ENDOMETRIOSIS
Introduction
Endometriosis is a chronic condition seen in women of child bearing age group due to ectopic presence of bits of the lining of the womb. If it is found in the muscles of the womb it is called Adenomyosis. It can be commonly found in the lining of the pelvis, the ligaments that support the uterus, the lining of the bladder and can infiltrate the lining of the rectum, the space between the rectum and the vagina and the bowel. When present in the ovaries it can give rise to cysts that is classically mentioned as “chocolate cysts” of the ovary due the altered blood present in them. Endometriosis is rarely seen in post-menopausal women.
Symptoms
‘How to Tell if You Have Endometriosis’? How can I tell the difference between severe period pain and endometriosis? What are the other symptoms?
The symptoms associated with endometriosis are painful periods that are usually not relieved with painkillers. You may also experience persistent pelvic pain which gets worse during the periods. A lot of women also experience a sense of heaviness in their pelvis, specially associated with pelvic endometriosis. Lower backache is another symptom which is related to endometriosis.
Some of the words used to describe pelvic and period pain associated with endometriosis are, stabbing, spasmodic, dull aching, constant throbbing, sharp agonising, shooting and cramping.
Some women describe their period so painful that it results in them feeling faint and nauseous.
Pain during and after having sex is a common symptom associated with endometriosis. You may also experience pain during passing urine and moving your bowels. Rarely blood in your stools and urine may be associated with endometriosis.
When should I go to the doctor?
A combination of these symptoms should prompt you to seek the help of a doctor.
Treatment
Does it have a cure?
Endometriosis is generally a chronic condition with a variable course and progression pathway. The gold standard to diagnose pelvic and abdominal endometriosis is by doing a diagnostic laparoscopy, by which you can examine the pelvis and look inside the tummy using a telescope.
Managing your symptoms is the mainstay of treating endometriosis. Controlling you pain with painkillers and by supressing your ovaries from producing hormones that exacerbate your symptoms with hormonal preparations are some of the ways of treating endometriosis.
Surgical ablation or resection can be done using minimal access approach to remove endometriotic deposits from the organs affected. Often this can result in improved fertility outcomes.
Using the Mirena intra-uterine system can help in managing period pain.
In women who have completed their family, who have exhausted medical and conservative surgical approaches, performing a hysterectomy and removing the ovaries and tubes may be the last resort in managing this profoundly debilitating condition.
How does it affect fertility?
Endometriosis can have significant impact on a women’s fertility. The present of endometriotic implants in the pelvis can result in scarring, adhesions and cause tubal damage. The ovaries when affected by “chocolate cysts” may not ovulate regularly, resulting in anovulatory cycles. Surgical treatment has often resulted in better fertility outcomes in women with endometriosis. However, some women will need to seek the help of fertility specialist to achieve a pregnancy.