The variable & broad symptoms of endometriosis mean that the healthcare workers are not able to diagnose it 7 and many individuals suffering from it have limited knowledge about it.

In the present day, we have a cure for endometriosis as the treatment aims at controlling symptoms.

It causes a chronic inflammatory reaction that might result in the formation of scar tissue (adhesions, fibrosis) with the pelvis or other body parts.

1. Superficial endometriosis is found mainly on the pelvic peritoneum.
2. Cystic ovarian endometriosis (endometrioma) is found in the ovaries.
3. Deep endometriosis is found in the recto–vaginal septum, bladder, bowels.
4. Rarely, endometriosis is also found outside the pelvis.

Symptoms associated with Endometriosis may vary & include a combination of:

1. Painful menstruation (dysmenorrhea), menorrhea.
2. Chronic pelvic pain.
3. Pain during or after intercourse.
4. Painful bowel movements.
5. Painful urination.
6. Fatigue.
7. Depression or anxiety.
8. Abdominal bloating & nausea.
9. In addition to the above, it also results in infertility due to its effect on the pelvic cavity, ovaries, uterus & fallopian tubes.

Symptoms often improve after menopause but are painful in some cases. It is also asymptomatic.

Sites: Abdominal, Extra abdominal, remote.

The common sites are :

1. Ovaries
2. Pelvic peritoneum
3. Pouch of Douglas
4. Utero sacral ligament
5. Appendix
6. Fallopian tubes

Rare or remote Sites: 

1. Umbilicus
2. Abdominal Scar
3. Lungs
4. Pleura
5. Kidney
6. Ureter

Causes of Endometriosis :

It is a complex disease that affects some women globally from the onset of their menarche till menopause. It is assumed to arise due to –

• Retrograde menstruation: During this, the menstrual blood containing endometrial cells flows back through the fallopian tubes into the pelvic cavity. It might result in the formation of endometrial cells which get deposited in the outer part of the uterus to implant & grow.
• Cellular metaplasia: Cells in the outer part of the uterus transform into endometrial cells & start to grow.
• Stem cells give rise to the disease that eventually spreads through the body via blood & lymphatic vessels.
• It also depends on Estrogen which facilitates the inflammation, growth & pain associated with it.
• Several other factors like impaired immunity, localized hormonal influences, genetics & environmental contaminants promote the disease.

Mechanism of pain :

The active endometrial implants, cyclical changes, bleeding in these places is contained & leads to congestion which results in pain.

Endometriosis areas have more pain-sensitive nerve endings.

Severe pain is seen in deep infiltrating endometriosis.

Mechanism of pain :

The active endometrial implants, cyclical changes, bleeding in these places is contained & leads to congestion which results in pain. The areas with endometriosis have more pain-sensitive nerve endings. Severe pain is seen in deep infiltrating endometriosis.

Vaginal Examination :

• The fixed uterus or limited mobility of the uterus.
• Adnexal tenderness may be present.
• Mass such as chocolate cyst may be palpable.

Grades of Endometriosis :

• Minimal (Grade I)  –  Score (1-5) with superficial peritoneal & ovarian implants & flimsy adhesions in one or both ovaries.

• Mild (Grade II)  –  Score (6-15) with few superficial & few deep implants in the peritoneum & ovaries, flimsy adhesions & small chocolate cysts in the ovaries.

• Moderate (Grade III)  –  Score (16-40) with deep implants in the peritoneum, cysts in the ovaries, dense adhesions in the fallopian tubes & or partial posterior POD obliteration.

• Severe (Grade IV)  –  Score (>40) with many deep implants in the peritoneum, large chocolate cysts, many dense adhesions & complete cul-de-sac obliteration.

Diagnosis :

• Blood for CA125.
• USG.
• MRI.
• CT Scan.
• Colonoscopy.
• Surgical  Hystero-Laparoscopy – A tissue sample is removed & sent for biopsy.

Treatment :

Treatment can be with medications and or surgery depending on symptoms.

Surgical  Hystero-Laparoscopy with adhesiolysis & cyst aspiration.