The not-so-ordinary period pain

Endometriosis is a painful condition when tissue similar to endometrium — the tissue that lines the uterus — starts growing outside the uterine cavity, causing acute menstrual and abdominal pain. Though it is common, not many people are aware of it, resulting in a delay in diagnosis. The precise reasons for a person developing endometriosis are still not clear and much research is ongoing to better understand the condition.

According to the World Health Organization (WHO), endometriosis affects approximately 10 per cent of women and girls aged between 15 and 44, which accounts for roughly 190 million globally. Around 50 per cent of infertile women are found to have the condition.

“The endometrium-like tissue can grow on the ovaries, bowels and in the pelvic region,” says Dr Suhasini Inamdar, consultant, obstetrician and gynaecologist, Motherhood hospital, Bengaluru. “This misplaced tissue gets affected due to the hormonal changes during the menstrual cycle and becomes inflamed and painful. As it grows, thickens and breaks down, it has nowhere to go and gets trapped in the pelvis. This leads to scar formations, irritation, severe pain during periods and fertility issues.”

Dr Inamdar says endometriosis tends to present symptoms that women might brush off as the normal ones occurring during periods. “This can result in diagnostic delay,” she says. “Women should seek the help of their doctors who will be able to do the proper tests to determine if they have endometriosis.”

She says that according to the data provided by the Endometriosis Society of India, the disorder is quite common and affects as many as 2.5 crore women in the country alone. “The majority of the cases we see are from states like Orissa, West Bengal, Andhra Pradesh, Karnataka, Tamil Nadu and Kerala,” she says. “The disease can impact any woman who has started her menstrual cycle, irrespective of her age. However, women in their 30s and 40s are the most affected.”

Dr Pallavi Prasad, fertility consultant at NOVA IVF Fertility, Bengaluru, says that endometriosis is a common reproductive problem. She says the most frequent symptoms of the condition are chronic lower abdominal (pelvic) pain, pain during menstruation (dysmenorrhoea), pain during intercourse (dyspareunia) and infertility. Other symptoms include backache and stomach problems like diarrhoea, constipation, bloating and nausea, primarily during periods.

“It is recommended that women who experience the symptoms of endometriosis should visit a gynaecologist to better understand the symptoms, causes and possible treatments,” says Dr Prasad. “The doctor might perform a few tests to confirm it. Women who have endometriosis should immediately get professional help as the symptoms of the disease worsen over time and start interfering with their daily routine. After examining the patient’s reproductive and medical history, other tests such as pelvic exam, ultrasound, laparoscopy and biopsy are conducted.”

Four stages of endometriosis

Dr Prasad says the stages of endometriosis are based on the spread of the tissue and its depth.

1. Stage 1 (minimal): At this stage, there will only be a few small implants or spots. There is little — and in many cases, no — scar tissue at all. Usually, the endometriotic spots will be found in the abdomen, on the peritoneal surface. (Peritoneum is the membrane that lines the abdominal cavity and the organs of the abdomen.)
2. Stage 2 (mild): Here the implants will be deeper. There may also be some scar tissue.
3. Stage 3 (moderate): At this point, there may be small cysts developing on one or both the ovaries and there will be many deep implants. The organs that could be affected are the ovaries, rectum and uterus. The anatomy of the pelvic organs can be significantly distorted.
4. Stage 4 (severe): This is the stage where the condition is most widespread. The person affected may have deep implants and thick adhesions. There will also be large cysts on one or both the ovaries. At this stage, the organs outside the pelvic cavity may also be affected like bowels, appendix and diaphragm.

Debilitating pain: Is prevention possible?

Dr Inamdar says that at present, there is no known way to prevent endometriosis. “It is a chronic condition that tends to be recurrent and has no permanent cure,” she says. “The solution lies in increasing awareness among women so they can get it diagnosed early, which will enable them to manage the symptoms. Timely treatment can aid in slowing or halting the progression of the condition. The treatments include medications and constant scans to keep a check on its progress.”

Dr Prasad also makes the same observation and says that there is no way to prevent endometriosis. According to her, early diagnosis and lifestyle changes can help manage and reduce the painful symptoms associated with the condition.

“If the symptoms are too severe, your healthcare provider may recommend pain medications or other anti-inflammatory drugs to help ease the pain,” she says. “Treatments for endometriosis usually lower the oestrogen levels and increase the progesterone levels to create a suitable hormonal environment. Hormone therapy, including oral contraceptives, may also be recommended to manage the symptoms. The surgical technique used to treat endometriosis is laparoscopy, in which the doctor removes the endometriosis tissue without harming the healthy tissue. Patients with endometriosis are advised to plan their conception early, as it is a progressive disorder and reduces the fertility potential of a woman. Endometriosis, if detected early, is manageable.”

Endometriosis can be recurring

Recalling a case study, Dr Inamdar says that one of her patients, aged 36, suffering from endometriosis had to undergo laparoscopic surgeries three times because the endometrial cysts kept reappearing and this affected not only the person’s fertility, but also her emotional health.

“This was a recurrent case of endometriosis where the expert had to tell the person to keep coming back for gynaecological checks as her condition had to be managed properly,” she says. “The person is still under observation and if the cysts subside, she will plan her pregnancy. In such cases, the risk of infertility rises as the ovarian tissue is being eaten up by the cyst. During surgical procedures, the cyst is removed, without causing any damage to the ovaries. Post-endometriosis, it can be difficult to conceive naturally.”