Endometriosis

What is endometriosis?

Endometriosis occurs when tissue similar to the inner lining of uterus (womb) is found elsewhere in the body- usually around uterus, ovaries and fallopian tubes, peritoneum. It can be found on other parts of body- scars after surgery, belly button or chest.

How common is it?

It affects an estimated 10% (190 million) of reproductive age women worldwide.

What are the symptoms?

Commonly associated with pelvic pain and painful periods. It may cause pain during or after sex, affect your bowel or bladder or may lead to fertility problems.

How to detect endometriosis?

It is not easy to diagnose it as there is no blood test, doesn’t always show up on scans and symptoms overlap with other conditions.

Some tests that may help

1. Transvaginal scan- may show cysts on ovaries or other evidence of endometriosis
2. MRI- can show when there is extensive endometriosis involving bladder or bowel
3. Laparoscopy- A key hole diagnostic surgery to directly see the pelvic as well as abdominal organs to see traces of endometriosis. Used to treat and diagnose endometriosis.

A normal ultrasound or MRI doesn’t rule out endometriosis but can help guide treatment options

How to prevent endometriosis?

At present, there is no known way to prevent endometriosis. Enhanced awareness, early diagnosis and quality health care may slow or halt the progression of the disease and reduce long-term symptoms, including possibly the risk of central nervous system pain sensitization. Currently there is no cure

What are the treatment options?

Treatment depends on:

• Type and severity of symptoms
• How much endometriosis, where it is present
• Whether planning a pregnancy
• Whether wanting a contraception
• Personal preferences

Pain relieving medicines

Range from over-the-counter medicines (like paracetamol or ibuprofen) to prescription medicines.

Hormone treatment

Hormone treatment help control symptoms, reduce bleeding and pain by stopping the periods. They include

1. Combined pill with or without a break (preferred)- makes flow lighter and reduces pain
2. Hormonal intrauterine device (e.g. Mirena) acts locally on uterus and stops periods
3. Progesterone based - mini pills, injections
4. GnRH analogues- Temporary stop the ovaries to produce estrogen and progesterone causing temporary menopause. Often given for short periods- when above medicines do not work or prior to surgery

Surgery

The type of surgery offered depends on individual situation. Most women can be treated by laparoscopy (key hole surgery) which requires very small cuts.

Depending upon the situation- sometimes a hysterectomy (removal of uterus) with or without removal of ovaries may be offered- this may not necessarily cure endometriosis but helps with other symptoms

Fertility treatment

Many women with endometriosis do conceive naturally, but some may require help.

Will it be cured completely?

There is currently no cure for endometriosis; access to early diagnosis and effective treatment of endometriosis is limited in many settings and treatment aims to control symptoms and limit long-term impacts.

*Reviewed by Dr Nikita Chauhan, MD (Obs & Gynae)

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