Dr. Sharmishtha Patra

Endometriosis is a condition that affects women, where the endometrium or the tissue lining the inside of the uterus, also starts growing on the outside. It is greatly painful and may affect everyday life largely. Here is a look at how the condition is diagnosed and how it can be treated.

Diagnosis of Endometriosis
Diagnosing the disorder can involve a few tests. Patients who visit the doctor, usually complain about the pain experienced during sexual intercourse or urination. The doctor will ask you a few questions regarding the symptoms that you experience and the general area where you feel the pain.

1. Pelvic Exam- This is the first test that the doctor may perform to determine the cause of the problem. The doctor will manually look for cysts and other abnormalities in the pelvic region. However, this examination is often inconclusive.
2. Ultrasound- High frequency sound waves are used to detect any abnormalities during this test. However, an ultrasound is only capable of revealing cysts, in the absence of which endometriosis cannot be confirmed through this test.
3. Laparoscopy- In this slightly invasive procedure, the doctor will use a specialized equipment to look inside the uterus. However, the condition is generally medically managed, before a laparoscopy is ordered, as the procedure involves some risks.

Treating Endometriosis
Endometriosis treatment relies on both medication and surgery. Since the symptoms and intensity of the problem differs from one woman to the next, finding the right drug to use may be challenging. Here is a detailed look at the treatment options for Endometriosis.

1. Pain medications- Over-the-counter pain medications can help deal with some of the discomfort that accompanies endometriosis. However, since the intensity of pain varies from one patient to the next, the correct dosage for medications may be difficult to determine. Patients will need to report whether the current dosage of medicine is working or whether a higher dosage may be required.
2. Hormone therapy- Supplementing certain hormones in the body may provide relief from the pain in some cases. Hormonal contraceptives, progestin therapy and hormone altering drugs are used.
3. Hysterectomy- In case of severe Endometriosis, women who do not want to conceive can consider surgically removing their uterus. This is usually the last resort.

Ensure that you find a doctor whom you trust completely when you are diagnosed with the condition. Treatment becomes much simpler under the care of such a physician.

A hysterectomy is a surgical procedure to remove a woman's uterus. The uterus, also known as the womb, is where a baby grows when a woman is pregnant. The uterine lining is the source of menstrual blood.
You may need a hysterectomy for many reasons. The surgery can be used to treat a number of conditions including certain types of cancer and infections.

A woman may have a hysterectomy for different reasons, including:

1. Uterine fibroids that cause pain, bleeding, or other problems
2. Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal
3. Cancer of the uterus, cervix, or ovaries
4. Endometriosis
5. Abnormal uterine bleeding
6. Chronic pelvic pain
7. Adenomyosis, or a thickening of the uterus
8. Hysterectomy for noncancerous reasons is usually considered only after all other treatment approaches have been tried without success.

Types of Hysterectomy: 
Depending on the reason for the hysterectomy, a surgeon may choose to remove all or only part of the uterus. Patients and health care providers sometimes use these terms inexactly, so it is important to clarify if the cervix and/or ovaries are removed:

In partial or supracervical hysterectomy, the upper portion of the uterus is removed, leaving the cervix intact.

Complete or total hysterectomy involves the removal of both the uterus and the cervix. This is the most common type of hysterectomy performed.

Hysterectomy with bilateral salpingo-oophorectomy is the removal of the uterus, cervix, fallopian tubes, and ovaries.

Radical hysterectomy is an extensive surgical procedure in which the uterus, cervix, ovaries, fallopian tubes, upper vagina, some surrounding tissue, and lymph nodes are removed.

Hysterectomy Surgical Procedures
Traditionally, hysterectomies have been performed using a technique known as total abdominal hysterectomy (TAH). However, in recent years, two less-invasive procedures have been developed: Vaginal hysterectomy and Laparoscopic hysterectomy:

1. Total Abdominal Hysterectomy (TAH): In a total abdominal hysterectomy (TAH), the surgeon makes an incision approximately five inches long in the abdominal wall, cutting through skin and connective tissue to reach the uterus. This type of surgery is especially useful if there are large fibroids or if cancer is suspected. Disadvantages include more pain and a longer recovery time than other procedures, and a larger scar.
2. Vaginal Hysterectomy: A vaginal hysterectomy is done through a small incision at the top of the vagina. Through the incision, the uterus (and cervix, if necessary) is separated from its connecting tissue and blood supply and removed through the vagina. This procedure is often used for conditions such as uterine prolapse. Vaginal hysterectomy heals faster than abdominal hysterectomy, results in less pain, and generally does not cause external scarring.
3. Laparoscopic Hysterectomy: During a laparoscopic hysterectomy, your doctor uses a tiny instrument called a laparoscope. A laparoscope is a long, thin tube with a high-intensity light and a high-resolution camera at the front. The instrument is inserted through incisions in the abdomen. Three or four small incisions are made instead of one large incision. Its advantage is less bleeding, less pain, faster recovery and shorter hospital stay. Its technically advanced and demands a lot of skill on the part of the surgeon.

A hysterectomy is a major decision that you should take after careful consultation with your doctor. You should understand the reason for the operation, the benefits and risks and the alternatives to a hysterectomy.