It is a condition in which the presence of tissue that normally grows inside the uterus, is found outside the uterus. The location of this abnormal tissue includes ovaries, outer aspect of fallopian tubes, urinary bladder, intestines, rectum and the space behind the uterus. It may also be found in the scar of a previous surgery. Every time the woman menstruates, the uterine tissues outside the uterus also bleed causing a myriad of problems. This condition is exclusively seen in women in the reproductive age who menstruate. It affects 10-15% of women in reproductive age group.
Endometriosis presents with a wide range of symptoms, from mild menstrual pain to infertility. In addition to infertility, it is commonly associated with symptoms such as irregular and frequent menses, dyspareunia (pain during sex), dysmenorrhea (painful menses), bladder/bowel symptoms (pain during passing stools), chronic pelvic pain and vague lower abdominal pain.
• Clinical history and examination by gynecologist
• Blood tests.
• Laparoscopy is gold standard for diagnosis and treatment
The prevalence of endometriosis increases dramatically to as high as 25% to 50% in women with infertility and 30 % to 50% of women with endometriosis have infertility. The chances of a couple getting pregnant in a month in normal reproductive-age couples without endometriosis is estimated to be around 15 % to 20%, whereas in women with untreated endometriosis it drops to 2-10%.
Infertility in endometriosis is due to the following reasons:
• Defective egg production and release
• Hindrance of sperm function
• Lining of uterus is damaged and hence there is difficulty in attachment of embryo.
Treatment for endometriosis depends on the kind of complaints with which the patient presents to us. If pain is the primary complaint, it is treated with anti-inflammatory medicines and hormonal medicines. When a patient has completed family, or wants spacing after first child, we can insert hormonal intra uterine device which causes temporary cessation of menses and greatly benefits these patients. Patients with infertility have to be treated by an infertility specialist. Such patients may require laparoscopy which is both diagnostic and therapeutic in this condition. It helps in staging the disease, removal endometriotic spots and cysts, release of adhesions. Laparoscopy increases the chance of pregnancy. Some women with endometriosis and infertility may require assisted reproductive techniques such as IVF or ICSI for conception. Please refer to our sections on IVF and ICS for more information.