Endometriosis is a common gynaecological condition in females where the innermost lining of the uterus called endometrial tissue starts to grow outside the uterus. It can involve many organs of body but effects commonly ovaries, tubes and tissue lining pelvis. It can affect the ovaries leading to blood filled cysts. It can cause tubal block and can make the uterus bulky. This type of growth on the surface of pelvic organ can cause adhesions These growths are very responsive to hormonal changes in body, it grows and breaks and bleed during the menstruation, the surrounding tissue thus forms scar tissue. These bands of fibrous tissue cause adhesions and thus pelvic organs stick to each other.
Q2 What is the cause of endometriosis?
We are still finding the exact cause of the disease. Few causes could be genetic, faulty immune system, back flow of menstrual blood etc.
Q2 How can I tell if I have endometriosis?
Endometriosis is unique in sense that the signs and symptoms don’t match with the disease load in the body. Many women don’t have any complains or symptoms and when they go for consultation, they first time realize that they are having the disease. But in majority it causes lot of pain which especially during periods which is progressive in nature and sometimes to the extent that it can interfere with daily activities of life. Some women find out about the condition when they can’t get pregnant. Almost half of all women who have endometriosis can have difficulty in conceiving. The symptoms commonly encountered are
1 Pain before and during periods
2 Pain/ cramps during ovulation
3 Pain when sexually intimate
4 Generalized fatigues
5 Increased frequency and pain during passing urine
6 Chronic pelvic pain
7 Pain with bowel movement
8 Heavy bleeding
9 Infertility
Q What are the risk factors?
1 Family history of endometriosis.
2 Starting with periods at an early age .
3 Short menstrual cycle e.g. less than 27 days .
4 Heavy periods
Q How can one diagnose endometriosis?
The diagnosis can be made by pelvic examination as well as ultrasound. This ultrasound can be done abdominally or vaginally to get the best view of pelvic organs. MRI may be needed to diagnose deep endometriosis. Laparoscopy is beneficial as superficial, or surface implants can only be seen during surgery as can be dealt as the same time.
Q How does endometriosis cause infertility?
This lining of uterus which grows in endometriosis can affect the reproductive function of the female by affecting the function of tubes, ovaries and causing disturbed tubo ovarian relationship.
1 Effect on ovaries – It interferes with quality of eggs due to local inflammation. Presence of endometrioma [ old blood filled with cyst ] can affect the growth of eggs
2 Effect on tubes – Tubes can be blocked /scarred due to presence of abnormal endometrial tissue implants surrounding them. They cannot perform the function of egg pick up and transportation due to this blockage. This leads to decrease in chance of natural pregnancy and increase in miscarriage and ectopic pregnancy.
3 Inflammation – The presence of endometrial tissue causes the production of cytokines which in turn inhibit the function of the reproductive cells – egg as well as sperms. It also decreases the fertilization capacity, defective progesterone receptors that might affect implantation and early pregnancy.
Q Can endometriosis be cured?
It is very difficult to cure endometriosis as it a chronic disease. Its management depends on age of women, symptoms, infertility duration, egg quality, extent and severity of disease, prior fertility treatment any related partner factor.
Q What are the treatment options available for endometriosis?
The treatment can be divided into medical and surgical procedures. The treatment plan also must be individualized if planning for pregnancy.
Pain killer with or without hormonal contraceptives are generally the first line therapy which in effective in reducing pain in endometriosis. Other medicines like progestins, hormonal IUCD, GnRH Agonist are often prescribed depending upon the severity of symptoms Surgical treatment can be advised with medical treatment if medicines fail to provide relief. The pain relief usually last while taking the medicines and symptoms can return after stopping medicines .
Laparoscopy is minimally invasive surgery done to view the pelvic structure and at the same time excise the visible lesions, adhesiolysis , restoring the normal tuboovarian anatomy . Removal of chocolate cyst is done instead of drainage as it reduces the recurrence and provides better pain relief. Endometriosis surgery can reduce the ovarian reserve so its planning should be done carefully.
Q What are the treatment options available for endometriosis and subfertility?
It depends on the age, symptoms and stage of disease. In case of minimal and mild stage disease fertility drugs with IUI can be tried for better fertilization and to increase the chances of pregnancy .In IUI washed and concentrated sperms are placed in the uterus at the time of ovulation .
In moderate to severe disease where tubes are not working properly and bilateral chocolate cysts in ovaries are seen, IVF is the right choice which offers maximum chances of conception. If pregnancy does not occur after laparoscopic treatment, then IVF may be the best option to improve fertility .Multiple attempts to remove cysts will reduce the ovarian reserve and decreases the chance of successful IVF .
When trying for pregnancy it is better not to take any hormonal medicines as they will suppress ovulation and delay pregnancy.
IVF helps in making embryos by combining egg and sperms in laboratory. the resulting embryos are placed in the woman’s uterus. Hormones used in IVF can neither cure nor aggravate the condition.
Q How can I increase my fertility with endometriosis?
While the journey towards parenthood can be tough. but there are things you can do to prepare yourself for the future journey
1 Reduce the intake of sugar, alcohol smoking and enrich your food with fresh vegetables and fruits.
2 Stay active by exercise, yoga etc.
3 Fertility consultation for reproductive health checkup and discussing the fertility options can be done .
