Endometriosis excision

Endometriosis – Overview

Endometriosis is a chronic and often painful condition in which tissue similar to the lining of the uterus (endometrium) grows outside the uterus. This endometrial-like tissue can attach itself to reproductive organs such as the ovaries, fallopian tubes, outer surface of the uterus, and nearby structures like the bladder, bowels, peritoneum, and cervix. In rare cases, it can be found in other parts of the body as well.

Unlike the normal endometrial tissue that sheds during menstruation, this tissue has no way to exit the body, causing inflammation, pain, scarring, adhesions, and in many cases, infertility.

Common Signs and Symptoms

Symptoms can vary greatly from one individual to another. While 20–25% of people with endometriosis experience no symptoms, others may have debilitating pain and complications. Common signs include:

• Chronic pelvic pain, especially during or before menstruation
• Painful periods (dysmenorrhea)
• Pain during or after sexual intercourse (dyspareunia)
• Painful bowel movements or urination, particularly during periods
• Heavy or irregular menstrual bleeding
• Infertility or difficulty conceiving
• Fatigue, bloating, nausea, or lower back pain

In addition to physical discomfort, endometriosis can affect mental health, work-life, relationships, and overall quality of life.

Causes and Risk Factors

The exact cause of endometriosis is still unknown, but potential factors include:

• Retrograde menstruation (when menstrual blood flows backward into the pelvic cavity)
• Genetic predisposition
• Hormonal imbalances, especially high estrogen levels
• Immune system dysfunction
• Surgical spread (cells transplanted during surgeries like C-sections)

Risk factors include early menstruation, never giving birth, short menstrual cycles, and a family history of endometriosis.

How Endometriosis Is Diagnosed

Diagnosing endometriosis can be challenging. Symptoms often mimic those of other conditions like pelvic inflammatory disease (PID), irritable bowel syndrome (IBS), and interstitial cystitis. Patients often experience a delay of 6 to 8 years from the onset of symptoms to a confirmed diagnosis.

The gold standard for diagnosis is laparoscopic surgery, during which a surgeon visualizes the pelvic cavity and may remove tissue samples for biopsy.

Treatment Options

Although there is no cure for endometriosis, several treatment approaches can help manage the condition and improve quality of life:

1. Medication

• NSAIDs (e.g., ibuprofen, naproxen) to manage pain
• Hormonal therapies:
  • Birth control pills (continuous use)
  • Progestin-only therapy
  • GnRH agonists to reduce estrogen production
  • Intrauterine devices (IUDs) with progestogen

2. Surgery

• Excision surgery is the most effective surgical method. It involves cutting out endometriotic tissue from affected areas, reducing pain and improving fertility.
• Ablation, which burns surface lesions, may relieve pain but does not remove deep-rooted tissue or allow for biopsy.
• Surgery is often recommended when symptoms are severe or unresponsive to medication.

Endometriosis and Fertility

Endometriosis can affect fertility by causing ovarian cysts (endometriomas), blocked fallopian tubes, and scar tissue. Up to 50% of women with endometriosis may struggle to conceive. Surgical excision of endometriosis often improves the chances of natural conception.

Living with Endometriosis

Chronic pain, fatigue, and emotional distress from endometriosis can impact daily life. Many women experience feelings of frustration due to delayed diagnosis and under-recognition of their symptoms. A multidisciplinary care approach, including medical, surgical, and psychological support, is essential.

Fast Facts

• Affects ~10% of women of reproductive age worldwide (~190 million people)
• Commonly misdiagnosed or overlooked
• Can significantly affect mental health and quality of life
• Early diagnosis and appropriate treatment improve long-term outcomes