Q. What is endometriosis?

A. Endometriosis is a medical condition in which the uterine blood lining (the lining inside a woman’s womb) that usually grows inside the uterus starts growing outside.

Q. Which doctor should I consult if I have endometriosis?

A. If you have endometriosis, you should consult a gynecologist to work out the best treatment plan for you.

Q. Will endometriosis affect my chances of having children?

A. Approximately 60 to 70% of women having endometriosis may have no problems having children, while about 30 to 40% of women having endometriosis may have difficulties in getting pregnant. A woman having endometriosis who wishes to get pregnant should consult a gynecologist to develop the best treatment plan for her.

Q. Will pregnancy treat endometriosis?

A. No, some women could observe that their pain symptoms may become less during pregnancy, but this is not true for everyone. Besides, in most cases the symptoms of endometriosis will return after childbirth and once the mother stops breastfeeding her child.

Q. Is endometriosis a type of cancer?

A. No, the fluid-filled sacs or cysts formed in the ovaries due to endometriosis are sometimes known as benign or non-cancerous tumors due to their behavioral similarity to cancer, but endometriosis by itself is not a type of cancer. In extremely rare cases, endometrial implants may lead to the development of ovarian cancer.

Q. Can I inherit endometriosis?

A. Although the exact cause of endometriosis is not clear, it is observed that when a close family member like a mother, sister, or daughter has endometriosis, the woman has a higher risk of developing endometriosis.

Q. Will the symptoms of endometriosis disappear with menopause?

A. Yes, the symptoms of most women will disappear after menopause. Although in rare cases, the symptoms of endometriosis may persist after menopause.

Q. How common is the condition of endometriosis?

A. Endometriosis is seen in more than 190 million women worldwide.

Q. Will stress affect endometriosis?

A. Studies show that endometriosis is associated with high levels of chronic stress. The intensity of stress correlates with the severity of pain and extension of the disease.

Q. Will endometriosis advance with age?

A. Yes, endometriosis usually worsens with time as it is a progressive condition. Usually, the symptoms of endometriosis are seen after a few years of puberty, the condition temporarily pauses during pregnancy and generally ends permanently after menopause.

Q. What is the cost of endometriosis treatment in India?

A. The cost of endometriosis treatment varies depending on the severity of the condition present, the type of treatment performed, and the expertise of the doctor. The cost of endometriosis treatment using medications is much less than the cost of endometriosis treatment by surgical method. On average, the cost of endometriosis treatment using medications is between INR 2,000 to INR 3,000 and the cost of endometriosis treatment using surgical methods is between INR 50,000 to INR 2,75,000.

Endometriosis Treatment and Management

Endometriosis commonly involves the ovaries (female reproductive organs that produce the female eggs and female sex hormones), fallopian tubes (tubes connecting the ovaries to the uterus), and tissues lining the pelvis.
The endometrial-like tissue will act like the endometrial tissue and will thicken, break down, and bleed with each menstrual cycle. Since this tissue has no way to exit the body, it gets trapped in the body and may lead to pain and fertility problems.

Causes:
The precise cause of endometriosis is not known. However, it is thought to occur due to the following reasons:

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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

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.
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.
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.
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.
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.
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.