What is Endometriosis?
Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus, in other pelvic organs. The other organs commonly include the ovary, fallopian tube, peritoneum (internal lining of the abdomen), bladder, wall of vagina/rectum and rarely even in outside the pelvis. This causes inflammation in these parts that can lead to scarring and adhesions.
Why does it happen?
Endometriosis can occur at any age post commencement of periods. The cause or risk factors are not known. Possible causes hypothesized are back flow of period blood with lining cells into tubes or ovary, or due to stem cells or other cells outside the uterus changing (metaplasia) into those like the uterus lining cells. Estrogen hormone increases the pain and inflammation in endometriosis.
What are the Symptoms?
The symptoms depend on the site involved.
- Pelvic pain that can be quite severe especially during periods
- Pain during intercourse
- Pain during urination or passing stool
- Heavy or prolonged periods
- Bleeding between periods that can also be heavy
- Infertility (unable to conceive)
- Bloating and nausea
Endometriosis can cause significant disruption of quality of life and also impact social and psychological well-being. Therefore awareness, timely diagnosis and management are very important.
How do you diagnose Endometriosis?
A careful history of menstrual symptoms and chronic pelvic pain provides the basis for suspecting endometriosis.
Endometriosis of the ovary can manifest as ovarian cysts, and mimic polycystic ovary syndrome (PCOS) thereby sometimes presenting confusion in diagnosis.
Diagnostic tests include ultrasonography or magnetic resonance imaging (MRI). A surgical or laparoscopic visualization may be needed, along with a biopsy taken to study the pathology and type of cells, to confirm diagnosis.
How is Endometriosis treated?
Pain relief is first and immediate priority for which non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, etc. maybe given. These may be complemented with physiotherapy and other alternative pain management techniques.
Hormonal medicines like contraceptives and GnRH-analogues are also given in the form of oral pills, injections, vaginal rings, intrauterine devices (IUDs) or implants, and patches
However, in those women desirous of pregnancy, fertility medicines like ovulating agents, and procedures like intrauterine insemination (IUI), and in vitro fertilization (IVF), etc. maybe needed.
Surgery usually by key hole (laparoscopy) may be needed to remove the area of endometriosis, or adhesions and scar tissues. Sometimes the entire uterus with both ovaries and tubes may be removed in older patients who have completed their family.