Gynecologic Surgery
ENDOMETRIOSIS

ENDOMETRIOSIS

Endometriosis is a common gynaecological disorder is seen in about 10% of women in the reproductive age group. Endometriosis is found in about 20% of infertile ladies and in about 15% of the ladies with chronic pelvic pain. Dr Mayur Pai is well trained in the diagnosis and treatment of endometriosis and endometriosis related infertility. He often performs laparoscopic surgeries and other non surgical treatments related to endometriosis.

This page will highlight various aspects of endometriosis like:

What is an endometriosis?

What are the various locations of endometriosis?

What are the warning symptoms of endometriosis?

Can endometriosis affect my fertility?

Why is it important to diagnose and treat endometriosis?

Can ultrasound help in diagnosis of endometriosis?

What is the role of laparoscopy in the treatment of endometriosis?

What are the chances of recurrence of endometriosis in the future?

What are the advantages of laparoscopic surgery over open surgery?

What is medical or non surgical management of endometriosis?

Keep reading till the end of the page in order for better and near complete understanding of endometriosis and the treatment of endometriosis. This will help you understand whether surgery or other non surgical treatments are best suited for you.

What is endometriosis?

The inner lining of the uterus is called endometrium. Endometrium consists of endometrial glands and their surrounding stroma. This endometrium (consisting of glands and stroma) grows during the lady’s menstrual cycle. At the end of the menstrual cycle, there is menses (menstrual bleeding) and the endometrium is shed off through the lower end of the uterus and out through the vagina.

In endometriosis, there is some amount of retrograde menses (menstrual blood comes out through the fallopian tubes) into the abdomen. This causes the endometrial glands and the stroma to stick (and implant) to various structures in the abdomen and grow. These glands respond to the cyclic hormones which are naturally produced by the lady during her menstrual cycle. At the end of the menstrual cycle, there is bleeding in the uterus and also in these abnormal glands and the process continues to spread.

 

What are the various locations of endometriosis?

 

Endometriosis causes the normal organs in the abdomen to stick to each other. Endometriosis can also invades deeper at the implantation site and enter the full thickness of organs like the ovary, intestine, urinary bladder, ureters, uterine ligaments, fallopian tubes and even far away organs like the liver, diaphragm, spleen, and umbilicus.

In the ovary, it can cause adhesions and chocolate cyst of the ovary.

Endometriosis can also infiltrate into the muscle layer of the uterus where it is called adenomyosis of the uterus.

Endometiosis can also affect pelvic nerves causing extreme pain and bowel bladder difficulties to the lady.

 

What are the warning symptoms of endometriosis?

Endometriosis often causes infertility and extreme pelvic pain (lower abdomen and lower back pain).

Some ladies may present with painful menses and painful intercourse.

Some ladies may have no pain but endometriosis signs can be seen on routine ultrasound like the presence of chocolate cyst of the ovary or an endometrioma behind the uterus.

 

Can endometriosis affect my fertility?

Endometriosis is found in about 20% of the infertile ladies. Recent studies have found that endometriosis produces infertility by various mechanisms. Some of these are discussed here below.

Endometriosis commonly affects the ovary and may produce adhesions of the ovary, surface endometrial deposits and even chocolate cyst of the ovary. Endometriosis may decrease the egg count and quality in ladies. Ladies with endometriosis of the ovary frequently require advanced fertility treatments like IVF/ test tube baby. They also sometimes require donor egg IVF due to poor egg count and quality leading to poor embryo development.

Endometriosis may also affect the fallopian tubes causing adhesions and preventing effective function of the fallopian tube. Fallopian tubes are very important for the meeting of sperms and eggs.

Adenomyoma or adenomyosis (a type of endometriosis that affects the muscle layer of the uterus) of the uterus can affect normal uterine function and implantation on the embryo.

Endometriosis may frequently coexist with other infertility producing diseases like PID further decreasing the chances of conception.

 

Why is it important to diagnose and treat endometriosis?

As stated above, endometriosis is an important and difficult to treat cause of infertility.

Endometriosis also affects 15% of ladies with chronic pelvic pain. This pain also worsens with passage of time.

It is important to diagnose and begin early treatment of endometriosis to make sure that we can prevent further spread of the disease and to treat it.

 

Can ultrasound help in diagnosis of endometriosis?

Ultrasound is an excellent tool to diagnose and follow up a patient with endometriosis. An ultrasound examination can reveal endometriosis of the ovary, adenomyoma of the uterus and endometriomas behind the uterus.

Ultrasound is the most frequently done test for endometriosis. In cases with severe degree of disease or endometrial spread beyond the pelvis of the patient, MRI is required.

Not all types of endometriosis can be diagnosed with ultrasound and MRI. Small deposits of endometriosis can only be diagnosed on laparoscopy but the use of ultrasound may sometimes warn the doctor of the possibility of endometriosis.

 

What is the role of laparoscopy in the treatment of endometriosis?

Laparoscopy is the gold standard method for the diagnosis and the treatment of endometriosis. Laparoscopy is often necessary in cases of endometriosis affected by infertility.

Laparoscopy can easily identify and treat small deposits of endometriosis on the surface of organs. Laparoscopic biopsy of suspicious lesions can be taken and help in giving a laboratory diagnosis of endometriosis (histopathology).

Deep invasion of endometriosis in to the organ tissues can also be treated by excision of the affected part and repair of the organ.

Endometriotic adhesions can also be separated and the normal structure of the organs be restored.

Laparoscopy also gives us a chance to search for endometriosis throughout the abdomen including upper abdomen like liver, spleen, diaphragm, and intestines which is not possible through a small open surgery incision.

Other infertility related procedures like myomectomy, tubal patency test or hysteroscopy can also be done in the same sitting. Due to these advantages, open surgery is not very commonly performed.

 

What are the chances of recurrence of endometriosis in the future?

Endometriosis is always an ongoing disease no matter how good surgical or non surgical treatment is performed. Even if all endometriotic deposits are removed, new ones do come and the process starts again. It is therefore advised that couples with endometriosis should begin treatment soon after surgery.

Endometriosis progresses much slower during pregnancy and after menopause.

 

What is medical or non surgical management of endometriosis?

Medical or non surgical management of endometriosis is preferred in cases where fertility is not important like in cases with chronic pelvic pain. The treatment of choice for endometriosis in cases of infertility is laparoscopy followed by fertility treatment.

Medical treatment involves long term use of hormones like progesterone, aromatase inhibitors like letrozole and anastrazole, long term mifepristone, GnRH Analogues like luprolide acetate and triptorelin etc. These treatments work by hormonally starving the endometrial glands from hormonal stimulation. These treatments are very effective in well selected cases. Some of the common issues with medical treatments of endometriosis are that they hamper ovulation during the treatment period and are not compatible with fertility treatment. These treatments are suitable only for non severe cases and can be used only for a short term. Surgeries like adenomyoma removal and hysterectomy following medical treatment is more difficult as some of the tissue planes are lost due to medical treatment.

The choice of the treatments is to be made with lots of thought with respect to what are the goals and time line for these goals that the patient expects.

Meet Hundreds of Healthy Women
For consultation regarding Infertility, Gynecological surgery, laparoscopy and Pregnancy book an appointment with our gynecologist now
Book Appointment