It is "that time of the month" again and you are forced to miss your office because of the severe unbearable pain. You pop pain-killers, use hot water bags.... and lie down in bed thinking that it is physiological...... But this could be a symptom of Endometriosis..... and it is important to consult your gynaecologist for further evaluation as a delay in diagnosis would only worsen the condition.
March is Endometriosis Awareness Month and Yellow is the colour for Endometriosis awareness.
What is Endometriosis?
The inner lining of the uterus is called Endometrium and the cyclical shedding of this endometrium leads to menstruation.
Endometriosis is a condition where the endometrium grows outside the uterine cavity at sites like the peritoneum, ovaries and Fallopian tubes. Repeated growth and shedding leads to localised collection of the blood and debris which sets up an inflammatory reaction leading to formation of adhesions and ovarian cysts. These ovarian cysts are called Endometriomas or Chocolate Cysts because of the presence of chocolate coloured old blood within them.
The peritubal adhesions can eventually lead to blocked tubes making spontaneous conception difficult for the woman.
Signs and Symptoms:
Painful periods
Pain during urination/bowel movements.
Pain during intercourse.
Intermenstrual spotting/bleeding.
Subfertility.
Note: If you have severe dysmenorrhoea or if you need to take painkillers during your menses, do not ignore the condition. Consult your gynaecologist urgently to rule out endometriosis.
Diagnosis and Investigations:
Ultrasound.
MRI (Depending on the severity of the condition)
LAPAROSCOPY (minimal access surgery) may be advised for direct visualisation of the lesions and also to take biopsy.
Ovarian Reserve Tests (AFC, AMH) if future fertility is a concern.
Is there a risk of Malignancy?
There have been reports of unexpected malignancy being discovered at the time of surgery. This possibility should be taken into consideration although the risk is very small.
Serum Tumour Markers may be helpful to exclude malignancy but the accuracy here is limited as some of these are raised in the presence of endometriosis too.
Treatment:
Treatment depends on
Severity of Symptoms.
Severity of the Endometriotic deposits.
Fertility concern
Options are:
Conservative - for symptomatic management
Hormonal Treatment - To slow the growth and progression of endometriosis.
Note: Hormonal Treatment needs to be taken long term and stopping the treatment will lead to a recurrence of the condition.
Surgery - Laparoscopy vs. Traditional Abdominal Surgery.
What should I know before going for Surgery?
Surgery should be done in a centre where the necessary surgical expertise is available.
Be aware of the risk of damage to the ovarian tissue in endometrioma surgery. This should be of concern, particularly if you are planning pregnancy in the future. Talk to your gynaecologist about the various means to reduce the damage and preserve the ovarian reserve.
Note: With atraumatic handling of the ovaries and use of anti-adhesion measures, we can reduce the trauma to the ovaries to a large extent.
ACADEMIA
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