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Endometriosis

What is Endometriosis?

Endometriosis is a gynaecological medical condition in which cells from the lining of the uterus, appear & flourish outside the uterine cavity, most commonly on the ovaries. Symptoms typically worsenin each menstrual cycle. It is a chronic, debilitating disease without cure but with proper treatment women can live normal, pain free lives for many years.

Signs and Symptoms:

• Pelvic Pain – pain during periods, chronic pelvic pain and painful intercourse.
• Infertility - due to anatomical distortions &adhesions or release of factors detrimental to gametes or embryos.

What is the cause of pain?

Endometriotic lesions react to hormonal stimulation and may 'bleed' at the time of menstruation. The blood accumulates locally, causes swelling and triggers inflammatory response.
Pain can also occur from adhesions binding internal organs to each other. The uterus, tubes, ovaries, bowel &bladderget bound to each other in varying degrees of severity.

What are the common sites?

How do we diagnose?

• Diagnostic Laparoscopy is the gold standard in diagnosis.
• USG – can pick up chocolate cyst in the ovaries (so called as they contain darkish brown, old blood resembling chocolate material)
• MRI

There are 2 modalities of treatment

• Medical
  • NSAIDS
  • For Major Pain Relief;
    • OCPS
    • Progestron
    • Dandozol
    • GnRn agonists
    • Aromatase inhibitors
• Surgical
  • Conservative surgery like cystectomy, ablation of lesions, adhesiolysis – where aim of Rx is to restore fertility.
  • TAH with BSO – 'definitive' excision of all lesions.

Is there a chance of recurrence?

Yes, most studies imply that recurrence may occur 20-40% of cases within 5 years of conservative surgical treatment.