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Early Diagnosis of Endometriosis. Is Your Pain Telling You Something?

Endometriosis is a condition affecting 10 -15 % adolescents and women of reproductive age. In these patients, endometrial glands and lesions are found outside of the uterus. The lesions may be present in the peritoneum, or as superficial implants or cysts on the ovary, or it may present as a deep infiltrating disease. Around 70% of women with chronic pelvic pain may be suffering from endometriosis.

When does endometriosis start showing up?
Even though the disease starts in adolescence the diagnosis may be delayed as pelvic pain can be due to other reasons. It has been observed that many women are diagnosed 6 – 7 years after the symptoms start. At the other end of the spectrum are women who do not have any symptoms and endometriosis is picked up while investigating the women for infertility.

Endometriosis is classified into four stages  – I-minimal, II-mild, III-moderate, and IV-severe. The stages are based on the location, extent, and depth of the lesions. Stages also depend on the presence or absence and/ or severity of scar tissue and size of endometrial implants in the ovaries.

What symptoms should one look out for?
Risk factors for endometriosis include hormonal variation, early age at menarche and short menstrual cycle length. Alcohol use, high caffeine intake and low BMI statistically lead to a higher chance of developing endometriosis.

The common symptoms are

intermenstrual bleeding (bleeding between periods)
dysmenorrhea (painful periods)
dyspareunia (pain during sexual intercourse)
pain while passing urine (dysuria) and stools (dyschezia)

Pain in pelvic region may start before menstruation. Other complaints are fatigue, late menopause and history of delayed child bearing.

If you notice symptoms like pain, heavy bleeding, severe cramps, bloating, and spotting between periods, consult your physician.

Can endometriosis be detected early?
Earlier, endometriosis was detected only during major abdominal surgery which is generally done in older women. It is a misconception that endometriosis starts after 30 or 40 years of age. With the advent of laparoscopy, it can be detected much earlier, especially in women being investigated for infertility.

Endometriosis can occur much earlier, especially if there is family history of the disease. Sometimes, it may take 7 -10 years to diagnose even though symptoms are present. The Global Study of Women’s Health, conducted in ten countries, showed that two thirds of women took advice and treatment for their symptoms before the age of 30, many had symptoms as early as their first period.

The condition is suspected when the patient complains of typical symptoms described above. There can be many causes of pelvic pain. Ultrasonography of pelvic region can detect endometrial cysts in the ovary. MRI and CT scan are useful. The gold standard to confirm the diagnosis is laparoscopy followed by endometrial biopsy. Since laparoscopy cannot be conducted in all patients, non invasive tools like biomarkers to detect early endometriosis are being studied.

Is extreme pain & bleeding during periods normal?
Most females experience some pain, cramping, and discomfort during menstrual periods. However, extreme pain and heavy bleeding indicates some abnormality and you must visit your gynaecologist if you suffer from the same. Untreated heavy bleeding can cause anaemia. If the pain interferes with your day to day life and prevents you from going to work or school, it is not normal.

Are these problems automatically corrected with time & post marriage?
It has been observed that pregnancy suppresses the symptoms. In women with mild endometriosis, the symptoms may disappear, however, the symptoms can recur in patients with severe disease. It has been observed that endometriosis recedes after menopause. However, it is a myth that symptoms disappear on their own.

Globally endometriosis management using safer options like evidence-based nutraceuticals are gaining steady acceptance. Studies prove the complementary action of nutraceuticals in conventional treatment strategies make it an attractive option in comparison to the use of only traditional management. For endometriosis diagnosed with milder disease conditions or adolescent endometriosis, a nutraceutical-based approach can be extremely useful. Nutraceuticals such as curcumin, resveratrol, N-acetylcysteine, vitamin D offer new hope as they are backed with several well-designed and validated clinical studies.

It has been noted that endometriosis is under-diagnosed, especially in adolescents. If detected early, timely treatment can be started and complications may be prevented or reduced. When the woman visits her clinician with suspected symptoms of endometriosis she must be referred to the gynaecologist and investigated further, if required.