Understanding endometriosis

Endometriosis is one of the most serious and potentially progressive chronic diseases related to the uterine lining that women can face in their lifetime. It causes incapacitating pain, marital disharmony and infertility. Endometriosis affects an estimated 1 in 10 women and about 200 million women worldwide.

Some risk factors for endometriosis include genetic, hormonal, menstrual irregularities like retrograde menstrual flow, environmental and chemical exposure etc.

March is endometriosis awareness month which is observed worldwide each year through activities like education, medical conferences, fundraising for research and marches all across the globe with a mission to raise awareness about the disease.

Symptoms: Symptoms associated with endometriosis can vary widely from patient to patient. Some women experience no symptoms. Others experience severe pelvic pain that can interfere with regular activities like bowel movement, urination and severe pain during and after sexual intercourse and worsen during menstruation. The severity of the disease is not related to the degree of pain. Pain can be much worse even in a very early stage than women whose disease is much more advanced. Women with endometriosis may have gastrointestinal distress, bloating, cramps, occasionally accompanied by diarrhoea and constipation.

Endometriosis has a negative effect on fertility. About 40% women with endometriosis suffer from infertility. The pathogenesis of infertility is dependent on the stage of the disease. In the early stage, it is hypothesised that this is secondary to an inflammatory response that impairs various aspects of conception. Whereas in later stages, disease distorted pelvic anatomy and adhesion contribute to impaired fertility.

Diagnosis: Laparoscopy is the gold standard method to confirm endometriosis. During laparoscopy, surgical therapeutic interventions can be taken at the same time as ablation, fulguration of endometriotic deposits, cystectomy, adhesiolysis etc. Pelvic ultrasonography can identify endometriotic ovarian chocolate cysts. Magnetic resonance imaging (MRI) is another method to detect endometriotic lesions in a non-invasive manner. Histopathology and immunohistochemistry are useful in the diagnosis of endometriosis.

Treatment: While the disease cannot be eradicated, the pain and other symptoms can be managed by modifying lifestyle, following a healthy diet avoiding highly saturated fatty food, avoidance of alcohol and caffeine, and reducing stress. As pain medication, Nonsteroidal anti-inflammatory drugs (NSAIDs), opioids and hormone therapy have been found promising. Limited evidence indicates the use of combined oral contraceptives can reduce the risk of endometriosis.

Surgical removal of endometriotic deposits is useful for pain control. It is more effective for addressing endometriosis associated with infertility. Surgery helps to remove endometriotic deposits, preserve the ovaries and restore tubo-ovarian distortion. In vitro fertilisation (IVF) is effective in improving fertility in women with advanced-stage endometriosis.

Patients with endometriosis deserve timely diagnosis at the onset of symptoms, non-invasive diagnosis as much as possible and improved treatment access to improve their quality of life.

The writer is a Consultant of Obstetrics and Gynaecology at Kuwait-Bangladesh Friendship Government Hospital, Dhaka.