What is Endometriosis and treatments?

Dr Foram Bhuta

Dr Foram Bhuta

BDS (Bachelor of Dental Surgery), 10 years of experience

December 31, 2021 Womens Health 377 Views

English हिन्दी Bengali

What is the meaning of Endometriosis?

A painful disorder in which tissue similar to the tissue that normally lines the inside of a woman’s womb or uterus (known as the endometrium) grows outside the uterus. The endometrial tissue is normally found in the ovaries (a part of the female reproductive system, that is responsible for the production of the female eggs), fallopian tissue (the tubes along which the female eggs travel from the ovaries to the uterus), or the tissue lining the pelvis (the region below the stomach). In normal circumstances, the endometrial tissue lining the uterus breaks down and bleeds during each menstrual cycle. However, in cases of endometriosis, the tissue has no way to exit the body. The surrounding tissue can thus become irritated, and eventually, develop scar tissue and adhesions (fibrous tissue bands that cause the pelvic tissues and organs to stick to each other). Endometriosis can lead to severe pain, especially during a woman’s menstrual cycle. It can also cause fertility issues.

In this article, we will be discussing endometriosis and its treatments.

  • What are the causes of Endometriosis?
  • What are the risk factors of Endometriosis?
  • What are the symptoms of Endometriosis?
  • How to diagnose Endometriosis?
  • What are the different stages of Endometriosis?
  • What is the treatment for Endometriosis?
  • What are the complications of Endometriosis?
  • How to prevent Endometriosis?
  • What is the cost of Endometriosis treatments in India?

What are the causes of Endometriosis?

The possible causes of endometriosis may include:

  • Retrograde menstruation: In this condition, the menstrual blood which contains the endometrial cells flows back through the fallopian tubes and the pelvic cavity instead of flowing out of the body. 
  • Induction theory: Certain hormones or immune (disease-fighting) factors promote the transformation of the peritoneal cells (cells lining the inner side of the abdomen or stomach) into endometrial-like cells.
  • Surgical scar implantation: After a surgery like a hysterectomy (removal of the uterus) or C-section, the endometrial cells may get attached to the surgical incision or cut made.
  • Embryonic cell transformation: Hormones like estrogen may change the embryonic cells (cells present in the early stages of development) into endometrial-like cells during puberty.
  • Immune system disorder: A problem with the body’s immune system may prevent the identification and destruction of the endometrial-like tissue growing outside the uterus.
  • Endometrial cell transport: The lymphatic (tissue) fluid or the blood vessels may transport the endometrial cells to the other parts of the body.

What are the risk factors of Endometriosis?

Certain factors may increase the risk of developing endometriosis and may include:

  • No history of delivery
  • Onset of the menstrual period at an early age
  • Menopause that occurs at an older age
  • Shorter menstrual cycles (less than 27 days)
  • Heavy menstrual bleeding that lasts for more than 7 days ( Know more about- What is Vaginal Cyst? )
  • Low body mass index
  • Family history of endometriosis
  • High level of estrogen (female sex hormone) in the body
  • Reproductive tract disorders
  • Medical conditions that prevent the passage of blood from the body during periods

What are the symptoms of Endometriosis?

The symptoms associated with endometriosis include:

  • Pelvic pain
  • Severe cramps during menstrual periods ( Know more about- Problems faced during menstruation )
  • Dysmenorrhoea (painful periods)
  • Pain during or after sexual intercourse
  • Pain during urination
  • Pain during bowel movements
  • Excessive bleeding during periods
  • Intermenstrual bleeding (bleeding between periods)
  • Infertility
  • Fatigue
  • Constipation
  • Diarrhea
  • Nausea
  • Bloating

How to diagnose Endometriosis?

  • Physical examination: The doctor will examine you physically and ask you to describe your symptoms, including the location of pain and when it occurs. You are also asked about your medical history and family history.
  • Pelvic exam: The doctor will manually feel or palpate the areas in the pelvis to check for abnormalities like scars behind the uterus or cysts (an abnormal, non-cancerous growth that is filled with liquid or semi-solid substance) in the reproductive organs. Small areas of endometriosis are usually not felt unless there is a cyst formation. ( Know more about- What is Cervical Cancer ? )
  • Ultrasound: High-frequency sound waves are used to create images of the internal organs of the body. A device called a transducer is pressed against the abdomen or inserted into the vagina (transvaginal ultrasound) to obtain images of the reproductive organs. This test helps in the identification of the cysts associated with endometriosis (called endometriomas)
  • Magnetic resonance imaging (MRI) scan: It is an imaging test that uses a magnetic field and radio waves to create detailed images of the tissues and organs within the body.
  • Laparoscopy: A tiny cut is made by the surgeon in the navel area and a thin tube with a camera and light on one end (called a laparoscope) is placed inside to look for signs of an endometrial-like tissue outside the uterus. It can provide information about the location, extent, and size of the endometrial implants. ( Know more about- What are Uterine Fibroids? )
  • Biopsy: The surgeon may remove a sample of the tissue using a laparoscope and send it to the laboratory for further examination.

What are the different stages of Endometriosis?

Endometriosis can be classified according to its severity from stage 1 to stage 4 as follows:

Stage 1: Minimal

Isolated endometrial implants are seen with no significant adhesions (sticky areas of the endometrial tissue that joins the organs together).

Stage 2: Mild

Superficial endometrial implants are observed on the ovaries and peritoneum (a thin film lining the pelvic cavity) with no significant adhesions. 

Stage 3: Moderate

Multiple endometrial implants are seen, both superficial and deeply invasive. Adhesions may be present.

Stage 4: Severe

Multiple superficial and deep endometrial implants are seen along with large ovarian endometriomas (cysts). The presence of filmy, dense adhesions is seen in most cases. ( Know more about- What is Ovarian Cyst Removal Surgery? )

What is the treatment for Endometriosis?

The treatment may include medications and surgery, depending on the severity of the condition and the overall health of the patient. The various treatment modalities may include:

Pain medications:

  • The doctor may recommend using painkillers like ibuprofen to ease the painful menstrual cramps.

Hormone therapy:

    • Hormonal therapy is recommended if the patient is not trying to get pregnant.
    • Hormonal medications may slow the growth of the endometrial tissue and prevent the formation of new endometrial tissue implants.
    • The various hormone therapies that are used to treat endometriosis are:

Hormonal contraceptives: Using hormonal contraceptives like birth control pills, patches, and vaginal rings help in reducing or eliminating the pain and heavy bleeding during menstruation.

Progestin therapy: Progestin therapies like using an intrauterine device (IUD), contraceptive injection, contraceptive implant, or progestin pill can halt the menstrual periods and the growth of the endometrial implants.

Gonadotropin-releasing agonists and antagonists: These drugs help in lowering the estrogen levels, blocking the production of the ovarian-stimulating hormones, and preventing menstruation creating artificial menopause. The periods resume once you stop taking these medications.

Aromatase inhibitors: These medications reduce the estrogen levels in the body.

Conservative surgery:

    • The doctor may perform surgery to remove the endometriosis implants while preserving the ovaries and the uterus.
    • This increases the chances of success in a woman with endometriosis who is trying to get pregnant.
    • The surgery can be performed in the following ways:

 Laparoscopic surgery: A thin instrument known as a laparoscope is inserted through a small incision (cut) near the navel. Surgical instruments are then inserted inside to remove the endometrial tissue through the incision. The doctor may recommend taking hormone medication to help in improving the pain.

Traditional abdominal surgery: In the more extensive cases, the surgeon will make a larger incision to remove the endometrial tissue.

Fertility treatment:

  • Endometriosis may lead to difficulty in conceiving.
  • The doctor may recommend fertility treatments like the stimulation of the ovaries to produce more eggs or in vitro fertilization (in which an egg and a sperm are combined outside the body, and then introduced into a woman’s body).

Hysterectomy with the removal of the ovaries:

  • Hysterectomy is the surgical removal of a woman’s uterus. Oophorectomy is the surgical removal of a woman’s uterus.
  • Hysterectomy can be used to treat the symptoms associated with endometriosis, like painful menstruation and heavy bleeding.
  • Removal of the ovaries results in early menopause. Early menopause increases the risk of developing heart and blood vessel diseases, some metabolic disorders, and even early death.
  • This method is the least preferred treatment for endometriosis and is only done if all other conservative forms of treatments have failed.

What are the complications of Endometriosis?

The complications of endometriosis include:

  • Difficulty in getting pregnant or not being able to get pregnant at all (infertility)
  • Adhesions
  • Ovarian cysts (fluid-filled cysts in the ovaries)
  • Bowel and bladder problems (problems in passing stools and urine)
  • Ovarian cancer ( Know more about- What is Ovarian Cancer and Treatment? )

The complications of surgery done for the treatment of endometriosis include:

  • Infection
  • Bleeding
  • Bruising around the wound area
  • Damage to a nearby organ like the womb, bladder, or bowel
  • Blood clot (a gel-like collection of blood) formation in the legs or lungs

How to prevent Endometriosis?

Endometriosis cannot be prevented. However, you can reduce your chances of developing endometriosis by lowering the estrogen hormone level in your body. Estrogen helps in thickening the uterine lining during the menstrual cycle.

For reducing the level of estrogen in your body, the following can be done:

  • Consult your doctor about using hormonal birth control methods like patches, pills, or rings having a lower dosage of estrogen
  • Exercise regularly
  • Maintain a healthy weight
  • Avoid excessive alcohol consumption
  • Avoid drinks with a large amount of caffeine (for example, sodas and green tea)

( Know more about- What are the symptoms of Blocked Fallopian Tubes? )

What is the cost of Endometriosis treatments in India?

The total cost of endometriosis treatment in India can range from around INR 80,000 to INR 2,50,000, depending on the type of treatment done. However, many prominent hospital doctors in India specialize in endometriosis treatment. But the cost varies across different hospitals. 

If you are coming from abroad, apart from the cost of endometriosis treatment, there will be an additional cost of living in a hotel and the cost of local travel. After surgery, the patient is kept for one day in the hospital and seven days in the hotel for recovery. So, the total cost of endometriosis treatment in India comes to a total of INR 1,00,000 to INR 3,00,000.

We hope we could answer all your questions about Endometriosis and its treatments through this article.

If you want to get more information and treatment about Endometriosis, you can contact a good Gynecologist.

We only aim to give you information through the article. We do not recommend medication or treatment in any way. Only a doctor can give you the best advice and correct treatment plan. 

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