It is time to raise awareness of a disease that affects women. Dr Rooma Sinha, associate professor, AHERF, senior consultant gynecologist, laparoscopic and robotic surgeon, Apollo Hospital talks to City Express about diagnosis, symptoms, and treatment for Endometriosis.
One can know that they have Endometriosis if they have symptoms like pain in periods, heavy bleeding, difficulty in conception or simply altered bowel habits with gas around the time of their periods. A definitive diagnosis usually requires visual inspection by laparoscopy. Ultrasonography can also pick up the disease if ovarian cysts have already developed.
Endometriosis and hereditary
Not necessarily. If one has family history of Endometriosis then there is increased chance of developing it. But does not necessarily mean that all family members will have it.
Endometriosis & pregnancy
Around 30 per cent of women who have Endometriosis can have difficulty in conceiving. But difficult to say if you will particularly have difficulty as every case is different and we don’t know for sure until you try to conceive. However, laparoscopic surgery increases the chance of conception by 30-40 per cent in early stage disease (stage one and two). Another fact to understand is that pregnancy in a way also treats the Endometriosis due to continuous high dose progesterone secretion that takes place during the nine months of pregnancy.
Endometriosis and recurrences
Endometriosis is a chronic disease and recurrences are therefore common. The usual reasons for recurrence are inadequate resection during the first laparoscopic surgery or conditions that predisposed its appearance in the first place are usually still present. On an average, one in three patients who had a laparoscopy for endometriosis will require a repeat procedure within five years. Complete removal of all implants during the first surgery is therefore important. Robotic assisted laparoscopic surgery gives the advantage of precise and complete removal of all endometriosis with preservation of ovarian tissues for future child bearing.
There is no definitive cure for Endometriosis, but there is treatment. Surgical treatment aims at removing all the Endometriosis, which would mean removing uterus, both ovaries and all the endometriotic implants in the pelvic cavity. Medical treatment aims at alleviating the symptoms and can provide relief to an extent. Different women may require different treatments or a combination of treatments. Surgical treatment is at times difficult due to adhesive nature of the disease and here also robotic assistance helps to complete laparoscopic removal with negligible chance of conversion to open surgery.
Is Endometriosis cancer?
No. Usually Endometriosis is a benign (non cancerous) disease but can behave and affect areas around the uterus like a cancer. Some research shows that women with Endometriosis have a slightly higher risk of developing a particular type of ovarian cancer, but it is still not confirmed by hard scientific facts. There are also some reports where endometriotic ovarian cysts have become cancerous.
Whom to consult?
A gynecologist should be the person to consult. However, many times both patients and doctors often ignore dysmenorrhea as an inconvenience of having menstrual cycles. A gynecologist can help you assess your symptoms initially. Treatment of endometriosis often requires a specialist care and experience. If one needs surgical correction it is better one at center with surgeon have extensive experience in managing Endometriosis by laparoscopy or robotic assisted surgery.
Depending on the level of Endometriosis the operation can be quite complex and not everyone is trained to do it. The first surgery gives the best chance of controlling the disease. Surgery is often a delicate balance between what to remove and what to preserve so as to give best outcome in terms of pain relief and pregnancy outcome.