Endometriosis is a very common condition where cells of the lining of the uterus (endometrium) are found elsewhere, usually in the pelvic cavity, bowel, ovaries and fallopian tubes. It’s a condition of reproductive years.

• Painful periods (dysmenorrhoea)
• Some women may have heavy periods(menorrhagia)
• Pain during or after sexual intercourse (dyspareunia)
• Lower abdominal pain
• Pelvic pain
• Difficulty in getting pregnant
• Pain related to the bowels and bladder

During the menstrual cycle, under the influence of the female hormones estrogen and progesterone, the lining (endometrium) of the uterus thickens and prepares itself for the implantation of the fertilized egg. If there is no pregnancy, the lining sheds as a period.

Endometriosis occurs when the cells of the lining of the uterus are found in other parts of the body, usually the pelvis. Each month this tissue thickens and bleeds in the same way as the lining of the uterus. This internal bleeding into the pelvis has no way of leaving the body. This causes inflammation, pain and damage to the reproductive organs and the normal anatomy of the pelvis.

• On the ovaries where it can form cysts (often referred to as ‘chocolate cysts’)
• In or on the fallopian tubes
• Almost anywhere on, behind or around the uterus
• In the peritoneum.
• The bowel and bladder
• Deep within the muscle wall of the uterus (adenomyosis).
• Rare places are lung and brain

The cause is not known but many theories are present. The most commonly accepted theory is- “retrograde Menstruation”- during a period, light ‘backward’ bleeding carries tissue from the uterus through the fallopian tubes to the different places in the pelvic cavity.

There is no simple test for endometriosis. Ultrasounds can identify chocolate cysts but not rule out endometriosis. Definitive diagnosis is formed by Laparoscopy.

The treatment depends on various factors. They are: age, degree of pain, menstrual problem, severity of endometriosis, desirous of pregnancy

The options for treatment may be:

• Pain relief: Pain-relieving drugs reduce inflammation and help to ease the pain.
• Hormone treatments: There is a range of hormone treatments which allow the endometriosis to shrink or disappear.
• Surgical: Surgical treatment depends on the site and the extent of endometriosis. It ranges from simple ablation of the endometriotic spots, cyst fulgaration or excision, hysterectomy. It can be done either by laparoscopy or as open surgery (laparotomy)
• IVF /ICSI for infertile ladies with endometriosis.