Endometriosis
March is Endometriosis awareness month.
We call endometriosis as a silent suffering disease in women. Many suffer from monthly pain and discomfort during periods without knowing that they may have this disease. This can even trouble women lifelong.
when young they are told that pain in periods is common and we all have to deal with it as part of being women. It will go away once you get married or have children. If endometriosis remains untreated, it can progress to advance disease causing infertility and long term disability.
What is endometriosis
Tissue that is present in the lining of the uterus (endometrium) is sometimes present in other areas in the pelvis, which could be ovaries, fallopian tubes, cul-de-sac (behind uterus), intestines, rectum or urinary bladder. Endometrium of the uterus grows under the influence of hormones every month and then breakdown and bleed during the menstrual cycle. Similarly 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. However the bleeding inside the uterus has a passage to come out as menstrual bleeding through vagina, but the bleeding in endometriotic site accumulates and forms cysts (chocolate cysts) or adhesions. This can cause pain, especially before and during period. One third of cases of infertility are due to endometriosis.
Risk factors
- Started periods (Menarche) at a young age
- Women who never had children
- Heavy menstrual bleeding or very frequent periods.
- Suffer from Fibroids
- Family history of endometriosis.
Who is commonly affected?
- Young women in the reproductive age group (20-40years)
- 30% of women with infertility may be suffering from endometriosis
- Women with uterine defects like septum or bicornuate uterus (double uterus)
- It can run in the family
What are the symptoms?
- Pelvic pain (pain in lower abdomen and back). Such pain is common few days before starting of menstrual cycle or during the bleeding days. It may also be felt during or after sex, during bowel movements or urination.
- Heavy bleeding during menstrual cycle causing anaemia and weakness
- Feeling of bloating & fullness in abdomen around the periods.
- Feeling of incomplete bowel emptying or diarrhoea or rectal pain during periods
- Associated Menstrual headache
- Some women with endometriosis may have no symptoms.
How do we diagnose?
The gold standard to diagnose is visual inspection & identification of the endometriotic lesions in the pelvis via a Laparoscopic or Robotic surgery. However if the disease is advanced then pelvic examination & Ultrasonography can pick up cysts in pelvis that may suggest endometriosis. There is no blood test that can confirm endometriosis. Serum levels of CA125 can suggest the presence of endometriosis.
What are the treatment options
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 can be treated with medication, surgery, or both. Although treatments may relieve pain and infertility temporarily, it is a recurrent problem and conservative treatment (medical or surgical) cannot provide permanent cure.
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. Hormones like progesterones or combined pills not only relieve the pain but also help to control the disease process. Hormonal injections or intrauterine contraceptive device with progesterone (Mirena) can benefit. These medications are for short term use. Some can have side effects which women are not able to tolerate.
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 almost always by minimally invasive technique (LAPAROSCOPY). During laparoscopy, endometriosis can be removed or burned away. Completeness of surgery depends on the patients needs and the surgeons skill. If infertility is the issue then conservative approach and trying to save the normal tissues is attempted followed by active treatment for infertility. If the woman does not desire any more children the complete removal of all endometriotic tissue, uterus along with both ovaries is done.
Robotic assistance during laparoscopic surgery is the most advanced surgical technique available. DaVinci surgical intervention combines the best of open and laparoscopic surgery. Thus giving a better outcome in terms of pain relief and fertility. With the assistance of Robotic ARMS (controlled by the surgeon of course!) we can perform surgeries through small incisions with unmatched precision and control. Robot-assisted surgery allows superior 3D visualisation of the surgical field with 10 times magnification with minimal scarring and loss of normal ovaries. Robotic assistance also reduces the need for conversion to open surgery (laparotomy).
Endometriosis is a progressive disease. Recurrence after surgery is not uncommon. The first surgery by experienced surgeon gives best outcome followed by some from of medical therapy. Patients treated with combination of surgery and medications have extended symptom-free period. Endometriosis is enigmatic & tricky disease and surgery should be done at centres that have experienced surgeon & facility to manage this condition.
Fast facts endometriosis
- An estimated 200 million women worldwide suffer from endometriosis.
- Endometriosis can also affect teenage girls.
- Incapacitating painful menstruation probably due to endometriosis is one of the main cause for women to miss school or work.
- Endometriosis is often undiagnosed or misdiagnosed. Due to non specific symptoms, women see orthopaedic or gastroenterologists instead of gynaecologists
- Common estimates indicate that after the onset of symptoms there is 6-10 years delay before it is correctly diagnosed.
- Endometriosis is one of the top three causes of female infertility.
- Endometriosis can be a source of chronic pelvic pain and disability.
- Multiple medical opinions maybe needed before correct diagnosis of endometriosis is made.
- There is no blood test to confirm the diagnosis of endometriosis.
- Visual inspection of endometriosis lesions is the gold standard method for diagnosis.