Best Endometriosis Treatment in Delhi, India

Endometriosis is a medical condition characterised by the abnormal growth of internal uterine tissue outside the uterus. Normally, this tissue builds up in the uterus each month and is shed during menstruation. However, in endometriosis, this tissue grows outside the uterus, commonly on the ovaries, fallopian tubes, and the tissues lining the pelvis.

This displaced endometrial tissue continues to act as it normally would inside the uterus, thickening, breaking down, and bleeding with each menstrual cycle. However, because it's located outside the uterus, the blood and tissue shed during menstruation have no way to exit the body. This can lead to inflammation, pain, scar tissue formation (adhesions), and sometimes fertility problems.

Endometriosis can be classified into several types based on its location and severity. The types of endometriosis include:

• Superficial Endometriosis: This is the most common type of endometriosis, characterised by the presence of small lesions or implants on the surface of pelvic organs, such as the ovaries, fallopian tubes, and the peritoneum (the lining of the pelvic cavity).
• Deep Infiltrating Endometriosis (DIE): Deep infiltrating endometriosis refers to the growth of endometrial tissue beneath the peritoneum, infiltrating into nearby structures such as the bladder, bowel, rectum, and pelvic sidewall. This type of endometriosis can cause severe pain and may lead to the formation of scar tissue and adhesions.
• Ovarian Endometriomas (Endometriotic Cysts): Ovarian endometriomas, also known as endometriotic cysts or “chocolate cysts,” are fluid-filled cysts that develop on the ovaries. These cysts form when endometrial tissue implants on the ovary and fills with menstrual blood over time. Ovarian endometriomas can vary in size and may cause pelvic pain and infertility.
• Rectovaginal Endometriosis: Rectovaginal endometriosis involves the invasion of endometrial tissue into the rectum and/or vagina. This type of endometriosis can cause symptoms such as painful bowel movements, pain during intercourse, and rectal bleeding.

The exact cause of endometriosis is not fully understood, but several factors may contribute to its development. Some potential causes and risk factors associated with endometriosis include:

Retrograde Menstruation

One of the most widely accepted theories is retrograde menstruation, where menstrual blood containing endometrial cells flows backward through the fallopian tubes into the pelvic cavity instead of exiting the body. These displaced endometrial cells can then implant and grow on pelvic organs, leading to endometriosis.

Hormonal Imbalances

Hormonal imbalances, particularly oestrogen dominance, may play a role in the development and progression of endometriosis. Oestrogen promotes the growth of endometrial tissue, and higher levels of oestrogen may stimulate the proliferation of endometrial cells outside the uterus.

Genetic Factors

There appears to be a genetic predisposition to endometriosis, as it tends to run in families. Certain genetic mutations or variations may increase the likelihood of developing endometriosis or make individuals more susceptible to environmental triggers.

Immune System Dysfunction

Dysfunction of the immune system may impair the body's ability to recognize and eliminate endometrial cells that have migrated to other parts of the body. This could allow the endometrial cells to implant and grow unchecked, leading to the development of endometriosis.

Environmental Factors

Exposure to environmental toxins, such as dioxins, polychlorinated biphenyls (PCBs), and phthalates, has been implicated as potential risk factors for endometriosis. These chemicals may disrupt hormone regulation and immune function, contributing to the development of endometriosis.

Inflammatory Factors

Chronic inflammation within the pelvic cavity may promote the growth and progression of endometriosis. Inflammation can attract immune cells and promote the formation of adhesions, which can exacerbate symptoms and complications associated with endometriosis.

These factors are believed to contribute to the development of endometriosis. The condition is complex and multifactorial, and it's not guaranteed that all individuals with these risk factors will develop endometriosis.

Symptoms of endometriosis can vary from person to person, but commonly include:

• Pelvic Pain: Persistent or intermittent pelvic pain that may worsen during menstruation.
• Dysmenorrhea: Severe menstrual cramps that may interfere with daily activities.
• Painful Intercourse: Pain or discomfort during sexual intercourse.
• Painful Bowel Movements or Urination: Painful bowel movements or urination, especially during menstruation.
• Excessive Menstrual Bleeding: Heavy menstrual bleeding or irregular bleeding between periods.
• Infertility: Difficulty getting pregnant or infertility.
• Fatigue: Persistent fatigue or low energy levels.
• Gastrointestinal Symptoms: Digestive issues such as diarrhoea, constipation, bloating, or nausea.
• Painful Pelvic Exams: Pain during pelvic exams or vaginal penetration.
• Back Pain: Lower back Pain, particularly during menstruation.
• Painful Ovulation: Pain or discomfort during ovulation.
• Other Symptoms: Other symptoms may include headaches, fatigue, depression, anxiety, and allergies.

Some individuals may experience mild symptoms, while others may have severe symptoms that significantly impact their quality of life. If you experience any of these symptoms, don’t hesitate to visit us at Max hospitals for proper evaluation and diagnosis.

Diagnosing endometriosis typically involves a combination of medical history assessment, physical examination, and diagnostic tests. Here's an overview of the diagnostic process for endometriosis:

Medical History Assessment

Your healthcare provider will begin by asking about your symptoms, including the type, severity, and duration of any pelvic pain or other symptoms you may be experiencing. They will also inquire about your menstrual cycle, past medical history, family history of endometriosis, and any previous treatments you have tried.

Physical Examination

A pelvic exam may be performed to check for any abnormalities, tenderness, or masses in the pelvic area. However, it's important to note that endometriosis cannot be definitively diagnosed based solely on a pelvic exam.

Imaging Tests

Imaging tests such as transvaginal ultrasound or MRI may be recommended to visualise the pelvic organs and detect any abnormalities, such as endometrial implants, cysts, or adhesions. While imaging tests can help identify certain features associated with endometriosis, they are not always conclusive for diagnosing the condition.

Laparoscopy

Laparoscopy is considered the gold standard for diagnosing endometriosis. It is a minimally invasive surgical procedure performed under general anaesthesia. During laparoscopy, a thin, lighted instrument called a laparoscope is inserted through a small incision in the abdomen to view the pelvic organs directly. If endometrial implants, cysts, or adhesions are found, a biopsy may be taken to confirm the diagnosis.

Histological Evaluation

Tissue samples obtained during laparoscopy are examined under a microscope to confirm the presence of endometrial tissue outside the uterus. This histological evaluation helps differentiate endometriosis from other conditions with similar symptoms.

Diagnosing endometriosis can be challenging due to its diverse range of symptoms and the lack of definitive diagnostic tests. It often requires a comprehensive evaluation by the medical team.

Endometriosis staging systems are used by healthcare providers to classify the severity and extent of endometriosis lesions and adhesions found during surgery. The most commonly used staging system is the American Society for Reproductive Medicine (ASRM) staging system. Here's an overview:

• Stage I (Minimal): Minimal endometriosis characterised by isolated implants or small endometrial lesions without significant adhesions.
• Stage II (Mild): Mild endometriosis characterised by superficial implants and mild adhesions, usually affecting one or both ovaries.
• Stage III (Moderate): Moderate endometriosis characterised by multiple implants, some of which may be deeper, along with more extensive adhesions, potentially involving the fallopian tubes and other pelvic structures.
• Stage IV (Severe): Severe endometriosis characterised by widespread implants and significant adhesions, often involving multiple pelvic organs such as the ovaries, fallopian tubes, uterus, bladder, and rectum. This stage may also involve the formation of ovarian endometriomas (endometriotic cysts).

The treatment for endometriosis aims to manage symptoms, reduce pain, improve quality of life, and, in some cases, preserve fertility. Treatment options may vary depending on the severity of symptoms, the extent of the disease, and the individual's preferences. Here are some common treatment approaches for endometriosis:

Pain Medications

Over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen may help alleviate pelvic pain and discomfort associated with endometriosis. For more severe pain, prescription pain medications may be necessary.

Hormonal Therapy

• Birth Control Pills: Oral contraceptives containing oestrogen and progestin can help regulate the menstrual cycle, reduce menstrual cramps, and decrease the frequency and severity of endometriosis-related symptoms.
• Progestin Therapy: Progestin-only contraceptives, such as progestin-only pills, hormonal intrauterine devices (IUDs), or contraceptive injections, may be recommended to suppress ovulation, thin the endometrial lining, and reduce menstrual bleeding and pain. A newer Progesterone ‘DINOGEST’ is also effective. 
• Gonadotropin-Releasing Hormone (GnRH) Agonists: GnRH agonists work by suppressing the production of oestrogen, inducing a temporary menopause-like state. They can help relieve symptoms of endometriosis, but long-term use is limited due to potential side effects such as bone density loss and menopausal symptoms.

Surgery

• Laparoscopic Surgery: Laparoscopic surgery is the gold standard for diagnosing and treating endometriosis. During this minimally invasive procedure, endometrial implants, adhesions, and ovarian cysts may be removed or excised, helping to alleviate pain and improve fertility.
• Laparotomy: In severe cases of endometriosis with extensive adhesions or involvement of multiple organs, open abdominal surgery (laparotomy) may be necessary to remove deeply infiltrating lesions and restore pelvic anatomy.
• Hysterectomy: In cases of severe endometriosis that do not respond to other treatments and for individuals who have completed their family planning, a hysterectomy (removal of the uterus) with or without removal of the ovaries may be considered to alleviate symptoms and prevent recurrence.

Lifestyle Modifications

Adopting healthy lifestyle habits such as regular exercise, a balanced diet, stress management techniques, and adequate sleep may help reduce inflammation, improve overall well-being, and manage symptoms of endometriosis.

Complementary Therapies

Some individuals find relief from endometriosis symptoms through complementary therapies such as acupuncture, chiropractic care, pelvic physical therapy, herbal supplements, dietary modifications, and mind-body techniques like yoga or meditation. While these approaches may not cure endometriosis, they may provide additional support and symptom management alongside medical treatments.

It's essential for individuals with endometriosis to work closely with a healthcare provider to develop a personalised treatment plan tailored to their specific needs, preferences, and goals.

Endometriosis can lead to several complications, which may vary in severity and impact on an individual's health and quality of life. Some of the common complications associated with endometriosis include:

• Chronic Pelvic Pain: Endometriosis is often associated with chronic pelvic pain, which can significantly impair daily functioning, work, and relationships. The pain may be cyclical, worsening during menstruation, or it may be persistent throughout the menstrual cycle.
• Infertility: Endometriosis is a leading cause of infertility in women. The presence of endometrial implants, scar tissue (adhesions), and inflammation within the pelvis can interfere with normal reproductive function, including ovulation, fertilisation, and implantation of the embryo. This complication can be managed by appropriate infertility treatment.
• Ovarian Endometriomas (Endometriotic Cysts): Endometriomas are cysts filled with old, dark blood that develop on the ovaries as a result of endometrial tissue implanting and growing within ovarian follicles. These cysts can cause pelvic pain, discomfort, and may affect ovarian function and fertility.
• Adhesions and Scar Tissue: Endometriosis can lead to the formation of adhesions, which are bands of scar tissue that can bind pelvic organs together. Adhesions may cause pain, restrict mobility of pelvic organs, and increase the risk of complications during surgery or pregnancy.
• Obstructive Symptoms: In severe cases, endometrial implants and adhesions may obstruct the normal function of pelvic organs, such as the bowel, bladder, or fallopian tubes. This can lead to symptoms such as bowel or urinary problems, including constipation, diarrhoea, painful urination, or difficulty conceiving.
• Dyspareunia (Painful Intercourse): Endometriosis can cause pain or discomfort during sexual intercourse, which may negatively impact sexual intimacy and relationships.
• Psychological Impact: Living with endometriosis can have a significant psychological impact, leading to feelings of frustration, anxiety, depression, and reduced quality of life. Coping with chronic pain, infertility, and uncertainty about the future can take a toll on mental health and well-being.
• Increased Risk of Certain Cancers: Some studies have suggested a possible association between endometriosis and an increased risk of certain cancers, such as ovarian cancer and endometriosis-associated adenocarcinoma. However, the overall risk remains relatively low, and further research is needed to better understand this relationship.

Preventing endometriosis entirely is not currently possible, as the exact cause of the condition is not fully understood. However, there are some strategies that may help reduce the risk of developing endometriosis or minimise its severity. These strategies include:

• Maintaining a Healthy Lifestyle: Adopting a healthy lifestyle can help support overall well-being and may reduce the risk of endometriosis. This includes maintaining a balanced diet rich in fruits, vegetables, whole grains, and lean proteins, staying physically active with regular exercise, managing stress levels, getting enough sleep, and avoiding tobacco use.
• Early Detection and Treatment: Early detection and treatment of endometriosis may help prevent complications and minimise the progression of the condition. Individuals experiencing symptoms such as pelvic pain, painful periods, or infertility should seek medical evaluation and diagnosis from the best gynaecologist in India.
• Hormonal Birth Control: Hormonal contraceptives, such as birth control pills, patches, or hormonal intrauterine devices (IUDs), may help regulate the menstrual cycle, reduce menstrual cramps, and suppress the growth of endometrial tissue. Using hormonal birth control methods may help decrease the risk of developing endometriosis or alleviate symptoms in individuals already diagnosed with the condition.
• Limiting Exposure to Environmental Toxins: Exposure to environmental toxins, such as dioxins, polychlorinated biphenyls (PCBs), and phthalates, may be associated with an increased risk of endometriosis. Taking steps to minimise exposure to these chemicals, such as avoiding plastic food containers, reducing consumption of processed foods, and using natural cleaning and personal care products, may help reduce the risk of endometriosis.
• Regular Gynaecological Exams: Regular gynaecological exams and screenings can help detect endometriosis early and monitor for any changes or complications. Women should schedule routine visits with their gynaecologists for pelvic exams, Pap smears, and other recommended screenings as part of their preventive healthcare routine.

While these strategies may help reduce the risk of endometriosis or alleviate symptoms, it's important to remember that individual factors such as genetics, hormonal imbalances, and immune system dysfunction also play a role in the development and progression of the condition. Therefore, individuals with a family history of endometriosis or symptoms suggestive of the condition should consult with a gynaecologist for appropriate evaluation, diagnosis, and management.

How serious is Endometriosis?

Endometriosis can vary in severity from person to person. While some individuals may experience mild symptoms, others may have severe pain and complications that significantly impact their quality of life. In some cases, endometriosis can lead to infertility or other reproductive health issues. 

What does endometrial pain feel like?

Endometrial pain associated with endometriosis can vary, but is often described as a dull, cramping sensation in the pelvic region. The pain may be cyclical, worsening before or during menstruation, and may also occur during sexual intercourse, bowel movements, or urination. Some individuals may also experience lower back pain or abdominal discomfort.

Can endometriosis go away on its own?

While endometriosis cannot be cured, some individuals may experience temporary relief or remission of symptoms, particularly during pregnancy or menopause when hormonal fluctuations occur. However, endometriosis typically requires medical intervention for effective management of symptoms and prevention of complications.

What happens if endometriosis is left untreated?

If left untreated, endometriosis can lead to chronic pelvic pain, infertility, and other complications such as ovarian cysts, adhesions, and bowel or bladder problems. Prompt diagnosis and treatment are essential to alleviate symptoms and prevent potential long-term consequences of untreated endometriosis.

Can you get pregnant if you have endometriosis?

While endometriosis can affect fertility, many individuals with the condition are still able to conceive with appropriate medical intervention. Treatment options such as surgery to remove endometrial implants or assisted reproductive technologies (ART) like in vitro fertilisation (IVF) may help improve fertility outcomes for individuals with endometriosis.

Can you still have endometriosis after menopause?

Although menopause typically leads to a decrease in oestrogen levels and may alleviate endometriosis symptoms for some individuals, endometriosis can persist after menopause in some cases. This is because oestrogen can still be produced in small amounts by tissues other than the ovaries, such as fat cells. Symptoms may improve with menopause, but may not completely resolve.

What is the difference between endometriosis and adenomyosis?

Endometriosis and adenomyosis are both conditions involving abnormal growth of endometrial tissue, but they differ in their location and presentation. Endometriosis involves the growth of endometrial tissue outside the uterus, while adenomyosis occurs when endometrial tissue grows into the muscular wall of the uterus. Adenomyosis typically causes symptoms such as heavy menstrual bleeding, pelvic pain, and enlargement of the uterus.

What is the best diet for managing endometriosis?

While there is no one-size-fits-all diet for managing endometriosis, some individuals find relief from symptoms by following an anti-inflammatory endometriosis diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Avoiding processed foods, excess caffeine, alcohol, and inflammatory foods may help reduce inflammation and alleviate endometriosis-related symptoms.

Can exercise help with endometriosis symptoms?

Regular exercise, such as aerobic activities, strength training, yoga, or Pilates, may help improve circulation, reduce stress, and alleviate symptoms associated with endometriosis, such as pelvic pain and fatigue. However, it's essential to listen to your body and choose activities that are comfortable and enjoyable.

Reviewed By Dr. Anita K. Sharma Senior Director & Head - Obstetrics & Gynaecology on 12 Aug 2024.