Endometriosis Surgery: Your Complete Guide to Treatment, Recovery, and a Pain-Free Future

by Dr. Anitha Kunnaiah | Apr 02, 2024 | Gynaecology

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Endometriosis Surgery: Your Complete Guide to Treatment, Recovery, and a Pain-Free Future

5. Diagnosis and treatment of endometriosis

Endometriosis is a medical condition characterized by the growth of tissue similar to the lining of the uterus outside the uterine cavity. This can lead to intense pelvic pain. It can complicate pregnancy, induce severe discomfort, fatigue, and contribute to feelings of anxiety and depression. According to the World Health Organization (WHO), approximately 10% of women and girls in their reproductive years worldwide are affected by endometriosis.

What is endometriosis?

The development and presence of histological components such as endometrial glands and stroma in anatomical places and organs outside of the uterine cavity is referred to as “endometriosis”. Endometriosis is a chronic gynecologic illness that results in the impaired fertility and persistent pelvic pain. Endometriosis is most commonly seen in the ovaries.

The displaced endometrial-like tissue is affected by the hormonal fluctuations of your menstrual cycle, which results in inflammation and pain in the affected location. Although the tissue is not cancerous, it results in adhesions. It may obstruct the fallopian tubes, causing blood clots to develop. Due to tissue fusion, changes in the reproductive organs could take place.

Types and stages of endometriosis

Types of endometriosis- Generally, endometriosis is classified based on the area of the pelvis or abdomen that endometriosis affects. Endometriosis is mainly of four types:

Superficial peritoneal endometriosis: It is the initial stage where the endometrial tissue attaches to the peritoneum.
Endometriomas: These cysts are dark and packed with hemorrhagic fluid form (chocolate like fluid). They can appear in various locations of your abdomen or pelvis and vary in size, but are commonly seen in the ovaries.
Deeply infiltrating endometriosis (DIE): In this kind, the organs inside or outside of your pelvic cavity have been infiltrated by endometrial tissue. This is referred to as a frozen pelvis. However, only 1% to 5% of endometriosis patients experience this.
Abdominal wall endometriosis: Endometrial tissue can occasionally develop on the abdominal wall. A surgical incision, such as a C-section, may become attached to the cells.

Endometriosis stages- While measuring the severity, doctors typically consider the distribution, depth, and bodily parts impacted by endometrial tissue. According to the American Society of Reproductive Medicine (ASRM) scale, the condition is categorized into four stages:

Stage 1: This is the minimal stage where the small implants, wounds, or lesions were seen. Scar tissue might be present or not. This stage is seen in the tissue lining of the abdomen or pelvis.
Stage 2: This is the mild stage where the implants are seen. Some amount of scar tissue could be present at this stage.
Stage 3: This is the moderate stage where the deeper implants are seen. Small cysts are present in the ovaries, along with thick bands of adhesions.
Stage 4: This is the most severe stage and is widespread in nature. Deep implants and thick cysts are seen in the ovaries, along with thick adhesions.

Symptoms of endometriosis

Endometriosis symptoms- The two main symptoms of endometriosis are severe pain and trouble getting pregnant. The pain is typically felt throughout the menstrual cycle and either during or after sexual activity. In addition to this, there are some common symptoms that include:

Heavy or irregular periods
Painful urination or defecation during the periods
Bleeding or spotting in between menstrual cycles
Fatigue
Infertility
Lower back pain during the periods
Diarrhea or constipation and more

Although not everyone will have all of these symptoms, some people may only have one or two of them, along with periodic pain and discomfort.

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Causes of endometriosis

Endometriosis causes- The exact cause of endometriosis is not known, but there are several mechanisms that might lead to it. Some of the causes that might lead to endometriosis are as follows:

Reverse or retrograde menstruation: Menstrual blood flows back into the pelvic cavity through the fallopian tubes in this case rather than leaving the body.
Blood and lymphatic transportation: Similar to the manner in which cancer cells can travel throughout the body, endometrial tissues can also be carried to other parts of the body through the blood or lymphatic systems.
Complication of the surgical scar: After surgery, such as a hysterectomy or C-section, endometrial cells might stick to the abdominal walls or other parts of the body.
Immune dysfunction: An immune system malfunction could prevent the body from identifying and eliminating endometrial tissue.
Transformation of the cells: It’s possible for other bodily cells to develop into endometrial cells and begin growing outside the endometrium. The peritoneal cells (the cells lining the inside of the abdomen) or embryonic cells may be changed into cells resembling the uterine lining with the help of hormones or immunological agents.
Genetics: There may be a genetic component to endometriosis because the condition appears to run in some families more often than in others due to inheritance.

Diagnosis and treatment of endometriosis

Endometriosis diagnosis- Based on the symptoms and patients assessment, the gynecologist might suggest the tests including:

Pelvic-digital examination: Cysts or scarring behind your uterus may be palpable to your doctor.
Laparoscopy: A tiny incision is made in your abdomen, and a thin tube with a camera attached (called a laparoscope) is inserted by your doctor. The location and size of the lesions are visible to them.
Imaging tests: An endometriosis Ultrasound, MRI, or CT scans can help your healthcare provider spot tissue and cysts that may be signs of endometriosis.
Biopsy: Usually during a laparoscopy, your doctor removes a sample of tissue, which is examined under a microscope by a specialist to confirm the diagnosis.

Endometriosis treatment- Endometriosis is usually managed with medications, conservative therapies, or surgery. The severity of your symptoms and whether you intend to become pregnant will determine the course of treatment that you and your medical team choose. Primarily medication is usually advised. If it is not helpful, surgery becomes a choice.

Non-surgical methods for endometriosis:

Pain medications: Medicines such as analgesics or NSAIDs (non steroidal anti inflammatory drugs) are suggested in order to treat the pain and menstrual cramps in endometriosis patients.
Hormonal therapies: Oral Contraceptives, Progestins, Gonadotropin-releasing hormone antagonists to limit ovarian hormones, Gonadotropin-releasing hormone agonists are suggested to regulate the hormonal imbalances and make your ability to conceive.

Endometriosis surgery methods: Procedure, Recovery And Success Rate

Surgery may be necessary for patients with more severe endometriosis. The surgeries suggested for endometriosis are:

Laparoscopy

Laparoscopic endometriosis procedure: A few tiny incisions are made in your belly by the surgeon during the procedure. A tiny tube containing a light and a camera is inserted through one incision. Little instruments are inserted through the other incisions. These instruments have the ability to remove endometrial tissue (excision) or damage tissues (ablation) using high levels of heat. This is the minimally invasive endometriosis surgery for fertility.
Laparoscopic endometriosis recovery: Most of the endometriosis individuals can resume their activities within 1 to 2 weeks.
Laparoscopic endometriosis surgery success rate: According to the studies and researchers, nearly 45 to 75% achieve pregnancy after the laparoscopy. However, the success rate will depend on the severity, staging, and surgical clearance of endometriotic lesions.

Laparotomy

Laparotomic endometriosis procedure: For endometriosis, a surgeon may occasionally need to perform a laparotomy rather than a laparoscopy. This indicates that in order to remove the endometrial tissue, the doctor will need to create a large abdominal incision.
Laparotomic endometriosis recovery: A few days of hospitalization followed by home recovery for a few weeks.
Laparotomic endometriosis surgery success rate: According to studies, 60–80% of women report significant pain reduction following surgery. In contrast to laparoscopy. recurrence rates are higher; estimates range from 30 to 70% for pain recurrence within five years.

Hysterectomy

A hysterectomy involves the surgical removal of the uterus, and with ovaries (oophorectomy) may also be recommended, inducing menopause. This procedure effectively treats endometriosis but eliminates the possibility of conception. Alternative fertility options, such as IVF, can be explored. The success rate of a hysterectomy is typically 80–90%, with a recovery period of 4 to 6 weeks, varying based on individual circumstances and severity.

Endometriosis and fertility

According to research by the American Society for Reproductive Medicine, endometriosis affects 24% to 50% of infertile women. Today, endometriosis and fertility treatments are growing simultaneously. The most common cause of infertility is endometriosis. It affects about 2 out of every 5 individuals who are unable to conceive. Endometriosis in mild-to-severe forms can only result in temporary infertility. A woman may become pregnant with the assistance of endometrial tissue removal surgery.

Frequently Asked Questions:

Which is the best hospital for endometriosis in hyderabad?

Yashoda Hospital in Hyderabad is renowned for its expertise in treating endometriosis. With a skilled team of gynecologists, nurses, and healthcare professionals, the hospital offers state-of-the-art treatment methods tailored to each patient’s needs. Their Gynecology Department is committed to delivering world-class care, meeting global standards. Yashoda Hospitals boasts a top-tier high-risk pregnancy team, comprising obstetricians and gynecologists. Equipped with modern medical facilities, including specialized units, the hospital ensures comprehensive care for women’s health.

What are the first signs of endometriosis?

The early symptoms of endometriosis include painful and irregular periods, excessive bleeding during periods, pain during intercourse, fatigue, diarrhea, or constipation. However, there is no rule that all these symptoms might occur in every endometriosis patient. It is possible that in some patients it may show up with few symptoms or not at all. Depending on their severity and overall condition of health, the symptoms may vary from person to person.

Is endometriosis dangerous?

Usually, endometriosis is not a life-threatening condition. However, if left untreated, it might cause some severe complications, such as ectopic pregnancy and depression that affects the lifestyle of the women. Without proper treatment, sometimes it may become dangerous.

Does endometriosis go away?

Endometriosis can spontaneously improve in certain cases, with lesions decreasing over time or after menopause due to declining estrogen levels. However, many patients still require ongoing treatment to manage symptoms like pain. Regular visits to healthcare providers are crucial for collaborative long-term management.

How to treat endometriosis?

There are several options to treat endometriosis based on the severity of the condition. Mild and moderate conditions could be treated by medication and hormonal therapies. Whereas, the severe type of endometriosis could be treated by surgical methods.

Is endometriosis cancer?

No, endometriosis is not a cancer. However, there is preliminary evidence that endometriosis may marginally increase your risk of developing some uncommon forms of endometrial and ovarian cancer. Rarely, these cells may travel to other areas of the body and develop into cancers.

What are the symptoms of endometriosis?

The symptoms of endometriosis include painful menstruation, irregular periods, excessive bleeding, unable to get the pregnancy, painful intercourse, fatigue, diarrhea or constipation etc., apart from the above there might be some minor symptoms too. However, it’s possible that some individuals won’t have any symptoms at all or just a few.

Is endometriosis genetic?

Research suggests that in some cases there might be involvement of some multiple genes, which could result in endometriosis, because endometriosis appears to occur in some families more frequently than in others due to inheritance.

Does endometriosis recur after surgery?

Studies have shown that even after a hysterectomy and bilateral salpingo-oophorectomy, endometriosis recurred and needed another procedure. About 10% of people may experience recurrent problems following the surgery.