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BRAIN ATTACK:

Endometriosis: Causes, Diagnosis, and Treatment

By Dr. Manju Khemani in Obstetrics And Gynaecology

Sep 14 , 2023 | 3 min read

Endometriosis is a chronic gynaecological condition that affects millions of women worldwide, causing significant pain and impacting their quality of life. If not diagnosed and treated, it can lead to infertility.

What is Endometriosis?

The innermost lining of the uterus is called the endometrium, on which the baby gets implanted. Endometriosis is characterised by the presence of endometrial-like tissue outside the uterus, commonly on the pelvic organs such as ovaries, fallopian tubes, and the lining of the pelvis. Cysts in the ovaries because of endometriosis are called endometrioma.

Causes of Endometriosis

The exact cause of endometriosis is still debated, but several theories shed light on its origins: 

  • Retrograde Menstruation: This theory suggests that during menstruation, some of the menstrual tissue flows backwards through the fallopian tubes into the pelvic cavity.
  • Genetics: A genetic predisposition to endometriosis has been observed, with a higher risk among women who have close relatives with the condition.
  • Immune System Dysfunction: An impaired immune response may fail to recognise and eliminate endometrial tissue outside the uterus.
  • Hormones: Estrogen, a hormone that regulates the menstrual cycle, is thought to promote the growth of endometriosis lesions.

Symptoms

This disease is more common in the reproductive age group. The patient usually complains of very painful periods. Pain may start before periods and continue during the period and may persist even when bleeding has stopped. Besides pain during periods, patients can also experience dyspareunia, which is pain during intercourse, chronic pelvic pain, and dyschezia. 50% of patients suffer from infertility or problems in conceiving.

Diagnosis of Endometriosis

The gold standard for diagnosis is Laparoscopy, a minimally invasive surgical procedure that allows direct visualisation of the pelvic organs and biopsy of suspicious tissue. Other diagnostic methods include ultrasound, especially transvaginal, and MRI of the pelvis.

  • Clinical Evaluation: Detailed medical history, pelvic exams, and symptom assessment aid in identifying potential endometriosis cases.
  • Imaging Techniques: Ultrasound and MRI can provide visual clues to the presence of endometriosis lesions.
  • Biomarkers: Research is ongoing to identify specific biomarkers in blood or urine that could aid in diagnosing endometriosis.

Treatment Options for Endometriosis

The treatment approach for endometriosis varies depending on factors like the severity of symptoms, the extent of the disease, and the patient's fertility goals. Treatment options include:

Medical Management

All the drugs that are used to treat the pain of endometriosis inhibit ovulation and, hence, are not suitable if the patient wants to conceive. These patients can try painkillers like NSAIDS.

Pain Management

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives are often used to manage pain and reduce inflammation associated with endometriosis.
  • Some newer Progestins like Dienogest may also suppress the progress of disease besides treating pain. This can also be given continuously for 5-7 years.
  • The second line of drugs includes GnRH analogues, which create a stage of pseudo menopause, and low estrogen in the body is also helpful in suppressing the disease and relieving pain. These cannot be given for a long time as they produce menopausal side effects and decrease bone density.

Surgical Interventions

Laparoscopic surgery can be both diagnostic and therapeutic, allowing for the removal or destruction of endometriosis lesions. In some of the severe cases, a hysterectomy may be considered.
Surgery is never the first line of management as it reduces the number of eggs when one is removing an ovarian cyst wall. Only when medical management fails, or diagnosis is in doubt does one resort to surgery. 
Even after surgery, the patient has to continue taking medicines for at least two years to prevent a recurrence. The nature of the disease is it recurs till the patient has reached menopause.

Fertility Treatments

For women trying to conceive, assisted reproductive technologies like in vitro fertilisation (IVF) may be recommended. Initially, if all other factors are normal, one can try IUI.

Lifestyle Modifications

Diet, exercise, and stress reduction techniques can play a role in improving overall well-being.
Early diagnosis, a multidisciplinary approach, and ongoing research will pave the way for a brighter future for individuals battling endometriosis.