Author Name: Dr. Vanashri Bahade || Mentor Name: Dr. Anuja Singh on April 25, 2020

Neglecting own health is in subtle nature of Indian women. But in 21st century where women are working side by side with men, disregard towards one own health has to change. Endometriosis is one of those chronic disease which affects them both professionally and socially. It not only has high morbidity rates with reduced quality of life but due to its effect on fertility causes mental and social problems too.

 WHAT IS Endometriosis…?

When endometrial lining inside the uterus starts growing in other locations other than uterus like in fallopian tube, ovaries previous caesarean scar/episiotomy scar, bowel etc., it’s called endometriosis. Most often it presents itself as pain during menstruation/ intercourse and inability to conceive.

 IS IT COMMON?

Endometriosis is a disease of adolescent and childbearing women.
– It affects 10-15% women of childbearing age and out of these 70% may have complaints of constant pelvic pain.
– it’s common amongst those, whose mother or sister have history of endometriosis.
– 40 to 50% usually have severe pain during menstruation.
– 10 to 50% have difficulty in conceiving .Due to invisible nature of illness along with nonspecific symptoms, diagnosis is often delayed. Many a times it is diagnosed when patient is undergoing pelvic surgery for other reasons.

 HOW TO FIND IT OUT?

-Tracking your own symptoms, its origin, severity and its association can be a guiding factor.
-Physical pelvic examination by your physician to assess mobility of uterus, any nodules, any masses and pelvic adhesions.
-Ultrasound, especially transvaginal scan to rule out ovarian cysts, to diagnose endometriotic cysts, adenomyosis, assess uterine mobility, fixity etc.
-MRI-to assess exact location, its extent before planning surgery.
-Laparoscopy-it forms a gold standard modality as it helps in direct visualisation of endometriotic implants,asess its spread and categorise it as minimal,mild,moderate and severe according to findings and severity of affection.
So diagnose early and initiate treatment early is the rule of thumb in endometriosis.

 SYMPTOMS-

Involvement of specific organ results in pain due to action of inflammatory mediators released by endometriotic tissues thereby resulting in physiologic dysfunction of those organs. Some of these symptoms are (depending on the organ involved)-

1) PELVIC ORGANS

(Uterus, fallopian tubes, ovaries, ligaments Supporting uterus, peritoneum).—-menstrual cramps, debilitating pelvic pain, pain during inter course, bleeding in between two menstrual cycles and infertility. Intensity of pain is associated with depth of penetration of endometriotic implants and direct and indirect effects of focal bleeding from such implants.

2) G.I.SYSTEM —

Painful bowel movements, pain during passing stool, blood in stool, diarrhoea, constipation, inflammatory bowel syndrome.

3) URINARY SYSTEM —

flank pain, back pain, increased frequency and urgency of urination, blood in urine.

4) LUNGS –

bloody sputum, chest pain during menses, in rare and severe cases collection of air and sometimes blood too between lungs and chest wall.

5) Vagina, cervix, episiotomy scars, caesarean scars sometimes too gets affected in severe cases causing formation of bluish nodules and pain during menstruation.

COMORBIDITIES WITH ENDOMETRIOSIS CAN POP UP IF ONE NEGLECTS OR UNDER TREAT IT.
Abnormal immune system response is seen in endometriosis and has been linked with the following diseases.

—Rheumatoid Arthritis
—Hypothyroidism
—SLE
—Asthma
—Sjogrens Syndrome
—Chronic fatigue syndrome
—Fibromyalgia causing bone pain, muscle pain, joint pain, ligament pain, headache
—Skin allergy, eczema
—Many times altered immunity in cases of endometriosis makes patients more susceptible to Tuberculosis too.
However we have to keep in mind that endometriosis is not an autoimmune disease.

 COMPLICATIONS OF ENDOMETRIOSIS IF LEFT UNTREATED

1) INFERTILITY/SUBFERTILITY —

many women with untreated endometriosis have difficulty in conceiving. This is mostly attributed to the following-

— It hinders conception by inflaming surrounding tissues and spur the growth of adhesions and scars. Inflammation of fallopian tubes affect tubal motility, disturb tubo-ovarian relationship and ultimately lead to impaired oocyte pick up by tube and eventually leading to infertility/subfertility

— if supports of uterus are affected then they lead to adhesion formation, distortion of pelvic anatomy leading to dyspareunia.

— Abnormal immune system response seen in endometriosis causes gamete injury.

— Hormonal and ovulatory dysfunctions, formation of endometriomas causes defects in maturation of eggs thus affecting quality of eggs and indirectly affecting fertilization and thereby leading to implantation failure.

Since it’s the disease of child bearing age, infertility in such women adds to social, and financial burden increasing one’s stress, anxiety and depression.

2) Endometriosis tend to affect ovaries forming cysts called endometriomas which may become palpable mass and cause abdominal distension, which may leak or rupture causing severe acute pain in abdomen needing emergency hospital admission and surgical intervention.

3) Increased risk of developing ovarian Carcinoma as compared to normal women.
4) Intestinal and bladder complications.

 FINALLY TO WRAP UP —

Endometriosis is an enigmatic, challenging, and ongoing condition. The individualization of the management is important. Choosing a qualified gynaecologist who is specialised with latest developments in endometriosis management is the need of the hour.

The options needs to be discussed with your gynaecologist. While surgery (in terms of excision of scar tissues, adhesiolysis, endometrioma removal, ablation of endometriotic deposits) remains the key therapy, medical treatment also has a role in the treatment of endometriosis either alone or in combination of surgery. With regards to infertility IVF is an efficient way to overcome infertility with women having more severe endometriosis, less invasive like IUI, ovulation induction etc. procedures should not be ignored.

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