Endometriosis Treatment in India

Last Modified: September 13, 2019  |   Created on: June 21, 2019
Gynecology

Endometriosis is a painful disorder in which the tissue that lines the uterus, called the endometrium, grows outside of the uterus cavity. It is a common gynaecological problem in women of reproductive age and cause several complications like severe and chronic pain during menstruation, intercourse, infertility, and others.  

In this condition, the endometrial tissue grows over other organs like –

  • Ovaries
  • Fallopian tubes
  • On the outside surface of the uterus
  • Pelvic cavity (peritoneum)
  • On other sites that like cervix, bladder, or rectum.

Commonly experienced symptoms include:

  • Pain – The major symptom of endometriosis is chronic pain in the pelvic region.

The pain due to endometriosis can be of different types:

  • Dysmenorrhea – painful menstrual cramps which might start days before menstruation.
  • Pain during or after sexual intercourse
  • Pain during bowel movements, especially during menstruation
  • Pain during urination, especially during menstruation
  • Pain in the abdomen and lower back
  • Heavy menstrual flow with excessive bleeding or intermenstrual bleeding (bleeding between menstrual periods)
  • Infertility – Endometriosis is many a times first diagnosed when women not getting pregnant seek treatment.  

Other symptoms include digestive problems like – diarrhea, constipation, fatigue, nausea or bloating, that especially occurs during menstrual periods.

What are the signs and symptoms of Endometriosis?

However, in some rare situations, the endometrial tissue might spread beyond pelvic organs, such as lungs.

The tissue that grows outside of the uterus is known as endometrial implants. With every menstrual cycle, the hormones cause the displaced endometrial tissue (endometrial implant) to thicken, break down and bleed. But this tissue and the blood, unlike normal endometrial lining of the uterus, does not bleed out of the vagina, and gets trapped in the pelvis.

This condition causes:

  • Irritation to the surrounding tissues;
  • Development of scar tissue and adhesions;
  • Results in formation of abnormal bands of fibrous tissue which causes organs to stick to each other and the pelvic tissue;
  • When the ovaries are involved, cysts – also known as endometriomas – may form

What are the causes of Endometriosis?

The exact cause of endometriosis and how it reaches other body organs is yet unknown but researchers suggest the following possible explanations:

  • Retrograde menstrual flow: It is the most likely cause of endometriosis. The menstrual blood and tissue containing endometrial cells flow back through the fallopian tubes and instead of flowing out of the body, it ends up accumulating in the pelvic cavity and other parts. These endometrial cells stick to the wall of the pelvic cavity and surfaces of the organs, and grow, thicken and bleed with each menstrual cycle.
  • Problem with Immune system: A defective immune system may fail to recognize and destroy the endometrial cells that are growing outside of the uterus.
  • Hormones:  Estrogen can cause transformation of embryonic cells, i.e. the cells of the early development stages, into endometrial cell implants during puberty.
  • Surgery: After a hysterectomy or C-section, endometrial cells may get attached to a surgical incision, such as abdominal scar.
  • Endometrial cell get transported: The endometrial cells may get transported to other parts of the body through blood vessels or tissue fluid of the lymphatic system may transport.
  • Genetic factor: Endometriosis can be inherited through genes and run in families.

How can Lyfboat assist you getting treatment for Endometriosis in India?

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Who is at risk?

Endometriosis can develop in any woman after the onset of menstruation cycle.

The risk factors that pose a greater likelihood of endometriosis include:

  • Never given birth to a child; 
  • Starting menstrual period at an early age; 
  • Having short menstrual cycles – less than 25 days; 
  • Heavy menstrual flow that goes on for more than seven days; 
  • A family member or relative like mother, aunt or sister with endometriosis;  
  • A medical problem that prevents the normal flow of menstrual blood out of the body; 
  • Having menopause at an older age; 
  • Abnormalities of the reproductive tract; 
  • Having higher levels of estrogen in the body; 
  • Low body mass index.

What complications does endometriosis cause?

Infertility: One of the major problems that women face with endometriosis is the inability to get pregnant. Endometriosis may cause obstruction of the fallopian tube and prevent the egg and sperm from fertilizing (uniting). It can also affect fertility by causing inflammation that can severely affect the functions of the ovary, egg, fallopian tubes or uterus. The condition may indirectly affect by damaging the sperm or the egg.

However, at times women with mild endometriosis are able to conceive and complete the term of pregnancy.

Formation of cyst: In some cases of endometriosis, the fallopian tube can get blocked when the endometrial tissue grows over the ovaries. The tissue and the blood gets trapped in the ovaries and can lead to formation of a cyst.

Cancer: Endometriosis can lead to a higher risk of ovarian cancer. Although, the lifetime risk of ovarian cancer is itself low as it is a rare cancer. Endometriosis can only increase that risk. Endometriosis-associated adenocarcinoma is another type of rare cancer that might occur in women with endometriosis.

Diagnosis

The tests that are done to diagnose endometriosis are:

Pelvic examination: During a pelvic exam, the doctor feels around the areas in the pelvis for large cysts or scar behind the uterus. Often, it is hard to feel for smaller areas of endometriosis.

Imaging tests:

  • Ultrasound: This test is done to visualize the insides of the pelvis and the reproductive organs. A stick-shaped scanner is moved across the abdomen or inserted into the vagina (trans-vaginal ultrasound). This test does not definitively tell the presence of endometriosis but can detect ovarian cysts caused by endometriosis.
  • Magnetic resonance imaging (MRI): This test provides a detailed image of the pelvic region and the organs. It is done to determine the location and size of endometriosis.

Laparoscopy: This procedure is conducted by a surgeon and the patient is put under a general anesthesia. The surgeon makes a small incision on the lower abdomen and a thin tube (laparoscope) is inserted to observe the endometrial tissue outside the uterus.

It is a sure test for detecting endometriosis as it enables the surgeon to directly view the endometrial tissue. In some cases, a small sample of tissue (biopsy) is taken out for further analysis under a microscope.

Treatment for Endometriosis in India

The treatment approach for endometriosis mainly involves – medication and surgery. The gynecologist will recommend the treatment option based on multiple factors like the severity of the symptoms, desire to get pregnant, etc.

Options for endometriosis treatment in India include:

  1. Pain Medication: Medication is the most conservative therapy for managing endometriosis. If the symptoms are manageable, the doctor will suggest over the counter pain relief medicines such as Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), ibuprofen or naproxen sodium for painful menstrual cramps. 

  2. Hormone TherapyHormone supplements are used to reduce the pain associated with endometriosis and also reduce the levels of estrogen in the body. The hormone medication can slow growth of endometrial tissue and also prevent the development of new endometrial implants. The hormones can help in decreasing inflammation, scarring, and cyst formation. The hormone therapy includes: 
    • Contraceptives – Birth control pills or patches, or vaginal rings: These can control the hormones that cause the growth of endometrial tissue each month. 
    • Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists: These hormonal drugs block the production of ovarian-stimulating hormone and lower estrogen levels. They prevent menstruation and cause shrinkage of endometrial tissue. This creates menopausal effects that can be managed by low dose of estrogen or progestin. 
    • Progestin therapy: This include use of Intrauterine Device (IUDs) with levonorgestrel, contraceptive implant, contraceptive injection or progestin pill. These can stop menstrual periods and the growth of endometrial implants to relieve signs and symptoms of endometriosis. 
    • Aromatase inhibitors are used  to reduce the amount of estrogen in the body. 

  3. Surgery: Surgical intervention is recommended by the doctor when the symptoms are severe and medication fails to improve the condition. The goal of the surgery to remove the endometrial implants and provide relief from the symptoms like pain. It is considered the most effective treatment of endometriosis. 

    Conservative surgery for endometriosis has the advantage that there are better chances of getting pregnancy after this procedure. In this, the endometrial tissue is removed while preserving the uterus and ovaries. 
    • Laparoscopic surgery for endometriosis is a less invasive (keyhole) procedure and the most commonly used endometriosis treatment these days. During the surgery, the surgeon makes a small incision on the abdomen and inserts a thin instrument, called a laparoscope, through it. Then it is used to remove or destroy endometrial implant by applying heat, electric current, a laser, or special gas to these tissues. This procedure can also be used to treat ovarian cysts which form due to endometriosis
    • Hysterectomy (removal of uterus) and removal of ovaries can be used to treat the endometriosis symptoms like heavy bleeding during menstruation, painful cramps, etc. However, removing the ovaries and uterus might lead to some problems and long-term effects on health. Removal of ovaries results in early menopause which carries a risk of developing certain cardiovascular (heart) diseases and metabolic conditions. This surgery also affects the hormone levels and certain hormone therapies might be recommended by the doctor.
    • If you do not want to have children in the future or if keyhole surgery cannot be used, hysterectomy alone or with removal of ovaries is the treatment option. 

  4. Infertility treatment: Laparoscopy can improve the chances of pregnancy but if you are still unable to conceive, fertility treatments like in vitro fertilization (IVF) is the best option for desirable candidates. IVF is a type of assisted reproductive therapy in which the egg and sperm are allowed to fertilize in the laboratory and then resulting embryo is transferred to the mother’s womb.
Vanshika Rawat

Written By Vanshika Rawat

Vanshika Rawat is an experienced content developer. She is well-versed and knowledgeable in topics of science and medicine, and has worked under brilliant scientist during her higher education. She has obtained her degrees in Masters and Bachelors in Science - Microbiology (with Hons. ) from renowned institutions - Panjab University and University of Delhi.
Dr. Suneet Singh

Verified By Dr. Suneet Singh

Dr. Suneet is a dentist-turned-Hospital Administrator with rich experience in the field of operation management and Public Health Administration. Formerly a dentist, Dr. Suneet holds a post-graduate degree in Hospital and Healthcare management from Tata Institute of Social Sciences (TISS)

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