Endometriosis

Endometriosis is a debilitating disease with chronic inflammation. It is estimated that 10-15% of reproductive-aged women suffer from pelvic endometriosis. It is one of the most common benign gynaecological proliferation in premenopausal women. Despite its prevalence, the disease remains poorly understood and current studies prove that there is no relationship between the extent of the disease and its symptomatology.

There are no blood tests available for the diagnosis of endometriosis. As of today, there is no single effective option for the treatment of endometriosis. Due to the relatively poor efficacy of hormonal therapy for endometriosis, several other experimental therapies are currently undergoing trials. Medical therapies are only reserved for patients who want immediate pain relief and who are on the waiting list for surgeries. Surgery is the best option for patients with endometriosis as the fulguration and ablation of endometriotic spots and implants can give greater relief and good results in terms of fertility resumption.

Endometriosis Guideline Development Group(GDG) recommends that clinicians should consider the diagnosis of endometriosis in the presence of symptoms like dysmenorrhoea, non–cyclical pelvic pain, deep dyspareunia, infertility and fatigue. Some of the non – gynaecological cyclic symptoms are dyschezia, dysuria, haematuria, rectal bleeding, shoulder pain etc. GDG also recommends that clinicians obtain tissues for histology in lap surgeries for ovarian endometriosis and deep endometriosis to exclude rare instances for malignancy.

Finally, the recommendation is for both ablation and excision of peritoneal endometriosis to reduce pain. Clinicians should not perform LUNA(Laparoscopic Uterosacral Nerve Ablation) as an additional procedure to conservative surgery. Presacral neurectomy is effective to reduce midline pain but it requires a high degree of skill and is a potentially hazardous procedure.

In infertile women with AFS/ASRM stage I/II endometriosis, CO2 laser vaporization instead of monopolar electrocoagulation is preferred. The GDG recommends that women should be counselled regularly regarding the risks of loss of ovarian reserve after the surgery and the possibility of a loss of ovary.

In previously operated patients, a lot of care and counselling is needed before posting for repeat surgeries because of dense adhesions, anatomical disorientation and the possibility of internal organs injury.

Finally, the GDG recommends the use of ART(Assisted Reproductive Technologies) for infertility associated with endometriosis, especially if the tubal function is compromised or if there is male factor infertility and/or other treatments have failed.