Satjot Hospital

Endometrosis

Endo is found in 20- 50% of women with infertility!
The presence of tissue that normally grows inside the uterus (womb) in an abnormal anatomical location is Endometriosis(Endo). It is very common and may not produce symptoms, or it may lead to painful menstruation. It has also been associated with infertility. Endometriosis occurs most commonly within the fallopian tubes and on the outside of the tubes and ovaries, the outer surface of the uterus and intestines and anywhere on the surface of the pelvic cavity. It can also be found, less often, on the surface of the liver, in old surgery scars or very rarely, in the lung or brain.
It is a condition of fertile age. The condition is rare before Menarche and after Menopause. The frequency of Endo increases from menarche to menopause. A most immediate issue in a young woman is pain and diagnose Endo and manage the symptoms. Laparoscopy remains a gold standard for establishing the diagnosis. NMR for blood and TVS are also used for diagnosis with nearly 80% accuracy. In general population the prevalence is 3-6%. It is more in the reproductive age group. Prevalence increases in 25 to 35 years . It is found in 20- 50% of women with infertility. It is estimated that incidence of Endo is on rise. This is due to life style factors like
  • Lowering of age of menarche
  • Late marriage
  • Late child bearing
  • Less no of children or pregnancies
  • Less duration of breast feed
All these factors lead to more number of menstrual cycles and more susceptibility to Endo.

Risk of Endo is higher in women whose mother or sisters have disease. They are found to be 3-9 times more at risk than the population whose first degree siblings are disease free. Risk of Endo cysts is alleviated by intake of vegetable saturated or unsaturated fate. Similarly beef and red meat increase the risk of Endo. However, intake of green vegetables and fruit lower the risk of Endo. A number of factors are taken into account when formulating the management plan of infertility-age, duration of infertility, family history, pelvic pain, coexisting infertility diagnosis, number of prior fertility treatment cycles, stage of Endo, and cost. Non steroidal anti inflammatory for treatment of dysmenorrhea is advised. IVF is recommended as an effective treatment of infertility. Medical treatment may unnecessary delay the time for pregnancy. Surgery is not necessary before IVF treatment. It carries a substantial economic burden. The following are the treatment options:

Common regions where
lesions of Endo appear

  • Medical treatment is less expensive and non invasive and should be a first line of treatment
  • Surgical
  • Surgery followed by medical treatment is more effective and recurrence is delayed.
  • Recurrence in 31% cases is reported.
  • In case of infertility, IVF without much loss of time is warranted.
Endo effects the pregnancy out come in following ways:
  • Preterm birth
  • Preeclampsia
  • Ante partum haemorrhage.
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