Endometriosis is one of the most common conditions gynecologists encounter during their practice. Classic studies indicate that 25-50% of infertile women have endometriosis and 30-50% of women with endometriosis are infertile. This disease affects all aspects of a woman’s reproductive system and can even cause spontaneous miscarriages.
Below are some of the questions about endometriosis I come across the most in my practice :
What is Endometriosis and What are its Symptoms?
The endometrium is a tissue lining the cavity of the uterus as it prepares to receive a baby every month. It is shed along with blood in absence of conception. Presence of this endometrium-like tissue outside the uterine cavity is called endometriosis.
Endometriosis symptoms include dysmenorrhea or painful menstruation, pain during intercourse, and passing motion. It is one of the major causes of inability to conceive.
Who is at Risk of Developing Endometriosis?
This condition affects women in their reproductive years and is sustained by female hormones. 1 in 10 women could develop endometriosis between the onset of menstruation to menopause.
How is Endometriosis Managed?
Endometriosis will need treatment for:
Conservative endometriosis treatment may be used in the form of hormones given orally or as in injectable depot preparations but has a temporary effect.
Surgical removal, on the other hand, is more comprehensive and can be aided by medical therapy post surgery to decrease recurrence.
What are the Chocolate Cysts and How are They Removed?
Chocolate cysts or ovarian endometriomas are collections of thick brown fluid inside the ovary. This is a mixture of blood and endometrial debris shed every month over sometime.
This blood causes scarring and adhesions which cause the ovaries and eventually the fallopian tube to stick to adjacent organs like uterus, bladder, and intestine. This causes pain and interferes with tubal function leading to infertility.
Laparoscopic removal of the cysts is the gold standard. Through very tiny abdominal cuts, sophisticated instruments are used with the patient under general anesthesia. The cysts are opened, drained and the wall is excised with precision using a high definition telescope and state-of-the-art camera. This allows minimal handling of the abdominal organs and expedites healing while preserving healthy ovarian tissue.
Return to the activity with minimal pain allows our patient to start fertility treatment early.
Is Laparoscopy to be Preferred Over Conventional Surgery?
Laparoscopic surgery provides:
- Better visualization and precise surgery
- Lesser scarring and adhesions
- Better fertility outcomes
- Lesser pain with tiny incisions
- Shorter convalescence
- Early return to activity
- Recurrence requiring another surgery with minimal trauma
What is Adenomyosis?
Adenomyosis is the presence of endometrium-like tissue inside the muscle layer of the uterus. It bleeds every month causing stretching and scarring the muscle which leads to severe dysmenorrhea or pain during menstruation. Treating adenomyosis is challenging as it is a generalized involvement of the uterus. The younger age group desire children and require pain relief. Hormones have minimal benefit. Surgical debulking of tissue may give some relief.
Having completed childbirth a woman could undergo a laparoscopic hysterectomy to relieve constant and sometimes severe intermittent attacks of pelvic pain.
How can Pain be Treated?
Pain can be treated by surgically excising the endometriotic implants and releasing the scar tissue. Surgeons can also block the pain by sectioning certain neural pathways.
This procedure is technically demanding and is possible laparoscopically with better visualization and access to challenging sites.
Is Laparoscopic Hysterectomy Possible in Recurrent Endometriosis?
Recurrent endometriosis with multiple interventions poses a challenge. Laparoscopic hysterectomy or removal of the uterus is the gold standard in such patients. The magnification and advanced surgical instruments with a skilled team can assure feasibility of such a complex procedure. Pain, a major concern due to disease and scarring of multiple procedures is best tackled laparoscopically.
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