What is endometriosis?

It is a condition in which the endometrium (the innermost layer of the uterus) is found outside the uterus and in other pelvic organs like ovaries, bowel, bladder, peritoneum etc.

What is the prevalence of endometriosis?

It is a disease of reproductive age group and mostly presents in women of 30- 40 years of age.

What all sites can endometriosis involve?

• Peritoneum
• Ovaries
• Fallopian tubes
• Surfaces of the uterus, bladder, ureters, intestines, and rectum
• Cul-de-sac (the space behind the uterus)

What is the patho-physiology behind endometriosis?

As defined above, endometriosis is presence of endometrial tissue outside the uterine cavity. So, the endometriotic implants respond to hormonal changes during menstrual cycle in the same way as does the endometrium. They grow and bleed during the menstrual cycle which causes irritation and inflammation of the surrounding tissue which further leads to scarring and adhesion formation with the adjoining tissues. This inflammatory process occurs and worsens in every cycle and is the reason of severe dysmenorrhea before and during menstruation.

Can endometriosis lead to infertility?

Yes, in approx. 40% of infertile women, the cause is endometriosis. It reduces the number and quality of eggs and also interferes with the motility of fallopian tubes and in extreme cases may even cause blockage of the tubes.

What are the symptoms of endometriosis?

• dysmenorrhea (painful periods)
• dyspareunia (pain during intercourse)infertility
• chronic pelvic pain (pain in lower abdomen for >6 months)
• dysuria (pain during urination)
• dyschezia (pain during bowel movements)
• heavy menstrual bleeding

How is it diagnosed?

physical examination
pelvic examination
diagnostic laparoscopy (gold standard test)

What medications are used to treat pain of endometriosis?

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs),
Oral contraceptive pills

Gonadotropin-releasing hormone agonists (GnRH)
Oral progestins (dienogest)

What is the treatment of infertility caused by endometriosis?

Infertility treatment requires surgical management. Excision of endometriotic implants and endometrioma of ovary; opening up of blocked tubes; clipping of hydrosalpinx are few of the many surgical procedures that can be offered to infertile couples with good outcomes both in natural cycles and IVF.

Is there any cure for endometriosis?

Endometriosis can be treated but not cured. Medical management is used to get relief from pain but is not definitive. Even after surgical excision of the implants there is a chance for relapse. Relapse is seen in 40–80% of women within 2 years of surgery and is linked to the severity of the disease. Medical management combined with surgical may help extend the symptom free interval.

Is there any role of hysterectomy in managing endometriosis?

If pain is severe and does not respond to medical and surgical management and the family is complete, removal of uterus and both ovaries can be considered as the last resort.