KOCHI: Endometriosis is abnormal cell growth that lines the inside layer of the uterus, (endometrial cells) happening outside of it. Endometrial cells are shed every month during the menstrual cycle. When these cells are deposited outside their normal location, they develop to produce endometriosis. Common locations are the ovaries, fallopian tubes, surface of the uterus, adjacent pelvic peritoneum, and less commonly, intestines, bladder, caesarean scar site.
Causes
So far only theories have been put forward, with no definite cause identified. Associated with early onset of periods, infertility etc.
Symptoms
Most of the women do not have any symptoms and are unaware that they have endometriosis. However, when women do experience symptoms it may include pelvic pain which worsens before and during periods, painful sexual intercourse, pain during bowel movements, diarrhoea during periods, pain during urination and infertility. Other symptoms include chronic fatigue, irregular heavy periods, low backache, and chronic abdominal pain.
All you need to know
30 to 40 per cent of endometriosis has difficulty in getting pregnant. Early to late-stage disease can cause infertility by different mechanisms. Endometriosis can damage the fallopian tube, form ovarian cysts (called chocolate cysts because of the dark brown colour of old blood), both of which affects ovulation. Endometriosis is also known to release certain chemicals which may affect ovulation and fertilization.
Diagnosis
A gynecologist can suspect this condition during a routine internal examination. An ultrasound may not be able to detect early endometriosis but will be able to detect later stages and chocolate cysts. A definitive diagnosis is by a surgical procedure, laparoscopy, which is performed under general anaesthesia. We can directly visualize the endometriosis and take biopsies as well as perform procedures to tackle it. Often endometriosis is seen as a surprise diagnosis when laparoscopy is performed for other conditions.
Treatment
The main aim is to reduce pain, help infertility and manage bleeding issues. Unfortunately, there is no single solution for this progressive disease, neither is there any permanent solution. Treatment may be medical or surgical. The use of medications for endometriosis is firstly based on pain relief using simple pain killers which is effective is all that is needed. Secondly, the treatment is based on the fact that the monthly menstrual bleeding is responsible for the aggravation of the endometriosis deposits. Thus hormone medications which stop monthly bleeding are very effective like oral contraceptives, progestins, GnRH analogues, Mirena.
(The author is a senior consultant at department of women’s health)AsterMedcity, Kochi