New Delhi: Endometriosis is a disease where tissue similar to the lining of the uterus grows outside it. Endometriosis is one of the most challenging diseases in women to treat as it is recurrent and needs constant management.

The symptoms usually include extreme pelvic pain and heavy bleeding, infertility, long menstrual cycles, nausea, or vomiting
"Pain occurs before, during and after menstruation. Treatment varies depending on the stage of the disease and age of the patient. If a patient comes in the early stage, hormonal medication will be sufficient," said Dr Naresh Purohit , Advisor National Reproductive and Child Health Programme (RCH)
 Renowned Epidemiologist  Dr Purohit informed Vibrant News that in the last 15 years there is a sharp rise in endometriosis (a multi-system disorder) cases in many women who complain of painful menstruation, cramping, painful sex, constipation, loose motions, bloating, back pain, leg pain, pain while urinating, pain while passing stools, and rectal bleeding. However, there are many women who are asymptomatic, too. 
According to the WHO, it affects 10 per cent of women in the reproductive age group, and roughly 200 million women across the world. 
The number of cases of endometriosis is increasing and affecting younger girls as they are attaining menarche earlier. 

Acclaimed Reproductive Medicine Expert Dr Purohit explained that the uterus lining, endometrium, sheds every month when a woman gets her periods. In some cases, the body doesnt clear the lining properly. Bits of the lining leak inside the abdomen, urinary bladder and adjacent organs., This is what happens in endometriosis. This causes tubal blocks, pain and infertility. It causes recurrent bleeding and leads to cysts.

Principal Investigator for the Association of Studies for Reproductive Healthcare Dr Purohit averred that endometriosis affects girls and women of reproductive age and is attached to any organ associated with reproduction. It can be described as an abnormal growth of tissues resembling the uterine lining outside the uterus. The cause of endometriosis is unknown although there are many theories. 

"As endometriosis hampers the quality of life due to constant pain, loss of concentration and self esteem, early diagnosis and follow-ups with the doctor is indicated." added he

“Foods rich in Omega-3 fatty acids (chia, flax seeds, walnuts, salmon), fresh fruits and vegetables, avoidance of trans-fats, avoiding intake of alcohol and caffeine, and a regular exercise regimen are found to help relieve and resolve symptoms of endometriosis,” he said.

According to Dr Purohit, stage I of endometriosis is minimal wherein the patient may have small adhesions and small amounts of endometriosis tissue on an ovary. It may also include inflammation in or around the pelvic area. 

Stage II is mild and there are more adhesions on or around the ovaries. These adhesions are defined to be “too insignificant” at this stage and are usually too small to be picked up on ultrasound unless the doctor pays attention to probe tenderness in the region while examining the ovary. 

Stage III is moderate where adhesions will be blatantly obvious and usually, there may be cysts on the ovaries. There may be growths in other areas of the pelvis blurring into the territory of stage IV endometriosis.

“Stage IV is the final stage associated with a large number of cysts and severe adhesions. Most of the cysts will appear on the ovaries while the adhesions will appear over the pelvic lining and may affect the fallopian tubes and bowels. This can make bowel movements terribly uncomfortable and period pain the absolute worst,” he explained.

He stressed that the main reason women should be aware of endometriosis is that the disease is quite common and not rare. 

He cautioned that the problem is that most young women come for treatment in Stage 3-4, the advanced stage of the disease. Since they have pain and heavy bleeding, they think it is normal and manage with painkillers. It is only when the painkillers dont work anymore, that they come to a doctor. They must come earlier. In later stages, surgical intervention is necessary, as tubes can get blocked and it affects the capacity of the ovaries to produce good quality eggs.

He revealed that usually, the medication given to these patients will suppress menstruation. If they are trying for a baby, the treatment is different and advanced reproductive treatments such as IUIs and IVFs is needed.

He pointed that endometriosis affects more  women than breast cancer. Many have not heard of it and the disease has not got the attention it deserves typically because it is not terminal. Many women may complain of excessive pain during periods. It is mistaken to be normal and they are asked to be stronger due to the lack of awareness.

Dr Purohit suggested that endometriosis needs its own subspecialty and this advanced disease is outside the realm of routine obstetrics and gynaecology practice, it must be dealt with by specialised endometriosis centers.

“Surgery needs to be done by a well-trained, well-coordinated team of specialists and treatments need to be tailored toward the patient and not just towards the disease. Every case is different and treatment has to be tailored,” experts mentioned, adding that the patient is discharged usually within 24–72 hours depending on their recovery and complexity of the surgery."he added.