ENDOMETRIOSIS: What you should know about it?

She was holding an ultrasound report in her hand, a diagnosis of an ovarian endometrioma. There were so many questions blowing her mind away, now what? what’s going to happen? is it a cancer? how dangerous is it? will I recover? will I have kids? how to treat it? These are common questions which patients ask, once they are diagnosed with Endometriosis. First of all ITS NOT A CANCER, it is not dangerous, endometriosis patients do have children, it is manageable with appropriate and timely treatment and its complications can be avoided.

This blog will answer most of your questions regarding this problem, and will guide you for living with it and overcoming misconcepts.

What is endometrium?
Endometrium is the inner most lining of uterus that becomes thick for preparation of a pregnancy, if conception does not occur then it shed during a normal periods.

What is endometriosis?
It is a condition in which endometrium, the lining cells of uterus, are found outside the uterus. These lining cells also respond to cyclical hormones of ovaries, during a menstrual cycle, they also build up and then shed off during periods like uterine lining.

How common is endometriosis?
It affects 20 to 30 % women of reproductive age group.

What is the affected age group?
It can occur from puberty to menopause, it’s rare to find it after menopause.

What are endometriosis sites in body?
These cells are usually found in pelvis, urinary bladder, uterine walls, ovaries, tubes, intestines. It can be seen in abdominal walls and in rare cases appendix, scars of wound, lungs and even brain.

How does it affect the body?
Every periods result in bleeding from these tissues causing formations of blood filled chocolate cysts in ovaries, chocolate red(nodules) bumps, dense adhesion between organs and scarring, all this disturbs normal structure and function of organs.

What is Endometrioma?
It is cystic blood collection in ovaries due to ovarian endometriosis, with the passage of time the water content of blood is absorbed and thick chocolate fluid is left.

What is Adenomyosis?
When endometrial tissue grows in muscle layer of uterus, it wall gets thick, resulting in painful heavy periods.

Why does it occur?
The exact cause is unknown, the most accepted theory is that in some women there is backward flow of some menstrual blood in pelvis during periods as a result endometrial cells in menstrual blood flow from Uterus to Fallopian tubes and then enter pelvis. They get implanted at various sites and then start growing and responding to cyclical hormone changes.

What are common symptoms?
The patients present with off and on pain in lower part of tummy, painful periods, pain during intercourse, infertility, pain during or after passage of urine or motion, irregular vaginal bleeding, blood in urine or motion during periods. Some patients present with diarrhea, constipation or colic.

How endometriosis causes infertility?
The cyst formation in ovaries destroys the normal structure and function of ovaries, whereas dense adhesion in pelvis cause tubal damage due to distortion and damage to structure of tubes, all this result in infertility.

Is it possible to have endometriosis with no symptoms?
Yes, sometime patients do not have any problem, these patients are diagnosed only on investigations. It should be noted that severity of disease DOES NOT correspond to severity of symptoms.

How it is diagnosed?
It’s not easy to diagnose it on first presentation, pelvic examination or blood tests. However, ultrasound could be of some help for diagnosing ovarian endometrioma, tub ovarian masses or adenomyosis.

What is investigation of choice?
Laparoscopy is the only way to diagnose endometriosis.

What is laparoscopy?
It’s an operation in which, under general anesthesia, camera (laparoscope) is inserted into abdomen through small cut in belly button. The surgeon can see all pelvic organs, identify endometriotic cysts or deposits.

What are suitable treatment options?
The type of treatment depends on age of patient, severity of symptoms and desire for pregnancy. You need to discuss it with your doctor for all the possible options.

What are medical treatments?
There are medicines for relief of pain, arresting disease progress, treating and preventing future  complications.

1. The painkillers are from(NSAIDS), non-steroidal anti-inflammatory drugs to stronger pain relief medicines.
2. There are various hormonal  preparations:
   • Combined oral contraceptive pills
   • Progestogens
   • GnRH analogues
   • Mirena coil

What is the treatment of infertility with endometriosis ?
The infertility workup of history ,examination and investigations evaluate severity of endometriosis. Ovulation induction medicines can be tried in cases, if tubes are patent and there are no cysts in  ovaries. These  patients should be timely referred to a tertiary care center where there are facilities of IVF and ICSI.

How surgery is helpful in treating endometriosis?
It is helpful in patients not responding  to medical treatment, severe extensive disease or fertility problems. Laparoscopic surgery is beneficial in identifying and treating endometriotic nodules or  cysts. It can drain the endometriotic ovarian cysts, break down adhesion and restore normal structures of organs. There are some selected cases of severe endometriosis, with no desire of more children, where uterus and ovaries removal are necessary.

Remember, awareness and education about endometriosis, early diagnosis and treatment would certainly make an enormous difference.

DON’T LET ENDOMETRIOSIS TAKE YOUR STRENGTH AWAY

Dr. Ayesha Azam Khan