Here we will have a look at endometriosis. If we break down the word endometriosis into 3 parts then, endo means inside, metrus means uterus and sis means similar to that. Abnormal growth of tissues similar to the uterine lining, endometrium. which grows outside of the uterus or in the pelvis, is called as Endometriosis. During the menstrual cycle the inner lining of the uterus, Endometrium, grows under the influence of hormones. At the end of the cycle this endometrium sheds off which we call as periods. Uterus has three exits, two tubes and cervix. The cause of endometriosis is not very clear. The suggested theory is - these endometrial cells go in the abdominal cavity through tubes and implants. Each month during the periods these endometriotic spots shed off. Leaving scars or raw area. While healing, if two raw areas join together, they get stuck to each other. These are called adhesions. For example, fallopian tubes can get attached to the uterus, intestine or omentum. Because of these adhesions one may suffer abdominal pain, more so around period time. when adhesions affect fallopian tubes or ovaries it can affect the egg transport causing infertility. Pain and infertility are the two problems caused by endometriosis.
In medical management the intention is to stop the monthly cycle of hormones. As the hormonal production is stopped, growth of endometriosis also stops. This can be done by contraceptive pills, danogen or leuprolide injections. In this treatment we stop the natural production of oocytes / eggs. As ovulation is stopped pregnancy is not possible. So, most of the medical treatment for endometriosis works as contraceptives. Due to lack of oestrogen, during medical treatment, bones lose calcium. This can lead to brittle bones. Hence use of medical treatment is restricted to a maximum of 6 months.
Surgery - patient needs to get operated when she is suffering from severe abdominal pain or there is a cyst formed. The endometrioma has old collected blood. Which is thick and chocolaty in colour. Hence endometrioma is also referred to as chocolate cyst. In case of adhesions where ovaries, fallopian tubes or uterus are stuck together. Laparoscopy is done to separate them. In some cases, fallopian tubes are blocked, which can be opened. After this operation there is a possibility of pregnancy. One must remember that we can improve the structure of the fallopian tube but, we may not be able to improve functionality. So, all laparoscopic corrections do not result in pregnancy.
IVF treatment is considered as a treatment of choice, for endometriosis. During pregnancy patients don't get periods, so it stops the cyclic growth of endometriosis for 9-12 months. Hence pregnancy is considered as the gold standard treatment for endometriosis.