Endometriosis is a common medical problem occurring in women of reproductive age group, wherein the tissue that forms the lining of the womb is present outside the womb and sometimes on other organs in the body. In normal women, the lining comes out in their menstrual flow. But when women with endometriosis get their period, this tissue swells and bleeds, just like the lining of the uterus. This is often painful and can result in a scar tissue.
We speak with Dr Anagha Karkhanis, consultant IVF and reproductive surgery at Cocoon Fertility about the condition and how it can be eased.
What are the symptoms and causes of this condition?
Endometriosis is usually found in the lower abdomen or pelvis, but can appear anywhere in the body. Pain in the lower abdomen, lower back or pelvis and pain in periods are the most common symptom of endometriosis. These symptoms are often “cyclical” that means the pain is worse right before or during the period and then improves.
Many women with endometriosis face difficulty getting pregnant and this may be the first presenting sign. Women may also experience pain during intercourse.
Other symptoms include pain in bowel movements, bloating, constipation, blood in the urine and pain in urination. On the other hand, some women with endometriosis may not have any symptoms at all.
Can it be avoided or prevented? How?
Endometriosis has been linked to genetic, immune system, physical, environmental and lifestyle factors. Although endometriosis cannot be completely prevented, timely diagnosis and treatment can help control its further progression or worsening. Healthy diet, regular exercise, avoiding alcohol and excess caffeine are advised in such cases.
What are the treatment options?
Endometriosis treatment is customised according to the woman’s presenting complaint. If the woman is suffering from infertility, then the presence, extent and severity of the endometriosis is judged with the help of laparoscopy (key-hole surgery). In mild cases of endometriosis, IUI can be done. However, if endometriotic lesions are advanced then IVF is needed.
For pain, around the time of periods, hormonal and other specific pain, relief medications help. However, these hormonal preparations offer contraception and hence cannot be used if the woman is trying for a baby at the same time. For severe pain, the endometriotic spots can be burnt during the laparoscopy using cautery or LASER.
If the woman suffers from pain with bowel movements or micturition, it could be because of scar tissue causing adhesions. These adhesions can also be released during a laparoscopy. Despite surgical removal, there is a possibility of recurrence of endometriosis within months or years.
Is conception possible even if a woman is diagnosed with endometriosis?
The incidence of endometriosis in women of reproductive age group is about 5-20 per cent. However, 30-40 per cent of women with endometriosis suffer from infertility. Studies show that the major problem in cases of endometriosis is the delay of a few years in the patient approaching the doctor. That is due to lack of awareness of the condition and its symptoms.
There may be a further delay in diagnosis when that time has been spent on futile, temporary relief treatments. Timely diagnosis is essential for targeted fertility treatment. For mild cases, IUI may help. However, in advanced cases, IVF offers the best chance of successful conception.
Endometriotic spots are commonly found around the womb, in the pelvis. Bleeding and scar tissue from these spots can cause the pelvic organs like uterus, fallopian tubes, ovaries and intestines to stick to each other forming a frozen pelvis. This often leads to blockage of tubes and infertility.
Sometimes, this tissue may be present inside the ovaries. And so, every time, the woman has her period, there is bleeding in this tissue inside the ovary. As a result, thick dark blood accumulates in the ovaries forming an endometriotic cyst, also known as a ‘chocolate cyst’ because the thick fluid resembles a chocolate. This not only destroys the ovarian tissue, but also affects the quality and quantity of eggs, thereby affecting the fertility further.