Endometriosis - DRHC Dubai Gynaecology Clinic

Endometriosis is a terrible, neuro-endocrine-immune system disease in which endometrial tissue (lining of the uterus that bleeds during your period) is found outside the uterine cavity, causing pain, infertility and other problems.

• It has a devastating effect on the quality of life of the sufferer. It may affect one in 10 women.
• The cause of the disease is not understood, although it may run in families. If your mother or sister has the condition, you may be likely to develop the disease.
• This happens to menstruating women commonly in their 30’s or 40’s.
• The endometrial lining of the uterus may spread into any site in your body, commonly to the ovaries (causing chocolate cyst) to the pelvic area, causing implants anywhere. It may affect the bowels, ureters, urinary bladder, or even it may travel to the chest cavity in some cases. No matter where the endometrium spreads, it bleeds on the same cycle as women get their periods, causing pain and scarring wherever it bleeds. This is regulated by estrogen hormones.

Causes:

• Dysmenorrhea (pain during and after period) can be severe enough to cause fainting or need hospital admission to control it.
• Dysuria (pain during micturition).
• Dyschezia (pain and difficulty in defecation).
• Subfertility (difficulty in getting pregnant).
• Chronic pelvic pain, even without period.
• Excessive bleeding during menstrual cycle.
• Severity is divided into 4 stages from I to IV or minimal I, mild II, moderate III, and severe is IV. This is usually done by laparoscopy based on the exact location, extent and depth of the endometrial implants, the severity of scar tissue, and the size of the implant in ovaries.

Is it a serious disease?

It is a benign condition. Implants can grow on very important organs such as the urinary bladder and bowel. The surgical removal of these implants can cause extra complications. Therefore, surgery is done on selective cases and repeated surgeries are of great risk and should be avoided.

Diagnosis:

• It is based on clinical suspicion and presentation.
• Ca 125 is a tumor marker which is raised in endometriosis patients. It is helpful in monitoring the disease progression.
• MRI pelvis is a diagnostic choice for endometrial cyst and ovarian chocolate cysts.

The gold standard in diagnosing endometriosis is laparoscopy in which the staging can be done for the disease severity.

Treatment (Medical versus Surgical):

The medical treatment is started based on symptoms and presentation. Strong analgesic is usually required in the form of NSAIDs such as Ponstan, Brufen, Diclofenac and Paracetamol.

• Combined oral contraceptive pills are effective. It is usually given without a break on a daily basis for three months.
• Androgen agents such as Danazol are effective but with many side effects.
• Provera, tablets on infection.
• Zoladex injection monthly or every 3 months is effective in pain relief and control of the disease.
• Mirena (IUD) is a hormonal intrauterine device that is proven to be effective in controlling pain.

Implanon contraceptive implant is found to be effective in reducing pain and inflammation. Recent studies showed that it markedly alleviates menstrual cramps and improves the quality of life with much less side effects.

The surgical option is done for infertility cases or for removal of large endometrial ovarian cysts (chocolate cyst). Laser ablation and electrocautery are carefully done for endometrial implants to avoid pelvic organ injury.

Dubai Obstetrics and Gynecology clinic at DRHC now provides leading gynecologists in Dubai to enhance the services on Cosmetic Gynecology, Surgical Gynecology, Contraception, Menopause, Fetal Anomaly Scan, and so on. For a pap smear test or colposcopy test, contact DRHC Dubai. We cater all services for women's health.