Endometriosis
Endometrium is the inner lining of the uterus.This lining develops every month and gets partially shed during menstruation.If the cells of endometrial lining develops outside the uterus, it is called endometriosis. These cells are out of their natural habitat and cannot be excreted through menstruation.They cause local irritation, adhesion formation between pelvic organs and blood like fluid collection causing various symptoms.
Endometriotic lesions can vary from small size spots to big or multiple chocolate cyst in the ovary. Endometriosis can affect the ovaries, nearby organs like urine bladder or far away organs like the lungs.
Symptoms
Dysmenorrhoea – pain during menstruation,dyspareunia – pain during sexual intercourse and infertility are common symptoms of endometriosis. Endometriosis is also a common cause of chronic pain in pelvic region.
Endometriosis can cause adhesionsbetween ovaries & tube (they are stuck together). Due to this the egg pickup from tube by the ovary is affected. It is one of the reasons of infertility in endometriosis.
Endometriosis is a progressive disease and size of endometriotic lesions and symptoms can worsen overtime.
Why endometriosis occurs?
The exact reason why endometriosis occurs is not properly understood.
Various theories include retrograde passage of menstrual blood during periods, autoimmune mechanism,and familial tendencies.
Diagnosis
Sonography
Sonography can diagnose some forms of endometriosis. Most common lesion is a cyst in ovary called chocolate cyst because of color of fluid inside. In sonography doctor may notice uterus and ovaries may be less freely mobile. Expert doctor can diagnose endometriosis early and evaluate the extent of disease more precisely.
Laparoscopy
Laparoscopyis the visualization of pelvic organ through an endoscope put in abdomen. It is a surgical procedure where the endoscope is put through a small incision near the navel (umbilicus) through a camera attached to the endoscope. We can visualize uterus, tubes, ovaries etc. We can take biopsy from these organs through laparoscopy.Based on severity & spread, endometriosis can be divided to 4 grades. Minimal ,mild, moderate and severe.
Laparoscopy is not only for diagnosis but also for the treatment of disease.
Surgeon can dissolve the endometriotic lesion by cauterization. (Applying electric current). Surgeon can remove the endometriotic lesion like chocolate cyst. Adhesions between organs can be cut. The tubal patency can be checked. Read more about laparoscopy
Other investigations like CT Scan, MRI are useful sometimes.
Treatment
The line of treatment depends on nature and extent of symptoms, desire to have a child and ovarian reserve capacity.
Endometriosis can largely be suppressed by pregnancy and breastfeeding as these conditions temporarily stop the menstrual cycle.
In women planning to get pregnant
If you plan to get pregnant, you should plan pregnancy early.
Endometriosis has minimal if any effect on pregnancy and child development, if you are planning a pregnancy removal of endometriosis is only indicated if you find difficulty in conceiving naturally.
Laproscopic Surgery
Laproscopic surgery is the best form of surgery because it gives us clear visualization of the extent of disease. Severe endometriosis surgeries require high level of skill and experience.
Chances of recurrence of endometriosis is there. So, after surgery you should plan pregnancy ASAP for best outcome.
Any form of surgery may damage the ovaries due to removal of some normal ovarian tissue with cyst and use of current for cautery. Thus, evaluation of egg count is imperative before surgery. If egg count is low IVF may be a better treatment option. Removal of endometriosis is not required before IVF as it does not affect IVF success rate. About IVF
In women not planning to get pregnant
If you are not planning a pregnancy or have completed your family, depending on the extent of endometriosis medical or surgical therapy is recommended.
Medical Treatment
Pain killers: In mild forms simple analgesics like aspirin Ibuprofen or Mefenamic acid are preferred therapy for pain relief
GNRHAnalogues: They suppress the release of gonadotrophin which in turn stops the release of oestrogen from ovary. GnRH analogues will cause artificial menopause. Once you stop the medicine, menstruation will restore normally. GnRH analogues have unwanted side effects like hot flushes, dryness of vagina, weakening of bones. Most of the side effects of this injection is completely reversible after stoppage of medicine. For bone strength calcium and other form of add back therapy may be recommended.
Dienogest: It is a synthetic progesterone which has relatively better safety profile. Many studies show it to be equally effective to GnRh analogues.
Surgery: Conventionally surgery is similar to surgery for women planning pregnancy. In severe cases hysterectomy or removal of ovaries may be required.
Adenomyosis
Adenomyosis is a disease similar to endometriosis. Here the endometrial tissue develops in the muscle layer of the uterus. Monthly menstrual blood can not escape from this muscle layer. It causes this layer to swell and thicken.
Symptoms are painful periods and heavy menstrual flow. Adenomyosis can significantly reduce the chances of embryo implantation causing infertility and miscarriage.
Adenomyosis can be diffuse affecting whole of the uterus or localized producing an adenoma.
Medical treatment is like endometriosis. Adenomas may be surgically removed. However, in most cases uterus preserving surgeries do not give very good result. In severe form hysterectomy may be required.
We have developed specialized infertility IVF protocols for adenomyosis treatment for the best results.
Advantage Bavishi Fertility Institute
Our experienced doctors can diagnose endometriosis early. Extent of disease & ovarian egg count help us determine the best treatment for you. Unmatched surgical skill for near complete removal of disease. Our specialized protocol has helped us achieve pregnancies with IVF in patients of severe adenomyosis and severe endometriosis.
Ahmedabad