Endometriosis – Causes, Symptoms and Treatment in Delhi

Endometriosis is a gynaecological condition in which uterine lining tissue grows outside the uterus in places like ovaries, fallopian tubes, pelvic cavity and sometimes in intestines, bladder, scar tissues etc.

This condition occurs in adolescents and in women aged between 15 to 44 years. In every menstrual cycle the uterine lining breaks down and bleeds outside the uterus and gets trapped, leading to painful lumps, cysts and chunks of big masses which stick together and cause discomfort. 

Types of Endometriosis

Superficial endometriosis:

Uterus lining tissue is superficially present on the surface of organs.

Endometriomas:

Uterine lining tissue is present inside the ovary which forms chocolate cyst.

Deep endometriosis:

Uterus lining tissue invades the organs either within or outside the pelvic cavity. It forms lumps and masses which stick together, resulting in a frozen pelvis.

Signs and Symptoms of Endometriosis

• Painful periods (dysmenorrhea)
• Pain during intercourse (dyspareunia)
• Pain with bowel movements or urination
• Excessive bleeding during periods or bleeding between periods (intermenstrual bleeding)
• Infertility

Other signs and symptoms include fatigue, diarrhoea, constipation, bloating or nausea, and rectal bleeding, especially during menstrual periods.

Causes of Endometriosis

Endometriosis affects the egg quality when present in ovaries. It causes tubal block by distorting the anatomy of the pelvis or by making tubo-ovarian masses. In addition, it alters the functioning of the immune system and impairs implantation for successful pregnancy. The exact reason is unknown, however here are some potential causes of Endometriosis includes genetics, poor lifestyle habits, smoking, alcohol consumption, improper intake of medication, from past surgeries etc. 

Diagnosis

Endometriosis can be diagnosed by ultrasound, MRI pelvis and laparoscopy. Laparoscopy gives the confirmed diagnosis of endometriosis and informs about the amount, location and depth of endometriosis and gives a score. The score determines if the endometriosis is minimal (Stage 1), mild (Stage 2), moderate (Stage 3), or severe (Stage 4) and correlates with pregnancy success rate.

Women with severe (Stage 4) endometriosis experience scarring, blocked fallopian tubes and damaged ovaries in which advanced fertility treatment is required.

Treatment of endometriosis

There is no cure of endometriosis. However, a symptomatic treatment for the same exists which depends on age and overall health. Treatment modalities include medicine, surgery or both.

Treatment of endometriosis depends on presence or absence of pain symptoms, patient age and preferences, history of previous surgery, presence of other infertility factors, ovarian reserve, and estimated Endometriosis Fertility Index (EFI) score.

In stage 1 and 2, as tubal function is maintained and if age is young with no other infertility factor, then controlled ovarian stimulation (medications for egg formation) with natural try or intrauterine insemination (IUI) can be tried for 3 to 6 months.

During IVF Treatment

Hormonal suppression in the form of GnRH agonist should be given prior to IVF. Long protocol egg stimulation should be recommended if endometrial cyst size is greater than 4 cm, laparoscopic cystectomy should be done before IVF to improve endometriosis-associated pain or the accessibility of follicles.

• Risks of reduced ovarian function after surgery should be informed to couples.
• Antibiotic prophylaxis should be given at time of oocyte retrieval.
• The couple should consult a fertility doctor immediately when planning for pregnancy with the condition of endometriosis.

Symptoms of endometriosis

Symptoms of endometriosis often become apparent several years after a woman begins menstruating. While pregnancy might alleviate these symptoms, there’s always a possibility of their recurrence. Additionally, the onset of menopause can bring about a reduction in pain, but this can vary if oestrogen therapy is part of the treatment.

What causes endometriosis?

It’s important to note that the exact causes of endometriosis remain unclear. That said, recent research efforts have identified a number of potential causes:

• Retrograde menstruation –

This occurs when menstrual blood doesn’t flow out of the body. Instead, it goes back into the fallopian tubes and enters the pelvic cavity. As a result, the endometrial cells in the blood stick to the pelvic walls and organs to grow and thicken over time and bleed every menstrual cycle.

• Embryonic cell changes –

Oestrogen and other hormones can make embryonic cells evolve into endometrial-like cell growths throughout puberty.

• Transformed peritoneal cells –

Experts found that immune factors or hormones might also transform the cells lining the abdomen’s inner side. This phenomenon results in cells similar to those lining the uterine wall.

• Surgical scar issues–

Endometrial cells can attach to scar tissue after surgery to the stomach or a C-section.

• Immune system condition –

Women with immunity issues have white blood cells that attack and destroy endometrial tissue.

• Endometrial cell transport –

When this happens, the tissue fluid system or blood vessels move the endometrial cells to other body parts.

Risk factors

We recommend timely treatment of endometriosis to minimise the condition’s impact on your fertility. Otherwise, you may be at risk of the following:

• Never getting pregnant and giving birth
• Late menopause
• Short menstrual cycles
• Heavy and lengthy menstrual periods
• High oestrogen levels
• Being underweight/having a low BMI (body mass index)

Additionally, any reproductive tract condition or health issue that prevents blood from properly exiting the body during menstruation can be a risk factor for endometriosis.

Complications

Endometriosis primarily leads to challenges with fertility. Up to 50% of individuals with this condition experience difficulty in conceiving. However, it’s important to note that women with mild to moderate endometriosis can still become pregnant and have a full-term pregnancy. Given that endometriosis can progress over time, it’s advisable for those with the condition to consider not postponing pregnancy.

Furthermore, while endometriosis does elevate the risk of ovarian cancer in some women, the overall lifetime risk is relatively low.

Treatment

Treatment of endometriosis is typically aimed at relieving the symptoms. At Advance Fertility, our doctors offer treatments to improve fertility and reduce pain. Surgery is often recommended for treating mild endometriosis and may help increase fertility. For pain relief, a doctor may recommend safe pain relievers, hormonal treatments to suppress the menstrual cycle or laparoscopy.

How to prevent Endometriosis

Endometriosis and pain go hand in hand, so it becomes important to prevent this condition. While its exact cause remains unclear, there are a few means to help reduce the risk of developing the condition:

Early Diagnosis and Treatment:

If you suspect endometriosis due to symptoms like pelvic pain, heavy menstrual bleeding, or pain during intercourse, seek prompt medical evaluation. Early diagnosis and treatment can help manage the condition more effectively.

Healthy Lifestyle:

Maintaining a healthy body weight and incorporating regular physical activity into your routine may reduce your risk. Obesity can be linked to hormonal imbalances that may exacerbate endometriosis.

Balanced Diet:

Consuming a diet rich in fruits, vegetables, whole grains, and lean proteins can help support hormonal balance. Limiting red meat and high-fat dairy products might be beneficial.

Avoiding Excessive Alcohol and Caffeine:

Excessive alcohol and caffeine consumption can disrupt hormone levels, potentially aggravating endometriosis symptoms. Moderation is key.

Manage Menstrual Hygiene:

Consider using sanitary products, such as tampons and pads that are free from harsh chemicals to minimise the risk of menstrual disorders that could potentially lead to endometriosis.

Oral Contraceptives:

Some studies suggest that the use of birth control pills can reduce the risk of endometriosis. Consult with your healthcare provider about this as a prevention strategy.

Pregnancy and Breastfeeding:

While not a guaranteed prevention method, women who have had pregnancies, particularly at a younger age, and have breastfed may have a lower risk of developing endometriosis.