It's her intimate health

It is very essential for women to have their intimate region checked atleast once in two years in order to keep endometriosis under control, advises Dr Manisha Singh

The lining of the womb or uterus is called endometrium. Endometriosis is an estrogen hormone-dependent condition that is characterized by the presence of ectopic endometrial tissue in places within the body but outside of the uterus.

How does it grow or develop?

Endometriosis may develop in some women that are genetically prone to develop or grow the endometrial cells in ectopic sites outside of the uterus (runs in the families eg: mother, sisters). In others it may develop due to retrograde flow of menstrual blood through the fallopian tubes or due to an altered immune environment in the pelvis. Endometriosis predominantly affects the ovaries by forming cysts at the back of the uterus. It may also be found in the space between the womb and bowel and very occasionally in areas as remote as bladder, in caesarean section scars and lungs

Symptoms

A woman may be completely asymptomatic and the condition may be diagnosed as an incidental finding during either sterilization surgery or during infertility assessment. Some women may suffer from painful periods and others may suffer from pain at the time of intercourse. Others may also experience painful opening of bowels around the time of the periods. It has been seen that occasionally women may have a cyclical bleeding (during menses) from the back passage (along with stools) or from the bladder (while passing urine). Women with endometriosis in the operation scar sites may find that the scar develops painful nodules that grow during periods. It has been shown that less than 10% of women would be accurately diagnosed with the disease when they first present to the doctor with symptoms.

Does endometriosis cause infertility?

Endometriosis can cause anatomical distortion of the pelvic organs due to scarring e.g chocolate cysts in the ovaries, adhesions etc. Distortion in the pelvis can impair the fertilization process. In addition it can affect the egg release process. Endometriosis is known to alter the immune environment within the body which in turn affects the fertilization process.

Diagnosis

A good clinical history and a thorough clinical examination help point in the direction of the correct diagnosis. To confirm the diagnosis, a woman will be advised to undergo a pelvic ultrasound assessment and laparoscopy (keyhole camera procedure) which is considered the “gold standard” tool. Other sophisticated tests such as MRI, intravenous urography (IVU), barium enema (X-ray procedure) may be required in some women with severe cases.

Treatment

Endometriosis can be managed either with the help of drugs or with surgery. The drugs used for the management are geared towards reducing the impact of the oestrogen hormone.

Drugs used:

* Painkillers

*  Combined oral contraceptive pill (COCP)

*  Progesterone only pill

*  Gonadotropin releasing hormone agonist (GnRHa e.g. Zoladex, Prostap, Luprolide acetate etc)

*  Mirena IUS (Progesterone loaded IUCD)

Unfortunately, one cannot completely cure endometriosis or eradicate the disease by surgery or medications. Following surgery for mild, moderate or severe disease, the chances of recurrence may be as high as 50% in 2 – 3 years. Also, symptoms of pain may recur once the medications are stopped.

Endometriosis & pregnancy

A woman cannot get pregnant while she is undergoing treatment or endometriosis. In those with minimal to mild disease, conception can occur spontaneously. Failure to conceive following 6 – 12 months of trying may necessitate help in the form of assisted conception treatment e.g., Intra-uterine insemination of semen (IUI) or In-vitro fertilization (IVF). The IUI treatment may result in 10 – 15% chance of pregnancy and IVF results in 25- 30% chance of success provided the reserve of eggs in a woman’s ovaries is good and the woman is less than 37 years of age.
 (The writer is a gynaecologist)