Endometriosis Treatment

Endometriosis is a very common disease. It affects millions of women worldwide. To understand endometriosis, let's first understand what is endometrium. Endometrium is that tissue which lines the inner wall of the womb or the uterus. And every month, cyclically, under the influence of hormones, this lining swells up and makes a bed for the baby. And in case no pregnancy happens, then this lining is shed in the form of periods.

When tissue similar to this lining is present outside the uterus, then we call it endometriosis. Most commonly, this tissue is present on the back surface of the uterus, on the tubes, and on the ovaries. Every month, cyclically, when hormones come, this tissue is also going to swell up and it's going to bleed internally. This will lead to chronic inflammation, scarring, adhesion formation and the formation of cysts in the ovaries (chocolate cysts). Gradually the reproductive organs get damaged. The progression of this disease can vary from woman to woman. In some women, it can remain only in the deposit stage, then it is called mild endometriosis. However, for some women, it may become rapidly progressive and lead to a lot of damage to the reproductive organs, then it is called severe endometriosis.

SYMPTOMS

It can produce no symptoms at all or lead to difficulty in conceiving and pain, this pain can be pain during periods, pain during intercourse, pain with bowel and bladder movements, or pain otherwise. Initially, to start with this pain can be cyclical happening only around periods, but later it can become constant when the disease becomes more severe.

Now what is interesting to note is that the severity of the disease may not exactly correlate with the severity of symptoms. So women with very mild endometriosis can have very severe symptoms and women with severe endometriosis can have no symptoms at all.

DIAGNOSIS

Diagnosis again can be difficult in this condition because the symptoms can be variable, can be nonspecific and we cannot see those deposits on ultrasound or MRI.

What we can see on ultrasound and MRI are the chocolate cysts. So however when a woman comes with these kinds of symptoms and we suspect endometriosis we do an internal checkup which can give us some clue regarding the diagnosis and we get an ultrasound done and an MRI if required. However, for some women, we may have to resort to a laparoscopy which is a surgical procedure with which we can make a definitive diagnosis. Also, it can help us deal with, the deposits and adhesions and the cysts as then we can do the treatment simultaneously.

TREATMENT

Treatment again can be challenging because there is no permanent cure. However, we have a range of options that can help you deal with your symptoms. Adopting a healthy lifestyle, exercising regularly, eating a balanced plant-based diet and having a positive outlook can help you to deal with your symptoms in a large way.

Treatment depends on your predominant symptoms whether it is pain or fertility, your age, your medical history and your personal preferences.

To deal with pain symptoms we have majorly two options. We deal with it medically or if medicines do not work then we have to go for surgery.

Medical treatment for endometriosis can be either just simple painkillers which you have to take during the pain episodes or it can be hormonal medications which can be given in the form of oral tablets, injections, patches or it can also be given in the form of an intrauterine device which is called a Mirena.

Medical treatment is going to shrink the deposits and to a large extent will resolve your symptoms. However if medicines are not working or the cysts are too big or you are not suitable for medical treatment then we have to go for surgery.

Surgery also can be of two types it can be a reparative surgery or it can be a definitive surgery.

So reparative surgery means we just deal with the deposits, we deal with the additions, we deal with the cysts.

But it is important to understand that one surgery is not going to permanently remove endometriosis so you still have to be on medical treatment so that it does not come back.

When we talk about permanent surgery it is generally the removal of the uterus, the tubes and all visible deposits with or without the ovaries depending upon your age and your condition.

Treatment of infertility associated with endometriosis

The treatment depends upon the severity of endometriosis.

So if it is mild endometriosis generally, we give medicines to release the egg, do a timed intercourse and we may or we may do an IUI. So ovulation induction and IUI are generally the preferred treatments.

However, if it is severe endometriosis then going for surgery can further hamper your egg reserve so going for IVF is the best option in those circumstances.

SUMMARY

To summarize endometriosis is a chronic disease. There is no permanent cure it can lead to debilitating symptoms. It is important not to rush into surgery, explore all the options because one surgery is not going to permanently cure endometriosis and there are a lot of other options to deal with your symptoms.

Hope this has helped you to understand better Understanding the disease process and helps you deal with the disease better.