(Dr Suman Bijlani has authored a chapter on endometriosis in the Text Book - "Current Practice in Obstetrics and Gynecology" - Vol 3, edited by Dr Pankaj Desai.)
Endometriosis is one of the most difficult to understand gynaecological disorders.It affects millions of women today.It is also one of the leading causes of infertility among urban women. It is now considered a lifestyle disease though the exact cause is not known.
What do you mean by endometriosis?
Endometriosis actually means that endometrial tissue (the inner lining of the uterus) is present outside the uterus at various sites inside the abdominal cavity. Just as the uterine lining bleeds and is shed every month, this tissue (known as endometriotic implants) responds to the female hormones estrogen and progesterone and also bleeds every month, inside the abdomen. Because of this bleeding, there are various effects.
Bands or rope like structures known as adhesions form between various organs. For example, the fallopian tubes may get stuck to the back of the uterus or get pulled towards the ovary. Or the intestines to the uterus, etc. This causes a pull between the various organs involved and pain. Thus periods may become painful and heavy and also intercourse may become painful.
How does endometriosis affect fertility?
Infertility may result from adhesions, inflammation in the pelvis, blocked or misshapen fallopian tubes and chocolate cysts. Over a period of time, chocolate cysts can decrease the ovary's capacity to produce eggs. In endometriosis, antibodies may be produced within the pelvis, which may harm the partner's sperm or the corpus luteum (an organ which maintains early pregnancy).These antibodies may cause miscarriage. Hence, miscarriages are commoner in women with endometriosis.
What is a chocolate cyst?
A chocolate cyst is a blood filled cyst in the ovary.Just as bleeding occurs anywhere in the pelvis, it may happen within a space in the ovary, which gets filled with blood (chocolate like old blood). This may interfere with egg formation(ovulation).
Are chocolate cysts cancerous?
Do I need to undergo surgery for the chocolate cyst?
That would depend on your symptoms, size of the cyst and whether you want children. Cysts larger than 4 cm usually require surgery. If you are in pain or are undergoing treatment for fertility, you may undergo laparoscopy to perform adhesiolysis (removal or cutting of adhesion bands) and cauterisation of endometriotic implants as well as check the condition of your fallopian tubes.
Is endometriosis curable?
Endometriosis tends to recur throughout your reproductive life and although not life-threatening, it may cause a lot of distress due to pain. We have yet to find a "cure" for this condition. Remissions and relapses form the pattern of the disease till you reach menopause.
Fortunately, it improves remarkably during pregnancy and resolves almost completely after menopause. Since the implants thrive on hormones, they grow actively only during her reproductive life (till menopause).
What is the treatment of endometriosis?
Treatment of endometriosis is based on the stage (severity) of the disease, the age of the patient, whether she wants to have children and her symptoms (pelvic pain or heavy periods).
Now days, various medical and surgical options are available to women.
Medications are effective to a large extentand work mainly to suppress pain and symptoms. Tablets and injections to the effect are available and they suppress periods for many months so that the implants do not grow or bleed. Recurrence after treatment is common.
Laparoscopic surgery remains an important treatment tool for most patients, mainly to treat chocolate cysts, remove adhesions and destroy endometriotic implants and restore fertility. However, many women would need more than one procedure during their lifetime.
The woman should be counselled thoroughly about her condition and the treatment plan should take into account her treatment goals and expectations. She should follow up regularly throughout her life till menopause in order to maintain optimum health and avoid complications.
For very severe cases, it may be wise to remove the uterus and both ovaries to cut off the hormonal supply to endometriotic implants.
What are my treatment options if I wish to get pregnant?
Regular treatment (in mild cases) Laparoscopic surgery (as mentioned above) Test tube baby (it is better to opt for test tube baby early before endometriosis becomes severe)
Each case has to be personalised depending on various factors such as your age, severity of disease, financial constraints, condition of fallopian tubes and ovarian reserve.
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