis. And this can lead to the symptoms which I have explained in the previously. Who are the people who will develop the endometriosis? Endometriosis is quite common in reproductive age group, between 25-35 years of age group in a woman. So, prevalence I would say is around 1 in 5 women in this age group will have endometriosis. The endometriosis can be having in woman who has started the period much earlier. Woman who has a periods, who bleeds more than 7 days. In woman whose mother or siblings have a similar type of problems, woman who has a pain during the periods, woman who has a pain during their lovemaking, woman who has a problem during passing the motion or bowel movement. All of these people can develop endometriosis.
What are the symptoms of endometriosis? Unfortunately, the severity of the symptoms of endometriosis and severity of endometriosis doesn’t go hand in hand. However, the common symptoms are painful periods which we call as dysmenorrhea, pain during lovemaking which we call as dyspareunia and difficulty in getting pregnant. However, the pain which might start the few days before the period, continue during the period and may stay few days after the period that means the woman will suffer quite a few days in her monthly period with pain. It is also associated with pain during passing the motion and pain can be present all over. These women may find it difficult to get pregnant. If these symptoms are present, then such women has to be further investigated for endometriosis.
How is endometriosis diagnosed? Endometriosis is diagnosed by combination of clinical features and some investigative tools. The clinical features like I mentioned are dysmenorrhea, dyspareunia and difficulty in getting pregnant. Women with above symptoms need to be further investigated. However, people should understand that severity of the symptoms and the severity of the endometriosis does not always co-relate. What I mean by this is women may have mild symptoms like pain but endometriosis might be very severe. Similarly, women may have very severe endometriosis but her symptoms will be very mild. Henceforth, along with these clinical features, some other investigations we need to do it to confirm the diagnosis of endometriosis. Three of them are blood test, CA125 is a blood test but it is non-specific. Next one is ultrasound. Ultrasound is very good in picking up the endometriosis, if it is in the ovary, which we call as endometrioma. Then is MRI. MRI is quiet good in picking up endometriosis if it is in the pelvic that is mainly in the bowel. Then comes the surgical intervention laparoscopy, which is the gold standard for diagnosis of endometriosis. It not only diagnoses but also establishes the extent of the disease and also can treat mild to moderate endometriosis.
What is the treatment of endometriosis? The treatment of endometriosis mainly depends on 2 factors – 1) Pain and 2) Fertility promotion. Initially, the aim should be suppress the pain and promote the fertility. Long term objective should be prevent the progression of endometriosis and prevent reoccurrence of endometriosis. Based on above 2 features, which is pain and fertility, the treatment differs from woman to woman. Henceforth, counselling become very important to the woman to tell which is the best way treatment forward.
There are 2 types of treatment for endometriosis – 1) medical and 2) Surgical. Medical treatment. What does medical treatment do? Medical treatments try to suppress the pain. This is done by suppressing the endometrial tissue. Again that will lead to the suppression of ovarian function and periods itself. These medications will vary from simple analytics to birth control pill to hormonal injections. However, what is more important is people who want to perceive the fertility or people who want to conceive, medical treatment is not the solution for them. Other mode of treatment is surgical intervention. Surgical intervention not only diagnoses the endometriosis but also can tell the severity of the disease or extent of the disease and also treat mild to moderate endometriosis. The surgical treatment mainly involves laparoscopy, which is also a gold standard for diagnosis. In laparoscopy, mild and moderate, up to moderate endometriosis can be treated, which not only helps for a woman to relieve her pain but also helps to promote the pregnancy, especially in the woman having mild or moderate symptoms. Finally fertility. Most of the women with endometriosis will need higher fertility treatments like IUI, IVF, and ICSI. Henceforth, if the woman has mild or moderate, minimal treatment with medical or surgical treatment recourse to one of the assisted reproductive technique will help her to get pregnant soon.