About Me
 List of Procedures
 Laparoscopy & Hysteroscopy
 Recurrent Miscarriage
 Understanding Hysterectomy
 Urinary Incontinence
 Training Programs
 Free Consultation
 Robotic Surgeries

Endometriosis is a puzzling disease commonly affecting women of reproductive age. The name comes from the word endometrium, which is the tissue that lines the inside of the uterus and builds up and sheds each month in the menstrual cycle. In endometriosis, tissue like the endometrium is found outside the uterus, the endometrial tissue develops into implants, growths, lesions or tumors.

The most common locations of endometrial growths are in the abdomen- involving the ovaries, ligaments supporting the uterus, area between the vagina and rectum (recto-vaginal), outer-surface of the uterus and the lining of the pelvic cavity. (Fig 1) Sometimes the growths are also found in abdominal scars, intestines and appendix, on the rectum, in the urinary bladder, and vagina. They have been rarely found outside the abdomen in the lung and other sites.

Like the lining of the uterus, endometriosis lesions usually respond to the hormones of the menstrual cycle. They build up tissue each month and break down. The result is internal bleeding, degeneration of the blood and tissue shed from these implants, inflammation of the surrounding areas, formation of scar tissue (adhesions), and cyst formation.


  • Cramps and menstrual pain
  • Pelvic pain
  • Pain during sexual intercourse
  • Trouble getting pregnant (infertility)

Other symptoms include painful bowel movements, diarrhea or constipation and other intestinal upsets with periods. The severity of pain is not necessarily related to the extent or size of the lesions. Tiny lesions (called petechial) may cause more discomfort than large cysts or growths.

Each woman has her own pattern of symptoms. Symptoms may appear at mid-cycle or peak during your menses.

Although your doctor may advice you a clinical exam, laboratory tests, ultrasonography, endometriosis is generally considered uncertain until proved by laparoscopy.


With laparoscopy can stage your endometriosis. The stages are
(I) Minimal (II) Mild (III) Moderate (IV) Severe.

Staging depends on number, size, site, depth of implants and also on the extent of adhesions and whether other pelvic organs are involved or not.

Hormone therapy controls or blocks the hormones that drive the menstrual cycle. This limits the swelling of the endometrium and endometrial implants. Hormone therapy may be used by itself or along with surgery. While you are on therapy, pregnancy is not likely to occur.

    Birth control pills contain estrogen and progesterone, and work by stopping ovulation. There are given in a continuous dose, so you have no periods at all, thus reducing growth and bleeding in the implants.
    Side effects : Weight gain, nausea, blood clots and phlebitis (inflamed veins)

    Progestins are a form of progesterone. Continuous dose prevents ovulation and limits implant growth.
    Side effects: Mid-cycle bleeding or spotting, acne, headaches, weight gain and bloating.

    Danazol is chemical derivative of synthetic testosterone (male hormone). It inhibits ovulation and stops periods.
    Side effects : Weight gain, hair growth, acne, vaginal dryness, hot flashes, decreased sex drive and mood changes. Liver problems may require you to stop treatment.

    GnRH agonists prevent the release of hormones (FSH and LH) from pituitary gland inhibiting production of estrogen and progesterone. It inhibits ovulating and stops periods, and implants shrink.
    Side effects : Hot flashes, headaches, mood swings, vaginal dryness. During the therapy, bone mass may decrease.

For some women, surgery is the best way to combat the effects of endometriosis.

Conservative surgery, either by open method (laparotomy) or through the laparoscope involve removal or destruction of the implants, can relieve symptoms and allow pregnancy to occur. As with other treatments, recurrences are common.

Radical surgery, involving hysterectomy (removal of the uterus) and removal of all implants and the ovaries (to prevent further hormonal stimulation), becomes necessary in longstanding severe cases.



This can be performed by laparotomy or laparoscopically

© Copyright 2007 www.drpranayshah.com