Dr Neha Gupta
Endometriosis is an enigmatic condition, affecting about 10% of females in their reproductive age group. We call it an enigma as the exact cause is not known, presentation can be varied with the diagnosis not being made sometimes for even up to two years and treatment is equally challenging. There is no “one size fits all” approach that works in endometriosis. Treatment of every woman suffering from this condition is highly individualized, keeping in mind their age, symptoms, disease extent and fertility desires.
In this article we answer ten most frequently asked questions about endometriosis.
Q.1 When should we suspect Endometriosis?
The hallmark symptom of endometriosis is pain. If your periods are becoming increasingly painful (dysmenorrhoea), there is deep pain during intercourse (dyspareunia) or the passage of motion is painful during the period days (dyschezia), then you must visit a gynecologist and get the necessary checks done to look for underlying condition of endometriosis. The symptoms sometimes may be vague like continuous pelvis pain, abdominal bloating, altered bowel habits or backache. In such conditions, it may take longer than usual to establish the diagnosis of Endometriosis.
Q.2 How is Endometriosis diagnosed?
Diagnosis is established by detailed clinical history, physical examination followed by imaging. Ultrasound is usually the first investigation but may be supplemented with MRI to assess the disease spread. Diagnostic laparoscopy is the gold standard for diagnosing endometriosis.
Q.3 Does Endometriosis lead to infertility?
Yes, endometriosis can lead to infertility. Almost 4 in 10 women with infertility have Endometriosis. It is a chronic inflammatory condition that causes scarring inside the pelvis. Tubes and ovaries tend to get stuck at the back of the uterus. Disturbed anatomic relationship leads to disruption of the tubal function. Also Endometrioma (chocolate cyst of the ovary) causes compression of healthy ovarian tissue around it and damages the ovarian reserve.
Q.4 What are my treatment options?
Pain can be managed with the pain relief medications. Hormonal therapy (birth control pills/ progesterone pills/ GnRh analogue injections) are also useful for disease and thus pain suppression. More severe cases require surgery.
Q.5 For how long can hormonal therapy be taken for Endometriosis?
Hormonal therapy used for managing Endometriosis causes suppression of periods. In the absence of periods, the disease also gets suppressed. Some of the latest reports have suggested safe use of these medicines for even up to 5-7 years. This is particularly useful in younger women where we want to avoid repeated surgeries. Hormonal therapy should always be under the supervision of an expert gynecologist.
Q.6 What are chances of disease recurrence after treatment?
Endometriosis is known for recurrence. It tends to flare up after stopping medicines. There is at least 25-30% chance of recurrence even after surgical removal. 6 months of post-operative hormonal therapy is advisable after surgery to reduce the chance of disease recurrence.
Q.7 What surgical options are available for Endometriosis management?
The goal of surgery in Endometriosis is to obtain as much disease clearance as possible. Ovarian chocolate cysts are managed by doing cyst removal. To break down the scar tissue and restore normal anatomy is the goal. Endometriosis going deep in pelvic surface or involving the bowel or urinary passage (deep infiltrating Endometriosis) requires more advanced procedures to remove the disease implant from affected organ. These surgeries are mostly laparoscopic or robotic.
Q.8 Does the choice of center/ surgical expertise have an impact on treatment outcome?
Deep Endometriosis surgery is a highly complex procedure and should be done at a specialized center with a surgeon having expertise in these cases for best possible outcomes.
Q.9 Is Endometriosis cancer?
Endometriosis is not cancer. In very rare cases, Endometriotic implants develop cancer but this is very very rare.
Q.10 Is this disease preventable?
There is no way to prevent Endometriosis. Enhanced awareness, followed by early diagnosis and management may slow the natural progression of the disease.
(The author is Senior Consultant Department of Obstetrics & Gynecology)
Follow our WhatsApp channel
