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Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — gets attached outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond pelvic organs. With endometriosis, displaced endometrial tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped.

Endometriosis affects about 10% of the women in the reproductive age group. It is rarely seen in postmenopausal women. Exact cause is unknown. One of the probable causes is trans tubal backflow during periods leading to adhesions or chocolate cysts. Other causes could be genetic, immunological, or estrogen dependent inflammatory conditions

Symptoms include *Pelvic pain worse before periods *Painful periods *Pain while passing stools or urine *Painful sex generally deep seated pain * Unusual pains in other parts of body at the time of menstruation *Chronic fatigue *Reduced fertility * Diarrhea, constipation, bloating or nausea, especially during menstrual periods.

See your doctor if you have signs and symptoms that may indicate endometriosis. The severity of your pain isn’t necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have intense pain, while others with advanced endometriosis may have little pain or even no pain at all.

Endometriosis can be a challenging condition to manage. An early diagnosis, and an understanding of your diagnosis may result in better management of your symptoms.

For diagnosis noninvasive ultrasound is a helpful tool in locating chocolate cysts or deep infiltrating endometriosis but the gold standard for the diagnosis of endometriosis has been visual confirmation with laparoscopy along with biopsy results.

Laparoscopy involves putting a thin laparoscope equipped with a camera through a small hole in the body wall near the navel and examining under direct vision. Laparoscopy is both a diagnostic as well as a therapeutic tool and is done under general anaesthesia.

Risk factors You might be at an increased risk if you fulfill one or more of the following conditions Never giving birth If your periods start at an early age Going through menopause at an older age

Short menstrual cycles — for instance, less than 27 days Low body mass index Alcohol consumption one or more relatives (mother, aunt or sister) with endometriosis any medical condition preventing the normal outward passage of menstrual flow.

Uterine abnormalities. The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant. Treatment *Few patients may be asymptomatic and may not require any treatment *Drugs may be prescribed to give relief from pain. *Hormonal treatment such as combined oral hormone therapy and various injectibles are also available. *Laparoscopic surgery is recommended when there are large patches of endometriotic cysts, or to increase the chances of pregnancy in infertility cases. *Removal of uterus can be considered if disease is severe and crippling and the family of patient is complete. If you are of child bearing age having painful symptoms, even nongynaecological ones, particularly cyclical in nature you should promptly seek expert medical advice.

With expert care many women with endometriosis can still conceive and carry a pregnancy to term.


Dr. Pooja Rana

Consultant - Obstetrics and Gynecology

Panchsheel Park