KOCHI: It is a question that nags the minds of many women suffering from endometriosis in silence. Can I get pregnant? Many times this question goes unanswered out of shame. Like me, many medical practitioners share the view that this tendency or habit among women to suffer the disease in silence is the singular issue that stands between them and motherhood. If only they believe in modern medical science, they can get cured and they can turn a new leaf in life.
Around 2.5 crore women in India suffer from endometriosis which is four out of 100. According to the World Health Organization (WHO), the condition is believed to affect 10% (190 million) of women worldwide who are of reproductive age. More importantly, the incidence of this disease among women living along the coastal belts of states like Kerala, Karnataka and West Bengal is found to be very high.
Equally important is the fact the fecundity rate’ or the ability to conceive among endometriosis patients improves to near normal if treated properly. In contrast, the chances of getting pregnant in untreated cases remain as low as 1% to 2%.
What is endometriosis?
Endometriosis is a chronic debilitating disease that impacts the quality of life. Diagnostic delays are common and may lead to a reduction in reproductive potential/fertility. It is a disease where a tissue similar to the lining of the uterus grows outside the uterus, causing pain and/or infertility. This progressive disease can afflict people from the age of 15.
A combination of painful periods, chronic pelvic pain, pain during and/or after sexual intercourse, painful bowel movements, painful urination, fatigue, depression or anxiety, abdominal bloating and nausea are the symptoms of this disease.
As a first-order derivative, endometriosis can cause infertility due to the chronic inflammatory effects leading to adhesions/scarring of the peritoneum, pelvic cavity, ovaries (chocolate cyst), fallopian tubes, uterus, or bladder too.
Cause
There is no single answer to the question of what causes endometriosis. That is because the exact cause(s) of the condition is said to be multifactorial. Risk factors include early menarche, shortened menstrual cycle, increasing age, family history of endometriosis, infertility, intercourse during menstruation, low body weight, high hormone exposure in the diet, low omega 3/antioxidant-rich diet (green leafy vegetables and fruits).
Diagnosis
Detecting endometriosis is a multi-stage medical procedure. The first step usually is to carefully study the history of menstrual symptoms and chronic pelvic pain. This forms the basis for suspecting endometriosis. Early suspicion of endometriosis is a key factor for early diagnosis, as the disease is a bit deceptive to detect since symptoms more often than not mimic other medical conditions leading to diagnostic delays.
Treatment
Medicines may be necessary for treatment and fertility enhancement for a prolonged duration, but if surgery is required, it has to be performed by an endometriosis expert through the laparoscopic technique. Depending on the severity of the disease the prognosis is decided. 40-45 % of women can conceive after surgery without any ART
Endometriosis does not automatically lead to infertility. But the incidence severity of the disease can make it difficult for women to get pregnant.
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The writer is consultant gynaecology, laparoscopic surgeon and infertility specialist (Endometriosis clinic) at LOURDES Hospital, Kochi