I am Dr. Anu Sidana, obstetrician and Gynecologist, Aastha Medicare. Today I am going to speak about endometriosis.
What is endometriosis? it is a painful disorder in which the cyclical period it becomes painful, tissue that involves the uterine cavity there is an endometrial lining also comes outside the uterus so this is known as displaced endometrium, it involves your ovaries, fallopian tube outside of the uterus as well as the whole abdominal cavity may be affected because of endometriosis. What happens in endometriosis is that this displaced endometrium which is lying outside the uterus also undergoes cyclical changes as the uterine lining also undergoing so it thickens and it's break out and it bleeds as the patient has cyclical periods.
Under the effect of hormones, this lining which is lying outside the uterus also thickens and bleeds and it doesn't come out as there is no exit, this blood gets trapped inside the ovaries or inside the abdominal cavity in the ovaries because of collection of blood it leads to formation of endometrioma or chocolate cyst, because of this blood collection in the abdominal cavity, pelvic as well as the abdominal lining gets irritated and it leads to formation of fibrous band inside the abdominal cavity and as a result of this various organs of the pelvic cavity like you uterus tubes, ovaries as well as rectum lying behind the uterus and the bladder in front stick to each other and leads to scarring.
How does the patient present to us? the typical symptom of endometriosis is painful cyclical bleeding, normal side cramping is normal during periods but in endometriosis there is extreme pain which starts before the period, may last during the periods and after the periods also, so patient feels cyclical painful bleeding and that painful cycle leads to disturbance in her daily routine activities and affect the quality of life because of severe dysmenorrhea patient is not able to do her daily activities even they are not able to resume the work.
It also leads to pain during intercourse as well as during periods patient may feel pain during bowel movements as well as urination, this is known as hematochezia as well as patient may not have any symptoms because of endometriosis, so the severity of the pain is not related to the extent of endometriosis sometimes patient having mild endometriosis they presents with severe pain but otherwise in another patient, patient having severe endometriosis they will not feel any pain and they are diagnosed only when they are coming to us because of endometriosis the whole anatomy is distorted and patient may have difficulty in conception also. So most of the patient they present after marriage when they feel difficulty in conception. So they are mainly approaching us when they are not able to conceive after 2 to 3 years of their marriage and their diagnoses at this time due to the fact that they are suffering from endometriosis.
Now what is the theory behind it? there is no exit cause known till now which leads to endometriosis. one explanation is retrograde menstruation, the menstrual blood with endometrial cells which is coming out of the uterus every period that flows retrogradely and it lines the ovaries, fallopian tube as well as abdominal cavity which leads to endometriosis. Second theory is known as induction theory that the cells aligning the abdominal cavity as well as peritoneal cavity they undergo transformation and those peritoneal cells they convert into an endometrial cells and they respond to various hormones and lead to cyclical changes in the displaced endometrium. Third last but not the least we have seen that patient after hysterectomy or after cesarean section they develops surgical scars endometriosis that is the endometriosis cells they invade the scar tissue and that lead to formation of surgical scar endometriosis.
So what are the risk factor for endometriosis? one is late pregnancy, second is starting period at an early age and 3rd achieving menopause at an older age. Patients who are exposed to the periods at an early age and those who achieve menopause at a late age they are more prone to endometriosis, reproductive tract anomalies they also increases the risk of endometriosis as well as patient having low BMI they are also prone to endometriosis.
Now what are the various applications due to endometriosis? as I have told because of endometriosis there is alteration of anatomy that is distorted anatomy between the uterus, fallopian tubes and ovaries which leads to because of fibrosis due to lesions so it leads to inability to conceive so what are the various complications which may arise in the long run because of endometriosis. One is as we all know it leads to cyclical painful bleeding so patients they become scared of endometriosis of their periods, affects their daily quality of life during periods and irrespective of day of cycle, then second comes infertility that is difficult in conception as we all know because of endometriosis there is distortion of the anatomy between the uterus, fallopian tubes and the ovaries which leads to difficulty in conception, then because of endometriosis studies have shown that patients who are suffering from endometriosis they are at increased risk of ovarian cancer.
Now how to diagnose endometriosis? we have different diagnostic modalities by which we can diagnose the patient is having endometriosis. One is clinical symptoms that patient having cyclical painful bleeding and associated with other findings on ultrasound and MRI which are suggestive of the patient is having bilateral ovarian cyst or single cyst and the gold standard for diagnosing endometriosis is laparoscopy, with the help of laparoscopy we can visualise directly uterine-fallopian-ovarian relationship as well as we can diagnose the extent of disease and simultaneously we can treat it.
Now coming to the treatment depending upon the age group and the presenting symptoms we treat the patient, if the patient is young and having mild symptoms of endometriosis then simple this age will work, if patient is having problem in conception then we give the treatment according to that and nowadays we have various suppressive therapies available to suppress the cyclical changes in the displaced ovarian tissue so that endometriosis doesn't grow and doesn't cause any further distortion in the anatomy of the tubes and ovaries and we advise patient to conceive as early as possible after the marriage because pregnancy has a suppressive role on endometriosis and we have seen that sometimes endometriosis gets resolved after the pregnancy and it is completely resolved once the patient achieve menopause.