Endometriosis Diagnosis and Treatment

Endometriosis is so much more than period cramps. A long-lasting inflammatory disease in which tissue that endometrium the inner lining of the uterus grows outside of it. The tumours can start to form on the ovary, fallopian tubes, lining of the pelvis, bowel, bladder, and occasionally other organs.

 These tissues react to hormonal fluctuations throughout the menstrual cycle, leading to inflammation, bleeding, scar tissue and adhesions just as the uterine lining does. This can cause the development of chronic pelvic pain, dyspareunia, bowel and bladder symptoms, fatigue and difficulty in conceiving over time.

Delayed diagnosis is one of the toughest challenges of endometriosis. The symptoms of endometriosis are frequently confused with normal menstrual pain, IBS, bladder issues or stress disorders and many women may wait several years to be diagnosed. This waiting period can result in a considerable impact on education, work, relationships, mental well-being and fertility during this time.

What is Endometriosis?

Endometriosis is a disease that occurs when tissue like the tissue that normally lines the inside of the uterus grows outside the uterus.

These growths may occur on the ovary, fallopian tube, the lining of the pelvis, bladder, bowel or nearby organs.

This tissue can become inflamed, painful, bleed and form scar tissue due to the monthly hormonal fluctuations that occur.

How common is Endometriosis?

Every 1 in 10 women and girls of reproductive age (around 190 million people worldwide) suffer from endometriosis.

It can start right after the first period and take place until menopause. Some people experience severe symptoms; others may not have any find out about the condition during an investigation of their fertility.

What are the common symptoms of Endometriosis?

Symptoms can differ from person to person. Some have mild symptoms and some have severe.

Common symptoms include:

• Pain: Menstrual periods that are especially painful Pelvic pain before to or during periods, pain during urinating or defecating during menstruation.
• Sexual Discomfort: Abdominal and pelvic pain after sexual intercourse.
• Bleeding: spotting in periods and heavy menstrual bleeding.
• Low back pain: that has persisted for weeks, months or more.
• Digestive Issues: Bloating, constipation, diarrhoea during menstruation.
• Fertility: Difficulty in conceive pregnancy.

What causes Endometriosis?

The exact cause of endometriosis is not known. But there are number of factors that play a role, such as:

• Retrograde Menstruation: The cause of the blood backing up into the pelvis through fallopian tubes instead of leaving body through vagina during menstruation.
• History of genetic or family history: Inherited genes play an important role, if there is history of endometriosis in family then your risk is higher.
• Immune system dysfunction: Normally, the immune system helps in removing tissue that grows outside the uterus. So, the person with endometriosis, the immune system may not diagnose or clear these cells but allowing them to survive and grow.
• Hormonal Factors: There is hormone name oestrogen which helps in the growth of endometriosis tissue and due to these symptoms often get worse during the reproductive time and may recover after menopause. Circulatory changes due to aging.
• Inflammation: Chronic inflammation responsible for the growth and spread of endometriosis by producing an environment that helps tissue implantation and pain.
• Extrinsic and intrinsic influences: It is believed that at present there is no single cause for endometriosis, but it is caused by a combination of factors, such as genetic, hormonal, immune and environmental.

Who is at higher of developing Endometriosis?

You may have an increased risk for having endometriosis if there is situation likes:

• The family history where a mother or sister that has endometriosis.
• Initiating menstruation early.
• Short menstrual cycles (less than 27 days).
• Menorrhagia: abnormally heavy or prolonged periods.
• Certain uterine abnormalities.
• Delayed menopause.
• Low body weight in some people.

How do doctors diagnose Endometriosis?

The first step in diagnosis is a careful listening to your symptoms and medical history.

They include:

• Pattern of Menstrual cycle.
• The intensity and type of pain.
• Family history of endometriosis.
• Fertility concerns.
• Medical history – Surgeries or treatments that have taken place in the past.

Examinations which are carried:

• Pelvic examination: The doctor examines for any tenderness, ovarian cysts or scar tissue. But a routine examination of the pelvis does not rule-out endometriosis.
• Ultrasound: Some deep endometriosis and endometriomas (“chocolate cysts”) can be seen on the ultrasound, either transvaginal or abdominal, but they may be too small to be detected.
• MRI (Magnetic Resonance Imaging): Used to determine the extent of the disease and help in its diagnosis. MRI is particularly helpful to find deep infiltrating endometriosis in the bowel, bladder, or pelvic tissues. It also aids in surgical planning for complex surgeries.
• Laparoscopy: Laparoscopy is the most reliable method of diagnosing endometriosis. This is a relatively simple surgical technique that involves inserting a small camera through small cuts in the abdomen to see and, if necessary, take-out abnormal tissue. A sample of tissue (biopsy) may be sent to a lab to confirm the diagnosis.

What is the treatment for Endometriosis?

Treatment depends on:

• Age
• Symptom severity.
• Disease extent.
• Pregnancy plans.

The main goals are to:

• Relieve pain
• Slow disease progression Make it more comfortable.
• Enhance living standard.
• Maintain fertility as much as possible

What medications are used to treat Endometriosis?

There are no medications that cure endometriosis for good. However, there are several medicines that will help with the symptoms of endometriosis and improve quality of life.

The treatment depends on your symptoms, your age, your desire to become pregnant and the seriousness of the disease.

• Pain Relievers (NSAIDs) -These drugs help to decrease pain and inflammation they are usually the first line of treatment for mild symptoms.

Benefits: Relieve cramps and pain in the pelvis during menstruation.

Limitations: They help to reduce pain, but do not cure the disease.

• Hormonal Birth Control – Hormonal contraceptives stop or decrease menstruation, which in turn decreases the level of oestrogen and slows the development of the tissue of endometriosis.

Examples include: COCP (a combination of oestrogen and progestin) like Progestin- only pills, Hormonal patches, Vaginal rings

Benefits: Easier and less cramps during periods.

Reduced pelvic pain May help to stop disease from getting worse for some people.

• Progestin Therapy – Progestins make the uterine lining thinner, and prevent endometriosis lesions from growing.

Benefits:  Effective pain relief during therapy, may stop menstruation.

• A Hormonal Intrauterine Device– (IUD) is a birth control method that is placed inside the uterus. The hormonal IUD is an intrauterine device that slowly releases progestin into the uterus.

Benefits: Energy efficient (economizes energy costs) Avoids heavy periods or cramps during menstruation and easy to use for patients.

• GnRH Agonists – These medicines temporarily reduce the amount of oestrogen in the body to bring on a reversible menopause.

Benefits: Reduce the endometriosis lesions and minimize moderate and severe pain.

How can Lifestyle help to manage symptoms?

Healthy lifestyle includes:

• Exercising regularly such as walking, swimming, or yoga.
• Maintain proper balanced diet. Intake of fruits, vegetables, whole grains, and omega-3 fatty acids.
• Avoiding highly oily, junk foods and excessive alcohol.
• Maintaining body weight which is most important one.
• Take proper sleep of 7-8 hrs.
• Practicing meditations and stress relief techniques.
• Avoid smoking.

What are modern innovations are used in diagnosis and treatment of Endometriosis?

Use of Artificial intelligence (AI).

This method is used to analyse Ultrasound and MRI reports more correctly.

AI helps to identify signs of endometriosis that may be unseen by human eye, reducing delays in diagnosis.

Non- Invasive Biomarkers?

Biomarkers find in:

• Blood
• Saliva
• Menstrual fluid
• Urine

This helps to investigate simple, non-surgical test that helps to detect endometriosis at an earlier stage.

Robotic Assisted Surgery

Robotic-assisted laparoscopic surgery carried by surgeons with better-quality precision, which have greater visualization for deep infiltrating endometriosis which affects the bowel, bladder, or ureters.

Digital Health and Mobile Apps

In this AI world, smartphones are helps to:

• Tracking menstrual cycles.
• Helps to rule out pain intensity.
• Use of medications can be monitored.
• Smartphones are help to find out symptoms.

Endometriosis is a severe condition which badly affects our physical health, emotional wellbeing, our lifestyle, work, relationship.

It can be treated early if we recognize symptoms properly, and seeking medical care as early as possible.

Future modern innovations like AI, precision medicine, use of smartphone for tracking symptoms offer hope for proper and early diagnosis and treatment of Endometriosis.