It is an enigmatic disease with presence of endometrial glands outside of uterus. There are many theories but the exact etiology of endometriosis is yet to be explained. There is an increasing trend in the incidence of endometriosis due to changes in the lifestyle pattern of high consumption of fat rich diet, early age at menarche. It is commonly seen among the higher socioeconomic class.
The most commonly affected organs are the ovaries, fallopian tubes, pelvic peritoneum, bowel, bladder and occasionally the upper abdomen, thorax.
There are a variety of symptoms in women with endometriosis.
- Dysmenorrhoea (painful menstruation)
- Chronic lower abdominal / pelvic pain
- Menorrhagia (excessive / prolonged bleeding – brownish discharge)
- Dysparunia (painful intercourse)
- Pain during passing motions / urine
- Blood in urine during periods
- Infertility (difficulty in conception)
Diagnosis of Endometriosis is challenging as there is no single test for identification. Pelvic examination There is no specific blood test available to diagnose it. Ultrasonography can be helpful to pick up ovarian cysts and if the content shows ‘Ground glass appearance’, endometriosis is suspected.
Few challenges in the diagnosis are – adhesions due to endometriosis cannot be picked up always, conclusive diagnosis is not possible (Laparoscopy and histopathology needed for confirmation), peritoneal endometriosis cannot be picked up.
Pelvic sonography, MRI can pick up ovarian endometriotic cysts called ‘Chocolate cyst’.
The management depends mainly on the presenting complaint of the patient. The common symptom for which a woman would present is pelvic pain.
Conservative treatment: Includes management of symptoms by taking NSAIDs, Oral contraceptive pills, Progesterone only pills, Dienogest, GnRH analogues, Hormone releasing Intrauterine devices. They can be prescribed for a few months and reassessed for improvement of symptoms.
Surgical treatment: If there is no relief of symptoms or worsening, plan for laparoscopy is idea to confirm the diagnosis and treat accordingly.
Laparoscopic surgery for Endometriosis includes-
- Adhesiolysis of Uterus, tubes, ovaries, small & large intestines, ureter to restore normal anatomy
- Chocolate cyst of ovary- The ideal treatment is complete removal of the cyst wall and aspiration of contents (Cystectomy). In cases of infertility, the treatment depends on the ovarian reserve (by AMH) prior to procedure. If low ovarian reserve is noted, it is ideal to do Cystostomy with Fulguration of cyst wall / Partial cystectomy. The cyst wall is sent for histopathological examination
- Endometriotic spots- Burning of lesions using bipolar current (Fulguration) or excision is done for biopsy
- Deep Infiltrating Endometriosis (DIE)- There is endometriotic nodule between the rectum and vagina leading to deep pelvic pain which is not relieved by medicines. Laparoscopic surgery to excise these fibrotic nodules though challenging gives good symptom relief
- Hysterectomy- Patients who have completed family suffering from endometriosis symptoms not relieved by medications need to undergo removal of the uterus along with tubes and ovaries to prevent recurrences.
The team of Gynecologists at AV hospital are highly qualified in handling all cases of endometriosis with around 3 decades of experience. The team is known for their expertise in this field and have operated patients from across the globe. As Endometriosis is a recurring condition, the team has performed large number of such complex surgeries. The availability of highly experienced Laparoscopic Surgeons at AV hospital to handle bowel adhesions has a great advantage for the patients.The hospital has all the state of the art equipment and gadgets like Ultrasonic scalpel, vessel sealing system, Interceed, High Definition Video-laparoscopic system and a whole range of laparoscopic instrumentation which ensures the best surgical outcome.