What is endometriosis?
Endometriosis occurs when cells that normally line the womb (the endometrium) are found elsewhere, usually in the pelvis and ovaries. It is a very common condition, affecting between 2 and 10 women out of 100.
What is the problem with endometriosis?
Common symptoms include pelvic pain and painful, sometimes heavy periods. It can cause pain during sex, pain in lower back, bleeding or pain while passing urine or stool,and long-term fatigue.
What causes endometriosis?
The exact cause of endometriosis is not known. It is thought to happen when cells that line the womb are carried to the pelvis via the fallopian tubes during your period. These cells respond to your hormones and bleed. Unlike the cells in the womb, which leave your body through the vagina, this blood has nowhere to escape. The blood accumulates and leads to adhesion (abnormal attachment)between organs. Endometriosis may be found:·
- on the ovaries, where it can form cysts (called ‘chocolate cysts’)·
- in the peritoneum (the lining of the pelvisand abdomen)·
- within the muscle wall of the womb (“adenomyosis”)·
- Occasionallyon the bowel and/or bladder.
How can I know that I have endometriosis?
Endometriosis can be difficult to diagnose. Women with severe endometriosis may not have any symptoms, while women with very mild disease may have severe pain or infertility. Endometriosis is suspected by history of pain or infertility. The doctor may carry out an internal examination with your consent. Usually a transvaginal ultrasound scan is done to check the uterus and ovaries. An MRI scan may be suggested if the condition appears to be advanced.But the“Gold standard” of diagnosis is laparoscopy. It is an operation where (“Microsurgery”), after making a small opening in the abdomen under anaesthesia, a telescope is introduced and the area is seen through camera in a television monitor. You may have a biopsy to confirm the diagnosis and images may be taken for your medical records.
How endometriosis is related to Infertility?
In around 50% cases, endometriosis can cause infertility, although this reason not properly understood. It may be related to the adhesion, causing difficulty in picking up the eggs from the ovaries by the fallopian tubes. Pain during sex may be reason for avoiding regular intercourse. In addition, it can interfere with ovulation (the release of an egg from the ovary), sperm transport, meeting between sperms and eggs and also the process of attachment of uterus with the embryo.
How endometriosis is treated?
Pain-relieving medication- This works by reducing inflammation. However, if you are planning to conceive, it is important to avoid certain painkillers (like diclofenac) during the time of ovulation (middle of the cycle) because they can interfere with ovulation.
Hormone treatments- These treatments reduce or stop ovulation and thus allow the endometriosis to shrink or disappear by decreasing hormonal stimulation. Most hormone treatments will also stop you becoming pregnant as long as you use them and can stop your periods temporarily.
They include: ·
- the combined oral contraceptive (COC) pill given continuously without the normal pill free break·
- an intrauterine system (Mirena®), which help sto reduce the pain and makes periods lighter; some women using an IUS get no periods at all·
- progesterone injection, tablets ·
- GnRHa (gonadotrophin-releasing hormoneagonists) injections. They are very effective but can cause menopausal symptoms such as hot flushes and are also known to reduce bone density.
Endometriosis-related pain is usually treated by these medicines. Before surgery, usually medicines are given to reduce the size and to reduce the blood loss during surgery. Unfortunately, after stoppage of medicines, often the symptoms of pain comeback.
Surgery- Surgery can remove areas of endometriosis. The surgery recommended will depend on where the endometriosis is and how extensive it is. This may be done when the diagnosis is made or may be offered later.
Possible operations include:·
- laparoscopic surgery – when patches of endometriosis are destroyed or removed·
- laparotomy (open operation) – for more severe cases. This is a major operation that involves a cut in the abdomen, usually along the bikini line.
Other options- Some women have found the following measures helpful:·
- exercise, which may improve your well-being ·
- cutting out certain foods such as dairy or wheat products from the diet·
- psychological therapies and counselling.
How laparoscopy is helpful?
Laparoscopy for endometriosis needs properly trained and skilled surgeons. Operations can range from “minor” (separating the adhesions, draining the chocolate coloured fluid) and “major” (like removing the cyst or removing major organs). The surgery has the advantage over medicines that it confirms the diagnosis and removes the diseased tissues. Laparoscopic surgery improves the pain and also increases the chance of natural conception. But there are risks related to anaesthesia and surgery. In particular, there is risk of injury to intestine and urinary tracts, even with the best hands. Laparoscopic removal of cyst can further damage the ovaries. The disease can come back again after few months or years and you may need repeated operations.
What happens if I cannot conceive even after laparoscopy?
Immediately after operation is the best time to conceive. You should not use any hormonal medicines that time. If natural conception does not happen, you can have short trial of treatments like ovulation induction (taking medicines to the chance of natural pregnancy) and IUI (intrauterine insemination). If with all these, you fail to get pregnant within one year after surgery, you should consider IVF (invitro fertilization) seriously. You also need to consider IVF earlier (not waiting for one year), if your age is more than 35 years, your tubes are blocked, partner is having sperm defects and also in case you are having extensive endometriosis.
Is laparoscopy mandatory for all cases of endometriosis and infertility?
Laparoscopy is not needed in all cases and treatment can be started after the doctors presume the diagnosis by history, examination and the ultrasound reports. If you need IVF for other purpose (like tube block, low egg count, low sperm count etc), laparoscopy may not be needed, unless if you have severe pain. If you plan for natural conception, other fertility factors are normal and your age is low, laparoscopy is definitely helpful.
What is the success rate after treatment?
Endometriosis(even after medicines or surgery) can interfere with any form of infertility treatment- ovulation induction, IUI and IVF. So, it’s better to start treatment earlier.
What is the cure for endometriosis?
Unfortunately, the only way of cure for endometriosis is by attaining menopause (permanent cessation of menses). This is possible by natural way or by operations to remove the ovaries and uterus.
Endometriosis is not cancer but it makes the women suffer a lot. Timely treatment by expert hands can help you conceive even with severe endometriosis.