Endometriosis is a chronic inflammatory disease defined as the presence of endometrium- like tissues (the inner lining of the uterus/womb) outside the uterus.(Kennedy,et al, 2005)
This is the disease of theory and the exact cause is unknown. The exact prevalance of endometriosis is unknown. But it is estimated that currently at least 190 million women and adolescent girls worldwide are affected by the disease during reproductive age. Although some women may suffer beyond menopause. (Gemmell et .al, 2017, Zondervan et. al, 2020)
The impact of endometriosis esp; pain has been shown on quality of life, daily activities, absenteeism of school and work, intimate partnerships and mental health.
Signs and Symptoms
The Guideline Development Group (GDG) recommends
The clinicians should consider the diagnosis of endometriosis in individuals presenting with
Dysmenorrhoea ( painful periods)
Dysuria ( Painful micturation /voiding)
Dyschezia ( Painful defecation)
Cyclical painful anal/rectal bleeding or haematuria
Cyclical cough, blood in sputum, chest pain.
Cyclical scar swelling and pain.
History and complaints will be helpful.
Clinical examination, including vaginal examination where appropriate, should be considered to identify deep nodules or endometriomas in patients with suspected endometriosis, although the diagnostic accuracy is low.
In women with suspected endometriosis, further diagnosis steps, including imaging should be considered even if clinical examination is normal.
But the negative findings of imaging cannot be excluded the endometriosis.
In patients with negative imaging results or where empirical treatment was unsuccessful or inappropriate , diagnostic laparoscopy for the diagnosis and treatment of suspected endometriosis.
a) Non hormonal
a) Minimally invasive ( Laparoscopic surgery)
c) Surgical interruption of pelvic nerve pathways
– LUNA (Laparocopic Uterosacral Nerve Ablation)
– PSN (Presacral Neurectomy)
The GDG recommends that clinicians take a shared decision-making approach and take individual preferences, side effects, individual efficacy, costs, and availability into
consideration when choosing between hormone treatments and surgical treatments for
References- Endometriosis Guidelines of ESHRE (European Society of Human Reproduction and Embryology) 2022