Dr Sarthak Sidapara


What is Endometriosis?

Endometriosis is a painful disease. This disease develops when the endometrial-like tissue acts as a wound; thus, it thickens and bleeds at the time of menstruation. But it does not find any exit and gets trapped, forming underlining. It grows inside the uterus, and the endometrium grows outside the uterus. Endometriosis can develop in your fallopian tubes, ovaries, and in the lining of the pelvis. In extreme situations, Endometriosis can grow an infertility problem. Endometriosis can cause severe pain at the time of menstruation.

Types of endometriosis

There are mainly three categories of Endometriosis; it is as follows:

  • Greatly infiltrating Endometriosis: This type mainly develops in organs besides the uterus like bowels or urinary bladder. It grows under the peritoneum. About one to five percent of women have this kind of Endometriosis.
  • Peritoneal lesion: In this type of Endometriosis, the lesion formed on the peritoneum area acts line a thin lining in the pelvic region. Most women experience this type.
  • Endometrioma (ovarian injury): These develop deep inside the ovary and are deep red. Because of its deep red color and fluid texture, it is also called a chocolate cyst. They are not usually curable and is capable of damaging healthy tissue.

Symptoms of endometriosis

The common signs that you may notice while suffering from Endometriosis are:

  • More painful menstrual cramps: Pelvic pain may get extended. It may start several days before the period and may continue after periods too. You can also experience pain in the abdomen and lower back too. The pain that you experience during menstruation may get worse.
  • Pain during intercourse: You may experience extreme pain during or after intercourse.
  • Pain during excretion: There will be pain during pooping or peeing, especially during the menstrual cycle.
  • Excessive bleeding: The blood flow may increase during periods. There may be blood in your stool or urine on regular days too.
  • Infertility: You may be facing problems relating to infertility.
  • Others: You may also feel unusual tiredness, constipation, diarrhea, nausea, etc.

When to see a doctor?

If you notice an issue mentioned above in your body, you should visit the doctor. It is not a rule that you may experience extreme pain for the problem to be severe. It is also possible that you have extreme Endometriosis even though you have mild pain. The intensity of your pain does not decide the severity of the problem.

You can mistake Endometriosis with other problems like irritable bowel syndrome or ovarian cyst, or pelvic inflammatory disease. Since these diseases also have the same symptoms as diarrhea, extreme abdominal pain, and constipation. But this does not mean you should ignore it. A doctor’s consultation can help prevent the serious issue.

Causes of endometriosis

The causes of Endometriosis are not specific but might develop due to the following reason:

  • Retrograde menstruation: The condition where the period blood, instead of flowing out of the body, flows back to the fallopian tube into the pelvic region. The endometrial cell in the blood sticks to the pelvis in the walls of the pelvic organ. These cells grow and thicken every time in the menstrual cycle.
  • The peritoneal cells’ lining: The peritoneal cells, after transformation, act like endometrial-like cells and get lined up in the abdomen’s inner walls.
  • Due to embryonic cell: Estrogens transform embryonic cells into endometrial-like cells, which may develop lining.
  • Transportation of endometrial cells: The blood vessel or lymphatic system transports the blood containing endometrial cells in other body parts.
  • Weak immune system: If you have a weak immune system, it may not prevent the lining up of endometrial-like tissue.

Endometriosis complications

Endometriosis can create a lot of complications in a women’s life. Some women enter depression and anxiety because of it. About one-fourth of the women who experience infertility issues have the issue of Endometriosis.

The inflammation caused can damage the egg or sperm or weaken their capability to fertilize. It can also make the eggs hard to transport. However, it can get treated with proper medical help. In some cases, there is a blockage in the fallopian tube because of scar tissue. Some women also experience ovarian cancer or cancer relating to Endometriosis called endometriosis-associated adenocarcinoma.

Endometriosis risk factors

There are several risk factor associated with Endometriosis, as mentioned below:

  • Problem with infertility.
  • Heavy flow during the menstrual cycle and last for longer days.
  • Frequent menstrual cycle.
  • Unusual weight loss.
  • Experiencing late menopause.
  • Release of hormones like estrogens in a larger quantity.
  • Reproductive organ abnormalities.

Endometriosis stages

There are four stages of Endometriosis:

Stage 1 is minimal here; you have fewer lesions and no scar tissue.

Stage 2 is mild; here, you have a few more lesions but still no scar tissue. They develop in about a two-inch area of the abdomen.

Stage 3 is moderate; here, the lesion has grown deep, containing scar tissue, and developed in the fallopian tube and the ovaries.

Stage 4 is severe, here there are lesions in large quantity, and the ovary may contain many large cysts. There are scar tissue in the fallopian tube, ovaries, uterus, and bladder.

Treatment for Endometriosis

There is no scientifically proved treatment to it; however, some medications or surgery can provide relief; they are as follows:

  • Pain medicine: The doctor may suggest some pain killers like non-steroidal anti-inflammatory drugs. These medications include ibuprofen, Motrin, or aleve. These medicines help a lot in releasing the pain.

However, if you do not feel relieved, you can take personal measures like taking a warm shower, performing a hot fomentation technique on the belly. Regular exercise can also help with pain.

  • Hormonal therapy: Some doctor recommends hormonal treatment which reduces the number of estrogens released by the body. Since the estrogens get reduced, there is less formation of the lesion, preventing inflammation, cyst formation, and scarring.

This hormonal therapy includes- Birth control pills, Gonadotropins-releasing hormone, progestin, or danazol.

  • Surgery: Some women require surgery as it is the only solution to it. The surgery will include cutting the affected tissue out of the body. Surgery can help women getting pregnant again.

How to diagnose endometriosis?

The doctor might perform the following test to confirm Endometriosis:

  • The doctor might carry a pelvic exam to feel if there is cysts or scars inside your uterus.
  • A CT scan or an ultrasound picture will be able to say if you have Endometriosis.
  • The doctor might conduct laparoscopy by cutting a small part in your stomach and push a thin tube containing a camera. It enables the doctor to see lesions or scar tissues.
  • After laparoscopy, the doctor might take a small part of the tissue to test it under the microscope.

What are endometrial cysts?

When tissue gets accumulated in the inside walls of the ovaries, they form a cyst. These are the size of lumps and can be two or more. The cysts are usually 2 inches in length; however, they can grow up to 8 inches. These cysts can cause the following problem:

  • May lead to ovarian cancer
  • Can cause difficulty in infertility treatments.
  • Result in severe pelvic pain.
  • Often reduces the chance of pregnancy.
  • Disrupt the workings of the ovary.

Surgery for endometriosis

If you are trying to get pregnant and are unsuccessful, the doctor may recommend going through surgery. Surgery can also be an option if no amount of medicine or hormonal therapy has helped you. The doctor might perform standard surgery or laparoscope to cut out the unwanted tissue.

Removal of endometriosis tissue can increase the chance of pregnancy. But if you are considering going through a hysterectomy, this involves removing the uterus or even the ovaries, without which you cannot get pregnant.

What to expect after endometriosis surgery?

If you have gone through laparoscopic surgery, then you will be able to recover fast. But if you have had hysterectomy surgery, it will take time to recover. You will have to take extra care of yourself, and the doctor might restrict you from some activity. Take suggestions from your doctor on how many days you will be able to go back to your everyday life. However, it can take about four to six weeks to recover from a hysterectomy.

You will experience shoulder pain after laparoscopic surgery because of the gas trapped in the abdomen. You will no longer have a period. If your doctor has removed your ovaries, you will enter menopause.

Endometriosis diet tips

You can include the following in your diet:

  • Take food containing omega-3 fats.
  • Avoid eating unhealthy food containing trans-fat.
  • Do not eat red meat, especially those that are processed.
  • Increase the intake of fruits, whole grains, and vegetables.
  • Avoid drinking caffeine and hard drinks as much as possible.
  • Go for a gluten-free diet.

Endometriosis surgery cost

Endometriosis surgery can be a little overwhelming. It is essential to go through the surgery in severe conditions and to avoid future problem anymore. The average cost of going through the surgery in India may range from 50,000 to 150,000. This amount only includes the direct price and may vary on many factors. This number may also depend on which hospital you are trying.