Endometriosis Treatment

What is endometriosis?

Endometriosis is a painful condition that involves ovaries, fallopian tubes and tissue lining the pelvis of women. In the case of endometriosis, the tissue which lines inside the uterus known as the endometrium is found on organs outside it. In very rare scenarios, we get to see the spreading of endometrial tissue beyond the pelvis.

In the case of endometriosis, the endometrial-like tissue thickens, breaks down and causes bleeding when the menstrual cycle starts. The tissues get trapped and as there is no way to get out of the body it makes the surrounding area swollen and inflamed and scarred.

Everything You Need to Know About Endometriosis Treatment

Stages | Difference | Diagnosis and Symptoms | Fertility And Endometriosis | Treatment | Pregnancy And Endometriosis

Stages of Endometriosis

India reports more than 10 lakh cases of endometriosis per year. It is a chronic disease and it may be long before the condition may be diagnosed. The endometrial tissue when found in the ovary leads to cyst formation and is known as endometrioma. This is a cyst that can cause irritation, inflammation and can develop scar tissues. At times, it can cause severe pain during the time of menstruation.

The classification of endometriosis is in four stages, these are as follows-

• Stage- 1: Minimal
• Stage- 2: Mild
• Stage- 3: Moderate
• Stage- 4: Severe

The American Society for Reproductive Medicine (ASRM) has defined the staging of endometriosis and its basis is the location, depth, extent, presence of the disease and the size of the ovarian endometriomas as well. It also depends on the severity of it. The three types of endometriosis are- superficial peritoneal lesion, ovarian lesion and deeply infiltrating endometriosis.

In the case of the superficial peritoneal lesion, the lesion will be on the women’s peritoneum. In the case of the ovarian lesion, dark, chocolate-colored blood-filled cysts fill the ovaries and are known as endometrioma.

In the case of deep infiltrating endometriosis, endometriotic lesions occur deep under the peritoneum and involve the organs near the uterus as the rectum and intestines of the woman. Since endometriosis leads to lots of swelling and scarring many a time the relationship between tube and ovary gets distorted and the fallopian tube may get filled with endometriosis leading to blocked tubes.

Difference between Endometriosis and Adenomyosis:

We know in endometriosis the endometrial tissue is found outside the uterine cavity but in Adenomyosis the endometrial tissue is found in the wall of the uterus. Adenomyosis can cause severe menstrual cramps, lower abdominal pressure, and bloating before menstrual periods and can result in heavy periods. This condition can be examined or located throughout the whole uterus or localized in one spot.

Endometriosis Diagnosis and symptoms

Endometriosis many times goes unnoticed due to which it may take many years before the disease is diagnosed They are often passed as normal and hence it may take long before the condition is diagnosed. Diagnosis is by:

• Detailed HISTORY TAKING for the following symptoms:
• 1. During a period, one can suffer from back pain.
  2. One can feel menstrual cramps severely.
  3. While pooping or peeing, you can feel pain.
  4. Unusual bleeding during periods is also a symptom.
  5. You can notice blood in urine or stool.
  6. It also includes painful sex and trouble in case of getting pregnant.
  7. The problem of constipation and diarrhea are also included in this.
• If the doctors suspect endometriosis on the basis of your symptoms further investigations have to be carried out. For confirmation, they recommend testing the following:

1. 1. A pelvic examination can help the doctor to feel the cysts behind the uterus.
   2. Imaging techniques as transvaginal ultrasound, MRI and CT scan help in diagnosing the condition. It provides a detailed picture of the organs.
   3. During laparoscopy, though a gold standard in diagnosing the condition is no longer recommended as the first line for diagnostic purposes especially in the case of young patients who wants future fertility. During laparoscopy, the doctor collects samples of the tissue and confirms the diagnosis by seeing it under the microscope. In the process of laparoscopy, after making a small cut in the belly, the doctor inserts the camera attached thin tube and the size of the lesions. This is the best way to confirm that one has endometriosis but should delay as far as possible so as to avoid multiple surgeries in the future.

Fertility and endometriosis:

Almost 30% to 50% of women that have endometriosis may experience some infertility issues. The condition of endometriosis can influence fertility in several ways:

1. Distorted anatomy of the pelvis, adhesions, scarred and blocked fallopian tubes.
2. Inflammation of the pelvic structures.
3. Altered immune system functioning.
4. Changes in the hormonal environment of the eggs.
5. Impaired implantation of pregnancy or altered egg quality.

Treatment for endometriosis:

The treatments of endometriosis include medication and surgery:

1. Medicine of pain: The doctor can recommend over-the-counter pain relievers, which include ibuprofen or naproxen. It helps many people but if it does not work for you, consult your doctor for other options. Sometimes, taking bath in warm water, regular exercise and using hot water bags or pads can help the patient. Some also get helps by starting changes in diet, doing acupuncture etc.
2. Surgery: Surgery is also an option that helps to remove the affected tissues and also increases the chances to get pregnant. The doctors can do the surgery by doing laparoscopy or by making the bigger cut.
3. Hormones Therapy: Doctors recommend hormonal therapy which helps to decrease the amount of estrogen in the body of women because excessive estrogen can stop the period. It decreases the bleeding, formation of the cyst and also inflammation. The hormones include- progestin Dienogest, pills for birth control, vaginal rings, gonadotropin-releasing hormone, Danazol etc. There is no role of medical management in case planning a pregnancy.
4. IVF ( InVitro Fertilization): In this method, some eggs are extracted from the female body and some sperms are collected from the male body. After this, the fertilization of this egg and the sperms is done in the lab, and embryo is transferred into the uterus for implantation.

Treatment for endometriosis-related Infertility

If you are facing problems in getting pregnant due to endometriosis, you should see an infertility specialist. This way your doctor will have an idea of the severity of the endometriosis and how it is affecting your infertility.

Treatments for endometriosis-related infertility include:

1. Freezing eggs: Endometriosis affects the ovarian reserve, so the doctors may recommend preserving your eggs by freezing them now in case you wish to become pregnant later in the future. This option can be expensive and isn’t usually covered by some insurance.
2. Superovulation and intrauterine insemination (SO-IUI): This is a treatment option for women who have mild endometriosis, normal fallopian tubes, and whose partner has good-quality sperm.
3. Fertility medicine: A doctor may prescribe some fertility medications like Clomiphene. These medicines will help in the production of two to three mature eggs. He may also prescribe progestin injections in some cases.
4. Regular Ultrasounds: Doctor will do regular ultrasounds to ensure the development of the egg and when they become most mature. When the eggs become ready, the doctor will insert a sperm collected from your partner.
5. In vitro fertilization (IVF): This treatment will involve extracting eggs from your ovaries and sperms from your partner. Then fertilization of this egg and sperm is done in the lab and then the embryo which is formed is implanted into the uterus.

The success rate of IVF cycle is around 50 percent for women who don’t have endometriosis. But on the other hand, a lot of women with endometriosis have successfully conceived just because of IVF treatment. IVF is a treatment option which often recommended to women with moderate to severe endometriosis, or for women who haven’t conceived after other treatments.

Pregnancy And Endometriosis:

It is seen that pregnancy can improve some symptoms of endometriosis by inducing some regressive changes in the endometriotic spots. This can happen due to increased progesterone levels during pregnancy.

Women with endometriosis have higher rates of:

• 1.5 times higher preterm delivery
• 36% of miscarriage
• Preeclampsia
• Placenta complications
• Cesarean deliveries

Still, a majority of women with endometriosis conceive babies with living a healthy lifestyle and proper medical care. It’s also important to live a healthy lifestyle in cases when you have endometriosis. These good habits can reduce the inflammation in your body and prepare it to help your child grow.