Understanding Endometriosis

Endometriosis is a dreadful disorder characterised by the growth of endometrial-like tissue outside of the uterine cavity. The tissue may grow over ovaries, bowel, fallopian tubes and tissue lining the pelvis. The name is given from the word endometrium, the tissue which lines the uterus or womb. In this condition, the endometrial-like tissue thickens, sheds off and bleeds with each period cycle. However, the tissue gets trapped being unable to exit the body. This may result in intense endometriosis pain, especially during menstrual cycles.

Endometriosis: Symptoms and Causes

Some other symptoms include:

• Bleeding and spotting
• Infertility
• Stomach problems

Researchers are trying hard to find the potential causes of the disease. Some of the possible causes may involve:

• A faulty immune system
• Retrograde menstrual flow
• Higher estrogen levels
• Genetic factors

Endometriosis is most prevalent among women aged between 30 and 40 years, making it difficult for them to conceive at times. However, several endometriosis medications and treatment options are available that can help in managing symptoms.

Key Factors Determining Endometriosis

Research shows that Endometriosis may develop when:

• A family member like a mother or sister has the same condition
• An abnormal uterus
• Early menstruation and shorter period cycles of less than 27 days
• Heavy menstrual periods continue for more than 7 days.

Endometriosis Treatments: How to Treat Endometriosis With Medication

Treatment for endometriosis is done either by medicines or surgical procedures. Doctors choose the right method of treatment depending on the severity of the symptoms. Therapies used for treating endometriosis include:

1. NSAIDs & COX-2 Inhibitors

NSAIDs, especially Naproxen, are effective in reducing endometriosis pain. COX-2 inhibitors, e.g., Valdecoxib, are more effective in dysmenorrhea. NICE recommends a 3-month trial of NSAIDs.

2. Birth Control Hormonal Contraceptives

Medication for endometriosis includes birth control pills that control the hormones building up endometrial tissue. The pills are composed of synthetic progesterone (progestins) and are effective for endometriosis. Women experience painless menstrual cycles with these pills along with lighter menstrual flow.

3. Hormonal IUD

Hormonal Intrauterine Devices (IUDs), namely MIRENA, reduce the hormone production that regulates ovulation and periods, thus controlling endometriosis. The growth of endometrial-like tissue outside the uterus is decreased with shorter and lighter periods.

4. Gn-RH (Gonadotropin-releasing Hormone) Agonists and Antagonists

Medication for endometriosis involves this group of drugs that prevents menstruation by blocking the synthesis of ovarian-stimulating hormones. This can lower estrogen levels and shrink endometrial tissue. The most commonly used amongst this category is Inj Leuprolide depot 11.25 mg.

5. Danazol

Endometriosis cure can be achieved by this group of synthetic steroids. Danazol suppresses ovarian function through a direct repressive effect on ovarian steroidogenesis.

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Surgical Endometriosis Treatments

Laparoscopy

A minimally invasive surgical method to treat endometriosis is laparoscopy. This procedure involves the insertion of a slender viewing device (laparoscope) by making a small incision in the abdomen. This helps the doctor to view the tissues around the uterus and check for endometrial tissue growth.

By executing laparoscopy, one can get information about the location, size, and extent of endometrial implants.

Advantages of Laparoscopy:

• Better visualization of subtle lesions
• Less tissue trauma
• Adhesiolysis
• Restoring tubo-ovarian anatomy
• Excision of visible lesions
• Staging of endometriosis
• Smaller incisions as compared to open surgery
• Speedy recovery
• Less post-operative adhesions and complications

It works on the principle of “See & Treat”, where diagnosis can be confirmed and treatment carried out at the same time.

Important Notes:

• Visual inspection of the pelvis is crucial as laparoscopy is the gold standard investigation.
• Laparoscopic aspiration, irrigation, and vaporization of the cyst wall are not recommended to destroy the mucosal lining.
• Instead, excision of the capsule (rather than drainage) and electrocoagulation of the endometrioma wall is ideally done — as it reduces recurrence, provides better pain relief, and offers a histological diagnosis.

Oophorectomy

Doctors may recommend removing ovaries along with hysterectomy by a process called oophorectomy. This results in substantially lower estrogen levels and inhibited endometrial tissue growth. This is beneficial in deep infiltrating endometriosis and severe cases.

Key Points:

• Total hysterectomy with removal of all visible endometriotic tissue with bilateral salpingo-oophorectomy improves pain and reduces the chances of future surgery.
• However, some side effects like heart disease, bone loss, depression, and anxiety may arise.

Endometriosis and Infertility Treatment

An innovation in women's health science has come up in the form of Restorative Reproductive Medicine (RRM). This infertility treatment not only restores women's reproductive health and well-being but also maintains and improves gynecological health conditions.

RRM offers medical and surgical treatments that solve the root causes of reproductive disorders, thus enhancing natural fertility.

Fertility Drugs and IUI

Fertility drugs facilitate ovulation by stimulating the pituitary gland to release more follicle-stimulating hormone and luteinizing hormone.

Intrauterine insemination (IUI) is a form of artificial insemination to treat infertility. Washed and concentrated sperm are placed in the uterus around the time of ovulation for better fertilization.

Explore the expert guide about - 10 Myths About Contraception Debunked.

In Vitro Fertilization (IVF)

During the IVF process, mature eggs from the ovaries are collected and fertilized in aseptic conditions that help in child conception.

Know more about - Best IVF Centre for Infertility Treatment in Delhi, India.

Takeaway

According to reports from the Endometriosis Society of India, 25 million Indian women are affected by this condition. However, this disease is seldom understood and discussed due to various taboos around menstruation.

Proper knowledge and treatment can better cure the disease and make women free from Endometriosis.