ENDOMETRIOSIS Dr Rooma Sinha, MD, DNB Senior Consultant Gynecologist & Laparoscopic Surgeon Apollo Health City; HYDERABAD www.gynecologyhyderabad.com, firstname.lastname@example.org 9550326662; 9849008180
WHAT IS ENDOMETRIOSIS ?• Tissue that forms the lining of the uterus (endometrium) is present outside the uterus in some women (ovaries, fallopian tubes, cul-de-sac, intestines, rectum, bladder)• Just like endometrium these tissue outside the uterus also responds to changes in hormones and grows every cycle & breaks down and bleeds like the lining of the uterus during the menstrual cycle every month.
UTERUSThe bleeding inside theuterus has a passage tocome out as menstrualbleeding. The bleeding BILATERAL ENDOMETRIOMA-at these site keep CHOCOLATE CYSTaccumulating and formscysts (chocolate cysts) oradhesions. This cancause pain, especiallybefore and duringperiod.
Laparoscopic AppearanceAdhesion between ovarian cyst uterus and rectum Chocolate material from endometrioma (chocolate cyst)
HOW TO DIAGNOSE? SYMPTOMS •PELVIC PAIN -may occur with sex, during bowel movements or urination, or just before or during menstrual cycle. •HEAVY Menstrual bleeding •Infertility •GASEOUS DISCOMFORT esp during periods •No symptoms-IN SOME EVALUATION •Pelvic examination; Ultrasonography •LAPAROSCOPY- GOLD STANDARDwww.gynecologyhyderabad.com
WHO IS AT RISK• Young women in the age group of 30-40 years• Women with infertility• Women with uterine defects like septum or bicornuate uterus• It can run in the family Endometriosis is found in about one third of infertile women.
Treatment• Treatment for endometriosis depends on the extent of the disease, presenting symptoms, and whether one has problem of infertility• It may be treated with medication, surgery, or both.
Medications• Used both to relieve pain and to keep the disease under control.• Painkillers like paracetamol or mefenemic acid relieves the pain up to great extent.• Hormonal medication like progesterones or combined pills not only relieve the pain but helps to control the disease process.• These medications are not useful in all women with endometriosis and some women are not able to tolerate the side effects that these medications have.• Medications do not provide permanent cure.
Surgical Treatment for Pain and Infertility• Hormonal therapy does not appear to eradicate endometriotic implant• Surgical intervention is the preferred way to manage the disease.• Surgery is done to remove endometriosis and the scarred tissue around it.• In severe cases surgery is the best choice for treatment.• Surgery is done by laparoscopy or key hole method.
SURGICAL APPROACHESCONSERVATIVE RADICAL• WHEN ONE WANTS TO • WHEN FUTURE FERTILITY IS PRESERVE FERTILITY NOT DESIRED• Endometriotic implants are • Hysterectomy along with removed and adhesions are removal ovaries are done released restoring the normal pelvic anatomy
Removal of the endometriotic implants can be achieved 1. Electrosurgical Ablation - Small implants may be ablated by applying unipolar or bipolar electro-cautery to the lesion causing tissue necrosis 2. Laser Ablation – Destroys the implants with minimal damage to surrounding tissue as the energy used does not penetrate much beyond the surface of the implant.3. Excision –preferred CYST WALLmethod in the presence ofendometriotic cyst. It endometrioticprovides a complete cystremoval. It is associatedwith a lower rate ofrecurrence. IT CAN BEDONE BY LAPAROSCOPICor BY ROBOTIC METHOD
Finally remember!!• Endometriosis is a progressive disease.• The source of the problem is the hormonal changes associated with periods and presence of endometrium at abnormal places.• After conservative surgery the disease has chances to recur.• Patients who are treated with both surgery and medications have extended symptom-free period. Endometriosis is less likely to come back if your ovaries also are removed.