Endometriosis is a disease in which tissue that grows on other parts of your body looks like the lining of your uterus. This tissue can cause painful signs that can affect not only your period but also your daily life if it grows in the wrong places. Scars and a blocked ovarian tube can make it hard for some people with endometriosis to get pregnant.
Endometriosis can happen most often in the following places:
On rare occasions, it may also develop on and around the:
Endometriosis is a general disease that affects around 1 in 10 women around the world. Most of the time, doctors find it in people in their 20s and 30s. Medication, surgery, or a combination of the two are used for the treatment for endometriosis.
Doctors don't know what causes endometriosis, although there are a few theories:
Endometriosis causes a variety of symptoms, the most frequent of which is pelvic pain. This pain may be very bad or not so bad. Symptoms often worsen right before and during your period owing to inflammation caused by hormonal changes.
The symptoms of endometriosis include:
Endometriosis might also be present without any symptoms. There are times when you won't know you have it until you can't get pregnant.
Your symptoms have nothing to do with how bad the situation is. There are some people who may only have a few spots of endometriosis but are still in a lot of pain. Other patients may have multiple areas of endometriosis but not feel any pain.According to research, various factors increase a person's likelihood of developing endometriosis, such as having:
Endometriosis is commonly treated with medication or surgery. The way you and your health care team choose will be determined by the severity of your symptoms and your desire to conceive.
Usually, medicine is advised first. If it does not provide adequate relief, surgery may be necessary.
Your healthcare provider may recommend over-the-counter pain medications. These medications include ibuprofen (Advil, Motrin IB, and others) and naproxen sodium (Aleve). They can relieve painful menstrual cramps.
If you are not attempting to conceive, your care team may offer hormone therapy in addition to pain medicines.
Hormone therapy can help alleviate or eliminate endometriosis discomfort. The rise and fall of hormones during the menstrual cycle causes endometriosis tissue to thicken, degrade, and bleed. Hormones synthesized in the lab may restrict this tissue's growth and prevent new tissue formation.
Hormone therapy is not a lasting treatment for endometriosis. The symptoms may return after you discontinue medication.
Treatments for endometriosis include:
Endometriosis tissue can be removed using conservative surgery. It seeks to preserve the uterus and ovaries. If you have endometriosis and are attempting to conceive, this sort of surgery could help. It may also assist if the problem is causing you severe discomfort; however, endometriosis and pain may return following surgery.
Your surgeon may do this treatment with small incisions, often known as laparoscopic surgery. To remove thick bands of scar tissue, surgery with a larger cut in the abdomen is occasionally required. However, most severe cases of endometriosis can be treated laparoscopically.
During laparoscopic surgery, your surgeon inserts a narrow viewing equipment called a laparoscope through a small incision near your navel. Endometriosis tissue is removed using surgical tools inserted through another tiny cut. Some surgeons do laparoscopy using robotic instruments under their control. Following surgery, your doctor may suggest that you take hormone medication to aid with pain management.
Endometriosis can cause difficulty getting pregnant. If you're having trouble conceiving, your doctor may offer fertility therapy. You may be directed to a reproductive endocrinologist, who specializes in infertility treatment. Fertility treatments may involve medications that stimulate the ovaries to produce more eggs. In vitro fertilization refers to a set of operations that combine eggs and sperm outside of the body. The best treatment for you is determined by your unique circumstances.
A hysterectomy is a surgery that removes the uterus. Endometriosis was originally thought to be treated most effectively by removing the uterus and ovaries. Today, some physicians consider it a last choice for relieving pain when other treatments have failed. Other specialists advocate for surgery that focuses on the meticulous and comprehensive excision of all endometriosis tissue.
Early menopause is caused by oophorectomy, which is the removal of the ovaries. A lack of hormones produced by the ovaries may alleviate endometriosis pain for certain people. Others, however, continue to experience symptoms due to residual endometriosis following surgery. Early menopause also increases the risk of heart and blood vessel disease, certain metabolic problems, and premature death.
Hysterectomy can be used to treat endometriosis symptoms in persons who do not want to become pregnant. These include heavy menstrual bleeding and severe menstruation caused by uterine cramps. Even if the ovaries are not removed, a hysterectomy can have long-term consequences for your health. That is especially true if you undergo the procedure before the age of 35.
To manage and treat endometriosis, select a health care expert with whom you feel at ease. You may wish to get a second opinion before beginning any treatment. This ensures that you are aware of all of your alternatives, as well as the benefits and drawbacks of each one.
Endometriosis is often diagnosed based on the symptoms you're having. If your periods hurt and are heavy, you might want to see a doctor. At your visit, the doctor (a gynecologist) may ask about your medical history and whether anyone else in your family has endometriosis. They are going to do a pelvic check. For the next step, they might ask for imaging tests like an MRI or ultrasound.
Laparoscopy is the only way to be sure that someone has endometriosis. Your doctor will use a laparoscope, a small camera, to look inside your pelvis during this process. They can take a piece of tissue (biopsy) and send it to a lab for tests once they know where the tissue is.
During this operation, the surgeon will also try to remove or destroy any tissue that looks like it might be endometriosis. This is one way that a laparoscopy helps with treatment and evaluation. Because of where endometriotic tumors are located, they aren't always easy to get rid of without hurting the important structures underneath. A team of doctors, such as minimally invasive gynecologists, colorectal surgeons, or urologists, may need to help with this operation.
Some people find they have endometriosis by accident. Endometriosis doesn't always cause signs in people who have it. This means that your doctor might find the problem while doing something else.
One of the most common diseases in women that makes it hard for them to get pregnant is endometriosis. The American Society for Reproductive Medicine found that between 24% and 50% of women who can't have children have endometriosis. Endometriosis that is mild to moderate may only make it impossible to get pregnant for a short time. Women can get pregnant with the help of surgery that gets rid of the uterine tissue.
Endometriosis can make it hard to get pregnant, but doctors aren't sure how. People with endometriosis may have trouble getting eggs from their ovaries or have eggs get stuck in the fallopian tube before they can reach the uterus because of the scar tissue. Endometriosis can also hurt sperm or fertilized eggs before they can connect with an egg in the uterus.
A lot of women who have endometriosis or infertility caused by it can still get pregnant and have a healthy baby. Women may be able to get pregnant with the help of treatments like fertility maintenance and in vitro fertilization (IVF). Talk to your doctor about your plans to get pregnant when you talk about your endometriosis treatment plan.
Endometriosis is an idiopathic condition, which means it has no known cause. There are no specific ways to prevent endometriosis. However, being aware of the signs and if you may be at increased risk might help you decide when to consult with a doctor.
Endometriosis can be diagnosed on Sonography and may also need further imaging like MRI to diagnose any deep infiltrating lesions. Endometriosis is an important cause of Infertility. We at Dr Sudha Tandon Fertility, IVF, Gynaec Endoscopy and Maternity center offer both Laparoscopy and Infertility (IVF) treatment for Endometriosis in Mumbai.
Endometriosis is a disease process in which the endometrium which normally lines the uterine cavity is found on other organs especially the ovaries and behind the uterus. Like the endometrium of the uterine cavity, this endometrium also responds to the hormonal changes causing symptoms like painful periods, infertility and pain while having intercourse. There are no blood tests which would definitely clinch the diagnosis of endometriosis. Presence of blood filled cysts in the ovaries on pelvic ultrasonography is again highly suggestive of endometriosis in an infertile woman. The diagnosis of endometriosis can be confirmed on laparoscopy. The treatment of endometriosis depends on the extent of the disease , symptoms and the size of the cyst . The focus of treatment for infertility is on getting the woman pregnant. In the rest of the women with moderate and severe endometriosis the treatment is a combination of laparoscopic surgery followed by medication to suppress the disease. Unfortunately, there is no complete and permanent treatment of endometriosis. Both medicines and surgery cause a temporary relief from the disease process.
Laparoscopy is an excellent tool to diagnose and correct all forms of endometriosis. In mild endometriosis, the endometriotic areas on the undersurface of ovaries and on the uterosacral ligament are cauterized. The endometriotic cysts of the ovaries also known as chocolate cyst are opened and drained, the inner surface of the cyst is cauterized and the cyst wall can be peeled out. The ovaries which are stuck to their base are freed through the laparoscope. In severe endometriosis, uterus could be stuck or adherent posterior to the rectum and this can be released laparoscopically. The fallopian tube which are adherent in a woman with endometriosis can be freed with laparoscopy.
After the surgery, the woman is generally advised Hormone Injections for 3 months whereby her periods stop and the Endometriosis doesn’t progress further. We at Dr Sudha Tandon Fertility, IVF, Gynaec Endoscopy and Maternity center have all the facilities for treatment of Endometriosis in Mumbai under one roof. The couple is encouraged to try for a natural conception. If it does not happen, they should not wait for more than 6 months and quickly decide either on IUI or IVF for getting pregnant.
Endometriosis is a recurrent disease and woman can have recurrence of the endometriotic cyst and may need further surgical treatment. A complete surgical removal can keep the patient symptom free for upto 5 to 6 years. Deep infiltrating nodules may need to be excised . Bowel endometriosis if present also needs to be surgically treated.
We at Dr Sudha Tandon’s fertility , IVF , Gynec Endoscopy and Maternity center have all world class facility for laparoscopic and hysteroscopic surgery and ART for endometriosis treatment in Mumbai.
We are happy to have treated more than 20,000 couples with fertility issues. IUI is simple treatment for couples with unexplained Infertility, PCOS, early endometriosis Know More
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MD. DGO.,
Gynaec Endoscopy Surgeon Fertility and IVF Consultant
M.S. Obgy,
Fellowship in Reproductive Medicine and IVF (London), Minimal Access Surgery and Ultrasound
MS, DNB Obgy,
Fellowship in Reproductive Medicine and IVF (London), Minimal Access Surgery and Ultrasound
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What is infertility ?
If the couple has regular intercourse, does not use any contraception and still does not conceive within one year, they are said to be infertile. 80-85% of the couples conceive within one year of unprotected intercourse i.e. without the use of any contraceptive. However, the rest 15-20 % who are unable to conceive naturally are said to be infertile and these would require proper evaluation and help for getting pregnant.
Does fertility depend on age?
Yes, in a woman fertility does depend on her age. A young woman is naturally more fertile as she has more number of good quality eggs than a woman who is 35 +. Hence a woman who is 35 + should not wait for a long period for a natural conception and should seek help from a proper fertility expert. Also the chance of genetic abnormalities and medical complications like Hypertension and Diabetes increases with age.
When should a couple seek medical help for infertility?
If the woman is below 35 years and has normal menstrual periods, and the couple has tried for a conception for a year with a frequency of sexual intercourse 3-4 times a week during the fertile period and has yet not conceive, then they need to consult an Infertility expert.
How does body weight, diet & exercise affect fertility?
For increasing the chance of pregnancy, balanced body weight of the woman would be beneficial. Being obese or grossly underweight affects the maturation of eggs in the woman and hence may affect her fertility. Also, a grossly obese woman would have mechanical difficulty in having normal sexual relations. Regular, moderate exercise especially in the form of yogasanas, walking, swimming, or jogging prove beneficial for fertility. It has been observed that strenuous form of exercises for example jogging over 3 miles a day can hamper ovulation and hence may lead to decrease in fertility in the woman. Balanced and nutritious diet help increase the chances of conception and ensure proper growth of the fetus.
Is stress a major factor in infertility?
Chronic stress may interfere with the ovulation, may decrease the sexual desire and hence affect the frequency of sexual intercourse in the couple.
How would one know the cause of infertility?
A detailed history of both partners is very helpful in giving a clue to the cause of infertility. For e.g. anovulation is the cause of infertility in a woman who has irregular periods and who is also obese, blocked fallopian tubes in a woman with previous history of pelvic infection, low sperm count in a man with past history of mumps. Examination of both the partners, and getting the required investigations would give a complete picture.
What are the most stressful stages of IVF?
A natural conception is obviously what all couples desire and wish when they plan a pregnancy but when it does not happen and the couple is counselled for an IVF treatment, it creates lots of stress for them.
The most stressful part is the acceptance of the fact that IVF is the only best option for their problem. A good discussion with the doctor to understand about Human Reproduction and why IVF is the best option for them to conceive will help the couple .They should take their time to understand about what the treatment involves and always ask questions to get their doubts cleared. A session with the counsellor would definitely help. Speaking to friends and family who are knowledgeable is a good way to reduce the stress but at times it could be counterproductive especially if they only talk of the problems and are themselves not positive.
In an IVF treatment, the woman’s eggs and her partner‘s sperms are fertilised in a laboratory. To get her eggs, she needs to take hormonal Injections on a daily basis and at the same time every day. This could create some stress especially if she is in a demanding job. It is best that she confides in someone who is reliable and understands the intricacies of an IVF treatment. The best part is that these Injections are not painful as very fine needles are used and she could also self-administer it.
She needs to see her fertility specialist for the follicular tracking for about 4-5 times in a cycle. This could also be demanding and stressful. She should just take all this in her stride and not get unduly stressed. The follicular response may not be satisfactory especially in a woman with poor ovarian reserve and she could become stressed.
She could have stress on the day of egg retrieval because of the fear of pain but this is a small procedure which is done under safe anaesthesia. The procedure is done through the vagina and there are no cuts on her abdomen. This is simple and safe procedure, not painful. At times the male partner gets stressed and is unable to give his semen sample on the day of egg pickup. To avoid this problem, almost all fertility centres will freeze the semen sample beforehand as a backup.
Of course the other stressful point is to worry about the numbers and quality of eggs got at the time of pickup, the fertilization of the eggs, and the numbers of good quality embryos. All these are important form success point of view. A communication with the couple before the procedure will allay all their fears and will go a long way in taking care of the stress.
The most important step in IVF Treatment
The most important step in IVF is Embryo transfer for which the woman should relax. Generally it is done without anaesthesia. The woman‘s cooperation is so very important for favourable results.
After the embryo transfer one has to wait for about 10 days to know the results. It could be very stressful at this stage. She should try to be calm and not just keep thinking of the results. After the embryo transfer the woman has to use either progesterone vaginal tablets or Injections and the stress of finances adds to the stress of procedure.
All in all we do understand the stress that the couple undergoes for an IVF treatment cycle. Have trust in your doctor and you would definitely become a successful.
At our IVF Clinic in Mumbai and IVF centre in Navi Mumbai, we spend quite a lot of time to make you feel comfortable. Our entire support staff and our embryologist are in constant touch with the couple. We try to see that you do not have to wait for too long to see the doctor. We have all facilities of Hysteroscopy/ Laparoscopy / IVF treatment and Maternity at Dr Sudha Tandon centre and we take utmost care of our patients.
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