Dr. Manasi Thakur | Gynaecologist In Nagpur | Pregnancy, Delivery | Abortion | Cosmetic Gynecology

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Endometriosis

Endometriosis By Dr. Manasi Thakur – Zenith Hospital, Nagpur

What is Endometriosis?

Endometriosis is a condition where the endometrium (the innermost lining of the uterus) grows outside the uterus, affecting other pelvic organs such as the ovaries, fallopian tubes, bowel, bladder, peritoneum, and the space behind the uterus (cul-de-sac). Who Does It Affect? Endometriosis typically affects women in their reproductive years, most commonly between 30–40 years of age.
Endometriosis

How Does Endometriosis Develop?

The endometrial tissue outside the uterus responds to hormonal changes during the menstrual cycle. Like the normal uterine lining, these implants grow and bleed each month. This process causes:

  • Inflammation of surrounding tissues

  • Pain and cramping

  • Formation of scars and adhesions

This cycle repeats each month, which is why women experience progressive pelvic pain and severe dysmenorrhea.

Can Endometriosis Cause Infertility?

Yes. Around 40% of women with infertility have endometriosis. It can:

  • Reduce the number and quality of eggs

  • Affect fallopian tube function and motility

  • Cause tube blockages in severe cases

Symptoms of Endometriosis

  • Painful periods (dysmenorrhea)

  • Pain during intercourse (dyspareunia)

  • Infertility

  • Chronic pelvic pain (lasting more than 6 months)

  • Pain while urinating (dysuria)

  • Pain during bowel movements (dyschezia)

  • Heavy or irregular menstrual bleeding

Treatment Options

For Pain Relief:

  • NSAIDs (Non-steroidal anti-inflammatory drugs)

  • Oral contraceptive pills

  • GnRH agonists (Gonadotropin-releasing hormone)

  • Oral progestins (dienogest)

For Infertility:

  • Surgical treatment is often required:

    • Removal of endometriotic implants

    • Excision of ovarian endometriomas

    • Opening blocked fallopian tubes

    • Treating hydrosalpinx
      These procedures improve fertility outcomes both naturally and with IVF.

Diagnosis

  • Clinical evaluation

  • Pelvic examination

  • Diagnostic laparoscopy (gold standard test)

Can Endometriosis Be Cured?

  • Endometriosis can be treated but not permanently cured.

  • Medical treatment relieves symptoms but is not definitive.

  • Surgical excision may provide long-term relief, but relapse is common (40–80% within 2 years), depending on severity.

  • Combining surgery with medical therapy may help prolong symptom-free intervals.

Role of Hysterectomy

In severe cases where:

  • Pain does not respond to medication or surgery

  • Family planning is complete

A hysterectomy with removal of both ovaries may be considered as a last resort.

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