Management of endometriosis

Endometriosis is a common chronic disorder affecting up to 1 in 10 women of reproductive age globally. Despite this, it lacks adequate awareness in the Indian subcontinent largely because it relates to two highly stigmatised topics in the region: menstruation and infertility.

What is endometriosis?

Each month, endometrial tissue which lines a woman's womb or uterus grows and sheds resulting in the woman's monthly period. Endometriosis is defined as the presence of this endometrial tissue outside the uterine cavity. This abnormal endometrial tissue can be anywhere in the body but is most commonly found in the woman's ovaries and ligaments surrounding her reproductive organs or bowels. Each time a woman undergoes her monthly periods, the abnormal endometrial tissue will also react to the hormonal cycle resulting in cyclical growth and shedding. Over the time, this can also lead to inflammation and damage to the surrounding tissues.

Signs and symptoms

The above understanding can help one appreciate the mechanism of the symptoms that accompany endometriosis.

Typically, endometriosis presents with disabling and cyclic pelvic pain that starts prior to each menstrual cycle and continues throughout menses. In addition, the patient may experience pain on intercourse, pain during defaecation or urination and increased bleeding during periods. While these symptoms alone can have a significant impact on the lives of women and their families, around 30-40% of women with endometriosis also experience infertility, that is, the inability to conceive a child after 12 months of trying.

The lack of awareness, poor education and the significant stigma surrounding these symptoms in developing countries such as Bangladesh can make it difficult for women to seek the necessary help which in turn contributes to poorer outcomes.

Diagnosis and management

Endometriosis is usually suspected based on the patient's history and physical examination by a physician. The physician may then order an ultrasound to further assess the pelvic organs to look for any signs of abnormal endometrial tissue.

However, the definitive diagnosis of endometriosis involves a laparoscopic procedure to directly visualise endometrial lesions in the abdominal cavity and take a biopsy sample for pathology. Typically, this diagnostic step is also part of the management process which involves excision and ablation (burning) of the abnormal endometrial tissue during the same procedure.

Not all women with endometriosis require such an invasive procedure as many are managed via medications such as NSAIDs and paracetamol accompanied by hormonal treatment such as the oral contraceptive pill.

As endometriosis is a condition dependant on the woman's monthly hormonal cycles, the condition usually subsides following menopause.

Riashad Monjur is a fourth year medical student at the University of Newcastle, Australia.

Email: riashad@hotmail.com