Endometriosis

Endometriosis is a condition characterised by the presence of endometrial issue, typically lining the uterus, found outside the uterus. This condition affects approximately 1 in 10 women of reproductive age, with a higher prevalence among those in their 30s and 40s.

Locations of endometriosis

Endometrial issue, also known as implants, commonly occurs in various areas, including the peritoneum, ovaries, fallopian tubes, outer surfaces of the uterus, bladder, ureters, intestines, rectum, and the cul-de-sac (space behind the uterus).

Mechanism and associated problems

Endometriosis issue responds to oestrogen, growing and bleeding similar to the uterine lining during the menstrual cycle. This process can lead to irritation, inflammation, swelling, and the formation of adhesions (scar tissue). Adhesions may cause organs to stick together, resulting in pain, particularly before and during menstruation.

Infertility and endometriosis

Nearly 4 in 10 women experiencing infertility have endometriosis. Inflammation associated with endometriosis can harm sperm, eggs, or impede their movement through the reproductive organs. Severe cases may lead to blocked fallopian tubes due to adhesions or scar tissue.

Symptoms of endometriosis

Chronic pelvic pain, especially before and during menstruation, is a common symptom. Pain during sexual intercourse, bowel movements, and urination may also occur. Heavy menstrual bleeding is another indicator, though some women may be asymptomatic and only discover endometriosis during fertility struggles or unrelated surgeries.

Diagnosis of endometriosis

While a physical and pelvic exam may be conducted by a gynaecologist laparoscopy is the definitive diagnostic procedure. This surgical intervention allows direct visualisation, and sometimes a biopsy is performed to confirm endometriosis.

Treatment options

Treatment options vary based on the extent of the disease, symptoms, and fertility considerations. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal medications, including birth control pills and gonadotropin-releasing hormone (GnRH) agonists, may be prescribed to manage pain and slow the growth of endometrial tissue.

Surgical intervention

Surgery, primarily laparoscopic, aims to remove endometriosis tissue to alleviate pain and improve fertility. However, surgery does not guarantee a permanent cure, and recurrence rates are notable, especially in cases of severe disease.

Post-surgery pain management

While surgery often provides relief, up to 8 in 10 women experience recurring pain within two years. Birth control pills or other medications post-surgery may help extend the pain-free period.

Hysterectomy as a last resort

In cases of persistent severe pain resistant to other treatments, hysterectomy may be considered as a last resort. The removal of ovaries during a hysterectomy reduces the likelihood of future pain associated with endometriosis.

Surgical goal

The primary objective of surgical treatment is to remove as much endometriosis tissue outside the uterus as possible. This content is shared with the permission of Dr. Baruah. You may find similar information in health publications.