Details about Endometriosis

Is it a hereditary problem? Does it run in the family? 

Endometriosis is sometimes believed to be hereditary, being present in some members of the same family. It is quite common in Asian women including Indian women.  However most women whom we treat do not have any family members suffering from the same disease. There are some environmental factors also that may contribute to its development.

How do women deal with this problem? Is medication lifelong or it can be treated within a short time? 

Dealing with endometriosis is a life long process. What kind of treatment advised depends on what they present with and what is their age of presentation. If it is a young women and pain is the main problem then medical therapy is the first line of treatment to give pain relief as well as to reduce the progress of the disease. If infertility is the presentation then surgical treatment by Laparoscopy or Robotic assisted surgery can improve pregnancy results in first and second stage disease. After laparoscopic treatment there can be almost 30% increase in pregnancy rates. However if the disease is advanced then procedures like IVF is advised to women with endometriosis. If women has already completed her family then removal of uterus and often both ovaries remains the treatment of choice.

What is the Endometriosis Awareness Level in India among Women?

The awareness about this disease is not much across the globe as well as in India. Most women ignore nonspecific symptoms and they keep ignoring them thinking it is part of life. Symptom like pain during period is almost always brushes aside saying it is part of growing up and will reduce after childbirth. This may be true in some but in many it may just be the initial symptom of endometriosis. So is the pain is preventing you from attending college or work, do get yourself evaluated by a gynecologist who specializes in this area. Hence we have demarcated MARCH as the month of endometriosis awareness month world over. 

How to Treat Endometriosis?

Treatment for endometriosis depends on the extent of the disease, presenting symptoms, and whether one wants to have children at that point in life. It may be treated with medication, surgery, or both. Although treatments may relieve pain and infertility temporarily, symptoms may come back after treatment.

 Medications- is used both to relieve pain and to keep the disease under control. Painkillers like paracetamol or mefenemic acid relieves the pain up to great extent. Hormonal medications like progesterone or combined pills not only relieve the pain but helps to control the disease process. These medications are not useful in all women with endometriosis and some women are not able to tolerate the side effects that these medications have. Medications do not provide permanent cure.

Surgery - is done to remove endometriosis and the scarred tissue around it. In severe cases surgery is the best choice for treatment. Surgery is done by minimally invasive way. Laparoscopic surgery is the standard approach. On average, one in three patients who had a laparoscopy for endometriosis will require a repeat procedure within five years. Complete removal of all implants during the first surgery is therefore important. Robotic assisted laparoscopic surgery these days gives the advantage of precise and complete removal of all endometriosis with preservation of ovarian tissues for future child bearing. Extent of surgery depends on the patient’s needs. If infertility is the issue then conservative approach and trying to save the normal tissues is attempted followed by treatment for infertility by advanced reproductive technology. If the woman does not desire any more children the complete removal of uterus along with both ovaries and all endometriotic tissue is done. Sometimes a procedure called laparotomy may be needed.

 Endometriosis is a progressive disease. The source of the problem is the hormonal changes associated with periods and presence of endometrium at abnormal places. After conservative surgery the disease can recur. Patients who are treated with both surgery and medications have extended symptom-free period. 

Author: Dr.RoomaSinha

Endometriosis - Time To End The Silent Suffering in Women

 Endometriosis Means:

Tissue that forms the lining of the uterus (endometrium) is sometimes present in other places in some women. These sites can be ovaries, fallopian tubes, cul-de-sac (behind uterus), intestines, rectum, bladder.

 Endometrial tissue outside the uterus also responds to changes in hormones. It also breaks down and bleeds like the lining of the uterus during the menstrual cycle every month. The bleeding inside the uterus has a passage to come out as menstrual bleeding. The bleeding at these extra uterine sites collect and forms cysts (chocolate cysts) or adhesions. This can cause pain, especially before and during period. Endometriosis is found in about one third of infertile women.

Who Is At Risk :

•      Young women in their reproductive age
•      Women with infertility
•     Women with uterine defects like septum or bicornuate uterus 
•      It can run in the family

Symptoms:

•   Pelvicpain (pain in lower abdomen and back). Such pain may occur with sex, during bowel movements or urination, or just before or during menstrual cycle.
•   Menstrual bleeding may occur more than normal or in abnormal pattern
•   Endometriosis also may cause infertility.
•  Feeling of gaseous distension around the periods.
•  Some women with endometriosis may have no symptoms.

Diagnosis: 

•   Pelvic examination
•  Ultrasonography
•  Laparoscopy-Visual inspection is the standard method in diagnosing endometriosis

Author: Dr.Rooma Sinha