It is the main reason for stomach pain and inability to conceive in women between 20 to 40 years of age. It is found in one third of infertile women. In this, the tissue which lines the uterus (endometrium) is found growing in abnormal locations such as the ovaries or around the uterus. Every time a woman has her menses, there is bleeding also inside this tissue. As a result, thick dark blood accumulates in the ovaries (endometriotic cyst). This is also called a ‘chocolate cyst’ since the thick liquid collected in the ovary looks like chocolate. There are blood spots all over the pelvis, which may cause the intestines, tubes and ovaries to stick to each other. Diagnosis is made by pelvic examination, sonography and a laparoscopy (keyhole surgery) may be required to diagnose and treat endometriosis at the same time. Treatment for endometriosis depends on the extent of the disease, presenting symptoms, and whether one wants to have children. It may be treated with medication, surgery, or both. Although treatments may relieve pain and infertility temporarily, it is a recurrent problem and conservative treatment (medical or surgical) cannot provide permanent cure. Medications- is used both to relieve pain and to keep the disease under control. Painkillers like paracetamol or mefenemic acid relieves the pain up to great extent. Hormonal medication like progesterones or combined pills not only relieve the pain but helps to control the disease process. Hormonal injections are also used in some situations. These medications cannot be used for long as women are not able to tolerate the side effects that these medications. Medications do not provide permanent cure.Surgery - is done to remove endometriosis and the scarred tissue around it. In severe cases surgery is the best choice for treatment. Surgery is done almost always by laparoscopy. During laparoscopy, endometriosis can be removed or burned away. Extent of surgery depends on the patient’s needs. If infertility is the issue then conservative approach and trying to save the normal tissues is attempted followed by active treatment for infertility. If the woman does not desire any more children the complete removal of uterus along with both ovaries and all endometriotic tissue is done. Sometimes severe endometriosis cannot be handled with laparoscopy and a procedure called laparotomy may be needed.(The author is the Consultant Gynecologist & Laparoscopic Surgeon, Apollo Hospital, Jubilee Hills. You can also mail her your queries at [email protected]; www.gynecologyhyderabad.com)
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