Lining inside the uterus is medically referred as endometrium. Endometrium thickens during the follicular phase of the menstrual cycle. If conception occurs endometrium under goes decidualization. The fetus derives nutrients and oxygen form the endometrium. If conception does not occur endometrium breaks down and is passed out through menstruation.
Endometriosis is the abnormal growth of cells similar to endometrium in locations situated outside the uterus which include outer surfaces of the uterus, the intestines, fallopian tubes, ovaries etc. endometrial implants can occur outside the pelvis rarely, on liver, surgical scars and even in brain. Even though they are benign, they can cause problems. They are asymptotic and is affecting around 5 to 20 % of the women. It is estimated that 20 to 50 % of women treated for infertility are affected by endometriosis.
Pelvic pain is the common symptom of endometriosis. Based on this pain and the findings of physical examination the preliminary diagnosis of endometriosis is made. Doctor may also conduct a rectovaginal examination inserting one finger in the vagina and other finger in the rectum, whereby he can feel the implants behind the uterus. In some cases no implants are felt, but the examination produces severe pain and discomfort. Ultra sound imaging can be useful in ruling out the possibility of other pelvic diseases. Laparoscopy is the diagnostic test which can be relied upon for confirming the preliminary diagnosis of endometriosis.
Diagnostic laparoscopy is usually done under general anesthesia and in rare cases it is done under local anesthesia also. This procedure is usually done as an outpatient procedure in which the patient can return home on the same day. As a first step the abdomen of the patient is inflated with carbon dioxide gas to make more room for viewing the internal parts clearly. Through a small incision a laparoscope is inserted and guided to the target area. This is an instrument which can give an enlarged video of the internal parts of the abdomen. The surgeon views the uterus and nearby area through laparoscope and assess and confirm the existence of endometriosis.
Treatment for endometriosis in intended to relieve pelvic pain and to enhance fertility can done through medication or trough surgical procedures. Pain relievers and non steroidal anti-inflammatory drugs like ibuprofen, naproxen etc is commonly prescribed. This will give relief from pelvic pain and menstrual cramping. Another drug used to reduce endometriosis implants and related pain is gonadotrophin has been found to be very effective.
When the response to medical treatment is not satisfactory or when some anatomic distortion of organs or when urinary tract or bowel obstructions are noticed surgical treatment has been found to be very effective. In conservative surgical treatments the ovarian tissues and the uterus are preserved. Hysterectomy is a definitive surgical treatment in which the removal of uterus is achieved.
In conservative surgical treatment laparoscopic procedure is generally followed. Laparoscopic procedures are minimally invasive procedures where the laparoscope and the instruments for carrying out the surgery are inserted through small incisions of the size 1 to 2 cms. The surgeon carries out the surgery viewing the videos taken by the laparoscope in a monitor near him and controlling the special instruments inserted for surgery controlling their controls which are available near him. Carbon dioxide gas is initially blown into the abdomen to expand it make more room for the surgical procedure and to get better videos of the surgery. The benefits of this procedure are that the wounds will heal faster and recovery will be quicker as the incisions and pain is smaller in this case.