Endometriosis
Endometrium is the inner lining of the uterus. This lining thickens every month in preparation for pregnancy and is partially shed during menstruation.
When the cells of this endometrial lining start growing outside the uterus, the condition is known as Endometriosis.
These misplaced cells cannot be expelled during periods and therefore cause local irritation, inflammation, adhesions (tissues sticking together), and blood-like fluid collections, leading to various symptoms.
Endometriotic lesions can appear as tiny spots or grow into larger cysts (commonly called chocolate cysts) in the ovaries.
Endometriosis can affect the ovaries, fallopian tubes, uterus, urinary bladder, and in rare cases, even distant organs like the lungs.
Symptoms
Common symptoms include:
Dysmenorrhoea: Pain during menstruation
Dyspareunia: Pain during sexual intercourse
Infertility
Chronic pelvic pain, which may persist even outside of periods
Endometriosis can cause adhesions between the ovaries and fallopian tubes, making them stick together. This can interfere with egg pickup and fertilization, becoming a major cause of infertility.
It is a progressive condition, meaning that the lesions and symptoms may worsen over time if left untreated.
Why endometriosis occurs?
The exact cause of endometriosis is not fully understood. However, several theories have been proposed, including:
Retrograde menstruation: Backward flow of menstrual blood into the pelvic cavity
Autoimmune factors: The body’s immune system may react abnormally to endometrial cells
Genetic tendency: A family history of endometriosis increases risk
Diagnosis
1. Sonography
Ultrasound (sonography) can help identify certain forms of endometriosis.
The most common finding is an ovarian cyst known as a “chocolate cyst” — named for the dark, thick fluid it contains.
During the scan, the doctor may observe that the uterus and ovaries are less mobile, which can suggest adhesions due to endometriosis.
An experienced sonologist can often diagnose endometriosis early and assess the extent and severity of the disease more accurately.
2. Laparoscopy
Laparoscopy is both a diagnostic and therapeutic procedure.
It involves inserting a thin telescope-like camera (endoscope) through a small incision near the navel (umbilicus) to visualize the uterus, ovaries, and other pelvic organs directly.
Through laparoscopy, doctors can:
Visualize and grade endometriosis (Minimal, Mild, Moderate, or Severe)
Take a biopsy for confirmation
Treat lesions during the same procedure
Laparoscopy allows the surgeon to cauterize (destroy) endometriotic lesions, remove chocolate cysts, release adhesions, and check the patency of fallopian tubes — all with minimal invasiveness and quick recovery.
Other imaging techniques such as MRI or CT Scan may occasionally be used for complex or unclear cases.
Treatment
The treatment approach depends on several factors:
Nature and severity of symptoms
Desire to conceive
Age and ovarian reserve (egg count)
Endometriosis symptoms often improve naturally during pregnancy and breastfeeding, as these conditions temporarily suppress menstruation.
For Women Planning Pregnancy
If you wish to conceive, planning pregnancy early is advisable.
Endometriosis generally has minimal impact on pregnancy or baby development.
Removal of endometriosis is recommended only if natural conception is difficult.
Laproscopic Surgery
Laparoscopy is the preferred surgical approach as it offers clear visualization and precise treatment of endometriotic lesions.
Severe endometriosis requires a highly skilled and experienced surgeon for the best outcome.
Recurrence of endometriosis is possible; hence, pregnancy should be planned as soon as possible after surgery.
Before surgery, your egg count (AMH/ovarian reserve) should be evaluated, as surgery may slightly reduce ovarian function.
If your egg count is low, IVF (In Vitro Fertilization) may be a better treatment option.
Notably, removal of endometriosis is not required before IVF, as it does not affect IVF success rates.
For Women Not Planning Pregnancy
If you are not planning a pregnancy or have completed your family, treatment may be medical, surgical, or combined, depending on the severity of disease and symptoms.
Medical Treatment
Painkillers:
Mild pain can often be managed with simple pain-relieving medicines like Ibuprofen, Mefenamic Acid, or Aspirin.GnRH Analogues:
These medicines suppress the production of estrogen by the ovaries, inducing a temporary and reversible menopause-like state.
Side effects may include hot flushes, vaginal dryness, and bone weakness, but they disappear once treatment stops.
Calcium supplements and “add-back therapy” are often prescribed to protect bone health.Dienogest:
A modern, synthetic progesterone-based medicine, Dienogest effectively reduces pain and lesion size.
Studies show it to be as effective as GnRH analogues but with fewer side effects.
Surgical Treatment
Surgical management is similar to that used in women seeking pregnancy — involving removal of cysts, adhesions, or lesions.
In severe cases, when the disease is extensive and symptoms are unmanageable, hysterectomy (removal of uterus) or ovary removal may be considered, especially for women who have completed their family.
Adenomyosis
Adenomyosis is a condition similar to endometriosis. In this disorder, the endometrial tissue (which normally lines the inside of the uterus) grows into the muscular layer of the uterus (myometrium).
Since this tissue becomes trapped within the muscle, menstrual blood cannot escape, leading to swelling, thickening, and enlargement of the uterus. This causes pain and heavy bleeding during periods and may also interfere with fertility.
Why Choose Sarkar Hospital for Adenomyosis Treatment
At Sarkar Hospital, Agra, we offer:
Accurate diagnosis using advanced imaging
Personalized treatment plans based on fertility goals
Expert laparoscopic surgery for precise management
Specialized IVF care for adenomyosis and endometriosis patients
Our experienced team ensures that you receive the most advanced, safe, and effective care for pain relief, fertility preservation, and successful conception.