The tissue that lines the uterus is called endometrium. When endometrium like tissue is present outside the uterus, it is called Endometriosis.
This abnormal tissue growth is a benign condition, but it very fast growing and spreads widely to surrounding organs like ovaries, fallopian tubes, peritoneum, bowel bladder etc.
When endometriosis affects ovaries, it forms cysts called Endometriotic Cyst or Chocolate Cysts.
Does hormonal imbalance cause endometriosis?
The same hormone that acts on the uterine lining, acts on the endometriotic tissues, this is the reason why Endometriosis is only seen in reproductive age group and not in menopausal women.
Is endometriosis a common condition?
1 in 10 women in reproductive age group i.e. 15 to 45 years and approximately 50% of infertile women visiting Fertility Clinics are affected by Endometriosis.
A recent study involving women with pelvic pain found about 75% to be suffering from endometriosis.
What are the common symptoms for endometriosis?
The most common symptom for endometriosis is pain in lower abdomen especially during menstruation. Other symptoms include painful intercourse, painful urination (if endometriosis has spread to the bladder).
Strangely the symptoms of endometriosis do not always correlate with the extent of spread of the disease. Many women might have negligible symptoms despite having very widespread underlying endometriosis and it may often go undiagnosed. While some may present with severe pain even with very mild spread of disease.
How can one diagnose Endometriosis?
Proper clinical history, clinical examination and investigations lead to diagnosis of endometriosis. Usage of ultrasound may not be very useful in diagnosis of endometriosis and it may not help in visualizing the spread of disease. However ultrasound can successfully diagnose Endometriotic / Chocolate Cyst.
The gold standard for diagnosis of endometriosis is Laparoscopy. One of the advantages of performing Laparoscopy is that in suspected cases, endometriosis can also be surgically treated during the same procedure, this is also known as confirm and treat approach.
What is the role of CA-125 measurement in Endometriosis ?
CA-125 is Cancer antigen 125. This test measures the amount of CA-125 antigen in your blood. CA-125 blood antigen test should not be used to diagnose or to track progress of the disease according to recent guidelines.
Does Endometriosis cause Infertility?
Yes. Endometriosis at times can cause obvious alterations to the anatomical relationship between the ovaries and the fallopian tubes and may hamper fertility.
Tubal function can also be impaired due to adhesions and scarring around the fallopian tube caused by endometriosis.
Ovarian chocolate cysts caused by endometriosis can compromise the ovarian reserve due to it’s invasive nature. This may cause fall in AMH level and further reduce the chances of becoming pregnant.
Many studies have also shown that endometriosis causes modification in the biochemical environment within the fallopian tubes and ovaries, this reduces the chances of getting pregnant naturally.
Hence there are multiple ways in which endometriosis can hamper chances of conception in women and about 50% of women visiting fertility clinic are diagnosed with endometriosis.
What are the treatment options for treating endometriosis?
Simple pain killers can be prescribed to tackle pain and pain related symptoms rising due to endometriosis.
Oral contraceptive pills can be prescribed to woman who do not desire pregnancy. The pills can be used for as long as patient wants to delay pregnancy.
In patients who present with Infertility as well as endometriosis, planning for pregnancy as soon as possible without delaying treatment is often suggested. Usually women are advised laparoscopy followed by IVF or just IVF if required, depending on clinical history.
Pregnancy and breastfeeding relieves the symptoms of endometriosis, because the hormones causing endometriosis are suppressed during pregnancy and breastfeeding.
It is better to work aggressively towards achieving pregnancy for patients with endometriosis rather than to wait and watch approach.
The views in the article are expressed by Dr. GajendraTomar who is a leading Infertility and IVF Specialist practicing in a busy clinic in Indore, India.
