Obstetrics & Gynaecology
  1. What is endometriosis?
  • Endometriosis is a condition that occurs only in women. It means a tissue similar to the lining of the womb (uterus) is found outside the uterus, usually in the pelvis of the female.
  1. What are the common areas where endometriosis found?
  • In majority of the cases it is found in the female pelvis almost in every pelvic organ including the uterus, ovaries, tubes, ligament, ureters, bowel, bladder and the pelvic surfaces.
  • he side of the implant and the depth to which they penetrate the tissues and the overall volume including adhesions are the main contributive factors for the signs and symptoms suffered by the patient.
  1. What are the signs and symptoms of endometriosis?
  • About 30% of the patients do not have any symptoms. The rest of the patients may have the following symptoms:
    • Pelvic pain, especially during menstruation with cramps and backache
    • Heavy or irregular menstruation
    • Pain during sexual intercourse
    • Infertility or miscarriage
    • Pain with bladder or bowel function, or intestinal pain
    • Painful bowel movements
    • Painful pelvic examination
  1. Who gets endometriosis?
  • Although genetic and familial factors can predispose a woman to endometriosis, it is still not proven. The incidence of endometriosis throughout the world is 12-15%. However, in women with severe menstrual cramps the incidence of endometriosis has been reported to be between 25-35%.
  • There are some studies to show that Asian women are more at risk for endometriosis than Caucasians or Blacks.
  1. Is it true that intercourse during menstruation increases the risk of endometriosis?
  • There is no evidence to this and this has not been proven in any study.
  1. Is it true that intercourse during menstruation increases the risk of endometriosis?
  • There is no evidence to this and this has not been proven in any study.
  1. Is there a relationship between endometriosis and the use of tampons?
  • This is unlikely and there is no scientific basis to support the notion.
  1. Is it true that career women have a higher chance or risks in developing endometriosis?
  • At present there is no scientific justification that supports this theory. Some studies have shown that women who exercise regularly and discipline their diet had lower risk of developing endometriosis.
  1. Do you see endometriosis after menopause?
  • Normally it does not occur. This is because the growth of endometriosis tissue is hormone dependent.
  1. Is there any age group which is more prone to endometriosis?
  • Endometriosis has been reported only in the reproductive ages, which means right after the start of the menstrual cycle until menopause or immediate post-menopausal years. This would mean that ovarian function is necessary for endometriosis.
  1. How is a diagnosis of endometriosis made?
  • A careful and a thorough medical history may give the most important clue for a correct diagnosis.
  • Ultrasound, CT and MRI can give valuable but limited information about the endometriotic cysts but not all women with endometriosis have cysts. CA125 in blood may be increased.
  • The diagnosis must be confirmed with laparoscopy, a surgical procedure that inserts a fiber-optic cable and camera into the abdomen through a small insertion in the belly button.
  1. What are the treatments available?
  • There is no permanent cure for endometriosis. However treatments are designed to relieve symptoms and improve fertility.

Medical therapy:

  • Oral contraceptives
  • Hormone supressing drugs (which stops ovulation)
  • Non-steroidal anti-inflammatory drugs

Surgical Treatment:

  • Laparoscopic surgical techniques help to remove or shrink the lesions and that improves fertility as well
  • Removal of the uterus and tubes is recommended only when everything else has failed and the patient is not desirous of having anymore pregnancy. Surgical procedure is often accompanied with drug treatment too.

Complementary and alternative therapies
Currently there is no evidence that any herbal supplement improves the situation. Diet and exercise may have a beneficial effect.

  1. What does endometriosis look like?
  • Endometriol lesions are blue/gray in appearance on the peritoneal surface or on the pelvic organs. This distinct appearance is due to encapsulated menstrual blood and menstrual debris. The appearance may become darker when it remains longer in the pelvis.
  1. What is a chocolate cyst?
  • Ovarian endometriosis usually starts on the surface and gets invasive into the ovaries. As the menstrual blood start collecting within the endometriosis and the invaded part of the ovary, it can form fairly huge cysts and these are known as chocolate cyst since they are filled with chocolate coloured liquid.
  1. What are the other common areas outside the pelvis where endometriosis is found?
  • Endometriosis has been found in appendix, large bowel, small bowel and occasionally in gall bladder, stomach, spleen and liver too.
  1. Is it possible to develop endometriosis on the incision of the skin where caesarean section was performed?
  • At the time of caesarean section, pieces of uterine lining could be transplanted in the incision and start growing although this is rare.
  • The lesions cause local cyclical pain and even occasional cyclical bleeding. Treatment is surgical removal of the involved area.
  1. What are pelvis adhesions? Why do people with endometriosis have adhesions?
  • During each menstrual cycle there is bleeding in the endometriotic area even outside the uterus. The bleeding that occurs in each menstrual cycle gets collected around the endometriosis area in the pelvis. The blood irritates the adjacent surface and tissues causing inflammation and scarring. This leads to adhesions of the endometriotic cyst to the adjacent pelvic walls, colon, uterus and cervix.
  • This adhesions coupled with blockage of the tubes are the main causes of not being able to conceive.
  1. How old is the disease endometriosis?
  • Theoretically endometriosis should have existed since the beginning of time although the first description was recorded about 300 hundreds years ago.


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