Endometriosis

Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrial stroma and glands, which should only be located inside me uterus) is found elsewhere in the body.

Endometriosis lesions can be found anywhere in the pelvic cavity: on the ovaries, the fallopian tubes, and on the pelvic side wall. Other common sites include the uterosacral ligaments, the cul-de-sac. the Pouch of Douglas, and in the rectal-vaginal septum.

In addition, it can be found in caesarian-section scars, laparoscopy or laparotomy scars, and on the bladder, bowel, intestines, colon, appendix. and rectum. But these locations are not so common.

In even more rare cases, endometnosis has been found inside the vagina, inside the bladder. on the shin. even in the lung spine.and brain.

The most common symptom of endometriosis is pelvic pain. The pain often correlates to the menstrual cycle. but a woman with endometriosis may also experience pain that doesn‘t correlate to ha cycle. For many women, the pain of endometriosis is so severe and debilitating that it impacts their lives in significant ways.

Endometriosis can also cause scar tissue and Adhesions to develop that can distort a woman‘s Internal anatomy. In advanced stages. internal organs may fuse together. causing a condition known as a 'frozen pelvis."

It is estimated that 30-40% of women with Endometriosis may not be able to have children.

Diagnosing Endometriosis

There is no simple test that can be used to Diagnose endometriosis. I fact, the only reliable way to definitively diagnose Endometriosis is by performing a laparoscopy and to take biopsy of the tissue.

However, this is an expensive. invasive procedure. Furthermore. if the Surgeon is not a specialist in endometriosis she/he may not recognize the Disease, which can result in a negative diagnosis. In addition, the female may not want to have surgery.

This makes diagnosis a challenge, and therefore an experienced Gynecologist should be able to recognize symptoms suggestive of Endometriosis through talking with the female and obtain a history of her symptoms. For this to be effective, it is important that the female patient is honest with Her physician about all of her symptoms and the pattern of these.

There are other tests, which the gynecologist may perform. These include Ultrasound, MRI scans and gynecological examination. None of these can definitively confirm endometriosis (though they can be o f the disease). not can they definitively dismiss the presence of Endometriotic lesions/cysts. The fact that there is no non-invasive. definitive method for endometriosis is as frustrating for clinicians as it is for women with the disease.

Treating Endometriosis

The cause of endometriosis remains unknown. A treatment which fully cures endomeniosis has yet to be developed. and these is no over whelming medical to support one specific type of treatment for endometriosis over another.

Choosing a treatment therefore comes down to the individual woman’s needs, Depending on her symptoms, her age, and her fertility wishes. She should discuss these wit her physician so that they, together can determine , which long term, holistic, treatment plan is best for her individual needs.

For many women, this can be a combination of more than one treatment over longer periods of time.

1. Pain Killers:
As pain is the most common symptom for many women with endometriosis.

2. Harmonal Therapies:
Endometriosis is exacerbated by oestrogen. Therefore, hormonal treatments for endometriosis are designed to attempt to temper oestrogen production in a women’s body and such treatment may subsequently relieve her of symptoms. Harmonal Therapies may include:
- The combined oral contraceptive pills(OCP)
- Progestogens/progestins
- GnRH-analogues (agonists and antagonists)
- Aromatase inhibitors.

3. Surgery:
Laparoscopic surgery is the only definitive way to diagnose endiometriosis. In many cases, the disease can be diagnosed and treated in the same procedure. The success of surgery depends greatly on the skill of the surgeon and the thoroughness of the surgery. The aim is to remove all endometriotic lesions, cysts, and adhesions.

It has been observed many a times that because of the endometromas hemorrhagic/ ovarian cyst(due to endometriosis) disables the ovary to produce a good quality oocyte or follicle and even after the excision of these endometromas, laproscopically does not yield a good outcome. In our days to day practice, in IVF cycles either through controlled ovarian stimulation or gonadotrophin stimulation, poor quality oocyte results in negative outcome of pregnancy. In few of the cases due to repeated OPU, Ovarian abcess have been observed resulting in severe rise in TUC levels & in body temperature and sometimes hospitalization of the patients. Patient with history of earlier failed IVF cycles with controlled ovarian stimulation or gonadotrophin stimulation are preferably counselled for donor oocyte programme to ensure better result. Down regulatation with donor egg programme makes the ART management more effective with a better result outcome.
Any query regarding the above management protocols can be discussed in detail with our team.