Endometriosis Treatment and Management

The following symptoms may be associated with endometriosis:

• Pelvic pain
• Dysmenorrhea (painful periods)
• Pain during or after sexual intercourse
• Pain during urination or bowel movements
• Excessive menstrual bleeding
• Intermenstrual bleeding (bleeding between periods)
• Fatigue 
• Constipation 
• Diarrhea
• Nausea
• Bloating
• Infertility 

1. Physical examination: The doctor examines the patient physically. The doctor will evaluate your symptoms and check for the location of the pain and ask when the pain occurs. The doctor will also ask about the medical history and family history of the patient.
2. Pelvic exam: The doctor manually palpates the pelvic areas and checks for abnormalities such as scars behind the uterus or cysts (fluid-filled sacs) in the female reproductive organs. 
3. Ultrasound: The test uses high-frequency sound waves to create images of the internal organs of the body. It helps in identifying the cysts associated with endometriosis, known as endometriomas.
4. Magnetic resonance imaging (MRI) scan: This is a type of imaging test that uses a magnetic field and radio waves to create detailed images of the female reproductive organs.
5. Laparoscopy: A small incision or cut is made by the surgeon in the navel area and a laparoscope (a thin tube with a camera and light on one end) is placed inside to check for the presence of any endometrial-like tissue outside the uterus. It helps in providing information about the size, location, and extent of the endometrial-like tissue.
6. Biopsy: A sample of the tissue is excised by the surgeon using a laparoscope and sent to the laboratory for further examination.

Depending on the severity of the condition and the overall health of the patient, the various treatment modalities for endometriosis may include:

1. Pain medicines:
Pain-relieving medications like ibuprofen may be recommended to ease the painful menstrual cramps.

2. Hormone therapy:
This type of treatment is recommended in the case of patients who are not trying to get pregnant.
Hormonal medicines help in slowing the growth of the endometrial tissue and preventing the formation of new endometrial tissue implants.
The different hormone therapies that may be used to treat endometriosis include:
Hormonal contraceptives: Birth control pills, vaginal rings, and patches help in decreasing or eliminating the heavy bleeding and pain during menstruation.
Progestin therapy: The use of an intrauterine device (IUD), contraceptive implant, contraceptive injection, or progestin pill help in stopping the menses and the also growth of the endometrial implants.
Gonadotropin-releasing agonists and antagonists: These medicines help to reduce estrogen levels, block ovarian-stimulating hormone production, and stop menstruation creating artificial menopause. The menses resume once the patient stops taking these medicines.
Aromatase inhibitors: These medicines decrease the estrogen levels in the body.

3. Conservative surgery:
This type of surgery is performed to remove the endometriosis implants while preserving the uterus and the ovaries.
This type of procedure is preferred in women who are trying to get pregnant but have endometriosis.
This type of surgery can be performed in the following ways:
 Laparoscopic surgery: A laparoscope (a tube with a light and camera on one end) is inserted through a small incision (cut) near the belly button area. Small surgical instruments are then inserted inside to remove the endometrial tissue through the incision. 
Traditional open-cut abdominal surgery: This type of surgery is performed in more extensive cases. The surgeon makes a large incision in the abdominal region to remove the endometrial tissue.

4. Fertility treatment:
Endometriosis could cause difficulty in conceiving.
Fertility treatments, such as the stimulation of the ovaries in order to produce more eggs or in vitro fertilization may be performed.

5. Hysterectomy along with the removal of the ovaries:
Hysterectomy is a surgical procedure performed to remove a woman’s uterus. Oophorectomy is the surgical removal of a woman’s ovaries.
Hysterectomy can treat symptoms of endometriosis such as painful menstruation and heavy bleeding.
Removal of the ovaries causes early menopause. Early menopause may increase the risk of developing cardiovascular diseases, and metabolic disorders, and may even cause early death.
This procedure is performed only if all other treatment options have failed.

The complications associated with untreated endometriosis are:

• Blocked and unhealthy fallopian tubes
• Chocolate cyst (endometrioma on the ovaries)
• Excessive abdominal pain
• Vomiting blood 
• Infertility
• Adhesions
• Ovarian cysts
• Ovarian cancer
• Problems in passing urine and stools
• The complications associated with surgery performed to treat endometriosis include:
• Bleeding
• Bruising around the wound region
• Infection 
• Damage to the nearby organs, like the uterus, ureter, bladder, ovaries, or bowel
• Blood clot formation in the legs
• Allergic reaction to the anesthesia used

• Following an endometriosis laparoscopic surgery, it is normal to feel fatigued for a few days after the surgery. The patient is usually discharged from the hospital on the same day or the next day after laparoscopic surgery.
• Activities like driving, swimming, having a bath in the bathtub, and having sexual intercourse should be avoided for two weeks to help you to recover from the procedure.
• The patient will usually be discharged after a two to three days stay in the hospital after a traditional open-cut surgery. 
• If the patient has had a hysterectomy, she will stop getting her periods as the uterus has been removed. If the ovaries have also been removed, the woman will go into menopause and have symptoms like loss of bone density and hot flashes.
• It is normal to experience mild pain and vaginal bleeding after surgery.
• The patient may also have irregular bowel movements and mood swings following surgery.
• Take adequate rest and eat a healthy, nutritious diet for a quicker recovery.
• Stay hydrated and do small movements to prevent indigestion.

Home remedies:

The following home remedies are helpful in relieving the symptoms of endometriosis:

• Heating pad and a warm bath are helpful in relaxing the muscles of the pelvic region and reducing the pain and cramping
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen sodium can help in relieving the painful menstrual cramps
• Massaging castor oil with a few drops of essential oils like peppermint and lavender onto the abdomen can help in relaxing the pelvic muscles
• Turmeric can help in inhibiting the growth of endometrial tissues
• Pelvic massages before the menstrual cycle help in relieving abdominal cramps and pelvic pain
• Ginger tea helps in the management of nausea and indigestion associated with endometriosis

Prevention:

Endometriosis cannot be prevented. However, lowering the levels of estrogen in the body can reduce the risk of developing endometriosis. This can be done in the following ways:

• Hormonal birth control methods such as pills, patches, or rings having a lower dosage of estrogen
• Maintain a healthy weight
• Exercise regularly 
• Avoid the consumption of excessive alcohol 
• Avoid caffeinated drinks

Cost of Endometriosis treatment in India- 

The cost of endometriosis treatment using medications in India is between INR 2,000 to INR 3,000.
The cost of endometriosis treatment in Mumbai is between INR 60,000 to INR 2,75,000.
The cost of endometriosis treatment in Delhi is between INR 55,000 to INR 2,50,000.
The cost of endometriosis treatment in Bangalore is between INR 55,000 to INR 2,50,000.
The cost of endometriosis treatment in Chennai is between INR 50,000 to INR 2,25,000.