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Diagnosis and Management of Endometriosis – An overview

Endometriosis is a condition that affects women, usually during their reproductive age. It is a condition that is characterized by severe pain and in many cases, infertility. Endometriosis has a huge impact on the quality of life of a woman. Endometriosis is commonly seen in the ovaries, fallopian tubes and the tissue lining the pelvis. It is very uncommon to see endometriosis extend beyond the pelvic region. The actual reason why endometriosis occurs is still unknown. Therefore, the diagnosis and the management/treatment of endometriosis is something that is still evolving and is often tricky.

Endometriosis can be broadly classified into 4 stages or types. They are classified as follows:

  • Stage 1: Minimal
  • Stage 2: Mild
  • Stage 3: Moderate
  • Stage 4: Severe

Diagnosing endometriosis, is it difficult?
It is true that diagnosing endometriosis is tricky. Most sufferers require multiple visits to their doctors for several years for their endometriosis to be diagnosed. There are various reasons why it is tricky for doctors to diagnose endometriosis. Some of the reasons include

  • Usually the symptoms between patients vary drastically. So it gets difficult to diagnose the condition.
  • Most symptoms observed are easy to mistake for symptoms of other conditions.
  • Many times the patients themselves downplay the symptoms. This makes it hard for the medical practitioner to diagnose the condition.
  • There are no full-proof methods for the diagnosis of endometriosis that are reliable.

The most common diagnostic methods for endometriosis include – Surgery, physical examination, ultrasound and MRI among others. At present, surgery is probably the most preferred way to diagnose endometriosis and is considered as the gold standard. Surgery for diagnosing endometriosis has its own share of advantages or disadvantages. Your doctor is the best judge when it comes to which technique should be used to diagnose endometriosis.

Management of Endometriosis
The management and treatment of endometriosis is evolving. There are several options available for woman, based on their symptoms and how severe the condition is. It is important to consult your doctor to decide which option is best in your case. Your doctor will look at the treatment options in 2 ways

  • How effective is it in treating your pain symptoms?
  • How effective is it in treating infertility?

Based on their analysis and experience, they will choose the best treatment option for you.

Currently the most common treatment options include:

    Surgery
  • IVF (In vitro fertilization)
  • IUI (Intrauterine insemination)
  • Medications

The table below summarises how the current treatment options.

  Surgery IVF IUI Medications
Fertility improvement Effective only at Stage 3 & 4 Most effective Somewhat effective Only effective when used with IVF
Pain Reduction Effective Not effective Not effective Effective but pain resurfaces on discontinuation
Cost of treatment option High Highest Moderate Low/Moderate
How invasive is the treatment option? High High Moderate Low
Risk (Side-effect profile) High Moderate High Low – side-effects on constant use

The above treatment options are the most sought after when it comes to endometriosis treatment. The issue with most of these options are the wide range of unwanted and undesired side-effects that accompany them. Also, there is no treatment option available that can completely cure endometriosis.

What other therapy options are available for the successful management of endometriosis?

The current treatment options that are being employed, fail to cure the underlying issue completely. Also, these treatment options only focus on treating particular symptoms and recur when the medications or treatment is stopped.

Other than the above mentioned treatment options, evidence-based nutraceuticals using natural novel ingredients are gaining steady acceptance around the world. They are gaining a lot of attention not just because they are safe (free from side-effects) but also because they are effective and complement the action of conventional treatment options. Natural ingredients such as curcumin, resveratrol, vitamin D, N-acetyl cysteine are safe and effective in endometriosis and have been validated through several clinical studies. They offer a more holistic approach in the successful management of endometriosis.

Curcumin, for instance, is hailed as the best natural anti-inflammatory and anti-oxidant and has been shown to have several benefits when it comes to improving fertility and to reduce pain associated with endometriosis. Curcumin has shown to reduce the growth of endometrial cells by regulating the secretion of oestrogen – the female hormone associated with menstrual cycle and fertility in women. It has been well-researched for its function to restore the proper shape and anatomy of the uterus. Curcumin has also been found to improve the blood flow to the pelvic region and uterus which further helps to normalize menstruation. Other advantages of novel ingredients like Curcumin are that they have well-backed safety studies and are non-invasive in nature. Also, the long term use of Curcumin helps to keep the pain related to endometriosis in check and helps to prevent the further progression of endometriosis.

Similarly, resveratrol, a natural polyphenol is well-known for its anti-proliferative and anti-inflammatory properties. It has been shown to be effective in improving fertility by improving the oocyte (egg) quality and maturation. Also, resveratrol suppresses the expression of COX-2 and aromatase enzymes which further helps in reducing the pain associated with endometriosis.

References
1.Harlev, A., Gupta, S. and Agarwal, A., 2015. Targeting oxidative stress to treat endometriosis. Expert Opinion on Therapeutic Targets, 19(11), pp.1447-1464.
2.Indrielle-Kelly, T., 2020. [online] Prolekare.cz. Available at: https://www.prolekare.cz/en/journals/czech-gynaecology/2019-4-7/diagnosis-of-endometriosis-1st-part-overview-of-diagnostic-approaches-118473.
3.Jamaica Observer. 2020. Turmeric And Fertility. [online] Available at: .
4.Mayoclinic.org. 2020. Endometriosis – Diagnosis And Treatment – Mayo Clinic. [online] Available at: https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661.
5.Parasar, P., Ozcan, P. and Terry, K., 2017. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Current Obstetrics and Gynecology Reports, 6(1), pp.34-41.