What is Endometriosis?

Development of inner lining of the womb (uterus) outside the uterus is called endometriosis. It grows every month under the influence of female hormones exactly in the same way as the inner lining of the uterus and then sheds off in the form of menstrual blood. As there is no way out for the menstrual blood, it is collected at the local sites in the form of cyst or lump.

Who are affected?

In fact any menstruating lady can get this disease. But most commonly it is found in young females in their 3rd and 4th decades of life. The incidence has been increasing every year. It is reported that 5.5 million women in USA are suffering from this disease and the estimated number in India is 25 millions.

Sites of Endometriosis:

Most commonly it occurs on the surface of the ovary. Other common sites are the supporting structures of the uterus (utero-sacral ligaments), the space between the uterus and the rectum (back passage), uterus, fallopian tubes, rectum and urinary bladder. Rarely it can occur in appendix, scar tissue or lung.

What causes Endometriosis?

The exact cause of this disease is yet to be derived. The most popular theory is a back-flow of the menstrual blood with sheded endometrium from the uterus into the abdominal cavity through the fallopian tubes. The lifestyles of modern society, environmental pollution and chemicals used in pesticides and fertilisers probably have some role to play. Genetic predisposition is also an important factor.

What are the symptoms?

Pain in the lower stomach before, during and after the periods is the classical symptom of endometriosis. Scanty or heavy menstrual flow and painful coitus are usually associated with it. Pain during defaecation, and urination can occur when rectum or bladder are involved. Irregular bowel habit in the form of constipation or diarrhoea can also occur. Childlessness is associated with endometriosis in about 20% cases.

Diagnosis:

Laparoscopy and biopsy is the most confirmatory method of diagnosis. However, symptoms and clinical examinations supported by ultrasonography can diagnose in most of the cases.

Available treatments:

Unfortunately there is no sure cure by medicines. However, the disease can be arrested in most of the cases by taking hormones, which stop menstruation. Similar effect is observed in case of pregnancy because of absence of periods for nine months. Removing the growing endometriosis tissue from the affected area by open surgery or laparoscopic surgery can give good result in terms of longer period of remission. Laparoscopic surgery is being accepted as the best modality of treatment because of less pain and morbidity, less hospital stay and early return to work. Removal of uterus and ovaries is required for permanent cure. This is not advisable however for young or childless ladies.

Prevention:

• Exercise: It might help to reduce pain during periods. Regular exercise in the form of jogging, cycling and swimming can be done.
• Nutrition: It is advisable to avoid fast-food, which usually contain bad fats. Try vegetables, fresh fruits and fishes and sunflower oils.
• Boosting the immune system: Avoiding foods and chemicals which can cause alteration of immune system of your body can arrest the progression of the disease.

Treatment of pain during disease:

Anti-Prostaglandin medicines like Mefenamic Acid, Tranexamic Acid or Drotaverine Hydrochloride can be taken safely during the painful periods.

What you should do when you know or suspect that you have endometriosis?

• Do not ignore the symptoms.
• Visit a gynaecologist with specialisation in the management of endometriosis.
• Discuss frankly your symptoms and worries with the doctor.
• Follow your doctor’s advice religiously.
• Contact Endometriosis Society, India. We are here to help you.

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