Scarred & scared

Dr Nirmala Chandrashekhar answers some key questions around endometriosis reducing the chances of women getting pregnant

Endometriosis is often known to be a painful disorder in which tissue that normally grows inside the uterus starts growing outside the womb. Women with endometriosis, in most cases find tissues in the fallopian tubes, ovaries, and pelvic area.

When women suffer from chronic pain in the abdominal area, they tend to misdiagnose it with another disease. In some cases, endometriosis may be present majorly as ovarian cyst at one end of the spectrum, while only specks of endometriotic tissue would be present in the pelvic areas, which gets undetected on MRI scans. Also, patients with very painful menses may attribute it to regular pain and may not report to a doctor until it gets severe.

Common signs and symptoms of endometriosis include:

Painful periods (dysmenorrhea): Women tend to get pelvic pain and cramping which may begin before and extend for several days into a menstrual period. At times they also experience lower back and abdominal pain as well.

Pain during intercourse: Women with endometriosis experience pain during or after sex which is the most common symptom.

Pain with bowel movements or urination: These symptoms may occur during a menstrual period.

Excessive bleeding: Patients may also experience occasional heavy menstrual periods or bleeding between periods (intermenstrual bleeding).

Infertility: In most cases, women get diagnosed with endometriosis only when they are seeking treatment for infertility.

In most cases, women experience fatigue, diarrhoea, constipation, bloating or nausea, especially during the time of menstrual periods.

The severity of pain does not always indicate the extent of the condition. There have been instances where women get mild endometriosis but experience severe pain, or women with advanced endometriosis suffer little or no pain.

There have been cases where women with endometriosis were misdiagnosed with ovarian cysts and pelvic inflammatory disease due to pelvic pain. Many women have mistakenly gone under treatment for irritable bowel syndrome (IBS), a condition that causes bouts of diarrhoea, constipation, and abdominal cramping. At times people also suffer from IBS along with endometriosis, which can complicate the diagnosis.

Causes and diagnosis

There are various reasons why endometriosis can cause infertility. The endometriotic spots may be toxic to the oocytes (egg) that is released, scarred fallopian tubes, changes in the hormonal environment of the eggs, inflammation in the pelvic area, decreased egg quality etc., can cause infertility. This condition is mostly diagnosed when couples are unsuccessful in trying to conceive and do a few tests to detect the problem. Some of the tests are:

Pelvic exam: During a pelvic exam, the doctor manually checks the pelvic area to check for abnormalities, such as cysts on the reproductive organs or scars behind the uterus.

Ultrasound: The transvaginal or transabdominal ultrasound are done to identify cysts associated with endometriosis (endometriomas).

Magnetic resonance imaging (MRI): An MRI helps with surgical planning, gives detailed information about the location and size of endometrial implants.

Laparoscopy: Keyhole surgery is conclusive of the diagnosis of endometriosis. Doctors, though, have observed a high pregnancy rate especially within the first 6 months of conservative surgery.

Fertility treatment

Endometriosis can lead to trouble conceiving. In most cases, doctors suggest treatment based on the stages of endometriosis. Fertility treatment ranges from stimulating the ovaries to make more eggs for in-vitro fertilisation (test tube baby). When there is no improvement due to endometriosis and infertility is pronounced, the couple is counselled for assisted reproductive techniques like IUI ( Intrauterine insemination), IVF, GIFT and ICSI.

(The author is a consultant in Obstetrics, Gynaecology & Gynaec Oncology.)