Endometriosis Treatment by Expert Gynecologists

Symptoms of Endometriosis

Endometriosis affects different women in different ways. There are about 20 symptoms of endometriosis. Here is a full list of common and less common symptoms of endometriosis:

Core Symptoms: Most Common Symptoms of Endometriosis

These symptoms are typically present in moderate to severe cases, regardless of stage. Here are the common symptoms of the  20 symptoms of endometriosis seen in most women with endometriosis:

1. Pelvic Pain

• The most common symptom

• It can start a few days before the period and last even after it ends.

• Often described as a sharp, cramping, or constant dull ache. 

2. Very Painful Periods (Dysmenorrhea)

• Severe period cramps that don’t go away with painkillers

• Pain may be stronger than usual and get worse over time. 

3. Heavy Period Bleeding

• Bleeding that lasts longer than 7 days

• Need to change pads/tampons very often.

• May also have spotting before or after the period 

4. Pain During Sex (Dyspareunia)

• Pain during or after intercourse, especially with deep penetration

• Can feel like a stabbing or burning sensation 

5. Pain During Bowel Movements or Urination

• Often worse during the period.

• May feel pressure or sharp pain while passing stool or urine 

6. Fatigue (Feeling Very Tired)

• Ongoing tiredness, even with enough sleep

• It can make it hard to do daily work or exercise. 

7. Infertility (Trouble Getting Pregnant)

• Endometriosis can block the fallopian tubes or damage eggs

• Around 30% to 50% of women with infertility have endometriosis.
  

Less Common Symptoms of Endometriosis

These symptoms may vary and are often misattributed to other conditions. These symptoms may not appear in everyone, but are also linked to endometriosis and are included in the 20 symptoms of endometriosis:

1. Lower Back Pain or Leg Pain

• Pain can spread to the back, hips, or down the legs

• Usually comes along with pelvic pain.

2. Bloating and Digestive Problems

• Swelling in the stomach area

• May also feel like gas, diarrhoea, or constipation

• Often confused with irritable bowel syndrome (IBS)

3. Nausea and Vomiting

• It can happen during periods due to extreme pain.

• Some women also lose their appetite.

4. Pain During Ovulation

• Sharp pain in the middle of the cycle (around day 14)

• Some women can even feel it on one side of the lower stomach.

5. Mood Changes

• Hormonal changes and constant pain can lead to anxiety or sadness.

• Some women feel frustrated, especially if the diagnosis is delayed.

6. Bleeding from the Bladder or Bowel (Rare)

• If the tissue grows on the bladder or rectum, there might be blood in the urine or stool.

• This is not common, but it needs immediate medical help.

Important Note

The 20 symptoms of endometriosis can change over time. They may get worse, stay the same, or sometimes improve, especially after pregnancy or menopause.  

Do the 20 Symptoms of Endometriosis Vary by Stage?

Yes, but not always predictably.

• Stage I or II (Minimal to Mild): Symptoms may be mild or absent

• Stage III or IV (Moderate to Severe): More likely to involve chronic pain, fatigue, and infertility, particularly if cysts or adhesions are present

However, there is no strict correlation between stage and symptom severity. Some women with minimal disease experience debilitating symptoms, while others with extensive endometriosis may remain asymptomatic. This is why clinical evaluation is so important.

Methods of Diagnosis for Endometriosis

Endometriosis can be difficult to diagnose because its symptoms are similar to other health problems like PCOS, IBS (Irritable Bowel Syndrome), or pelvic infections. Many women wait years before getting a proper diagnosis. 

Here are the main methods used to diagnose endometriosis:

1. Medical History and Symptom Discussion

The first step is a detailed talk with the doctor.
The doctor will ask about:

• Menstrual cycle and period pain

• Pain during sex, urination, or bowel movements

• Family history of endometriosis

• Any past surgeries or pregnancy issues

2. Pelvic Exam

• The doctor gently presses areas in the pelvic region to feel for cysts or lumps.

• It’s a simple check, but it may not show small or deep endometriosis.

• Still useful as a starting point

3. Ultrasound Scan

• A transvaginal or abdominal ultrasound uses sound waves to create images of the uterus, ovaries, and nearby organs.

• It can show signs like endometriomas (chocolate cysts on the ovaries)

• But small endometriosis spots may not be visible

4. MRI (Magnetic Resonance Imaging)

• A more detailed scan than an ultrasound.

• Useful for spotting deep endometriosis in the bladder, bowel, or behind the uterus

• Often used before surgery to guide doctors

5. Laparoscopy (Keyhole Surgery)

• This is the most accurate way to diagnose endometriosis

• A small cut is made near the belly button, and a tiny camera is inserted.

• The doctor looks directly inside the body to check for endometriosis tissue.

• If found, the tissue may also be removed or tested during the same procedure.

• Done under general anaesthesia

6. Biopsy

• During laparoscopy, a small sample of tissue may be taken

• This sample is tested in a lab to confirm if it is endometriosis.

• A biopsy gives a 100% sure diagnosis

7. Other Tests (to rule out other causes)

Sometimes, doctors may also suggest:

• Blood tests to check for infection or hormone levels

• Stool or urine tests if bladder or bowel symptoms are present

Endometriosis Treatment Options

There is no permanent cure for endometriosis, but many endometriosis treatments can reduce pain, control the condition, and improve the chances of pregnancy. Here are the main treatment options:

Medical (Non-Surgical) Treatment for Endometriosis

For many women, endometriosis treatment without surgery is the first line of care. Below are the main non-surgical options for endometriosis:

1. Pain Relief – First Step

Doctors usually begin treatment with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or mefenamic acid.

• These medicines are effective in reducing pelvic pain, period cramps, and lower back pain caused by endometriosis.

• However, they do not stop the disease from progressing.

2. Hormonal Therapy for Endometriosis

Hormonal therapy helps reduce or stop menstruation. This lowers the chance of bleeding in endometriotic tissue and relieves symptoms like pain and inflammation.

a. Progestogens and Combined Oral Contraceptives (COCs)

• These are commonly used to reduce menstrual bleeding and slow the growth of endometrial tissue.

• They are safe for long-term use and available as pills, injections, or intrauterine devices (IUDs).

b. Dienogest – A Newer Targeted Option

• Dienogest is a type of progestin that directly targets progesterone receptors.

• It is highly effective in reducing pelvic pain and improving daily quality of life in women with endometriosis.

• Suitable for long-term therapy with fewer hormonal side effects.

c. Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists

• Drugs like leuprolide acetate (agonist) and elagolix (antagonist) reduce oestrogen levels by affecting the brain’s hormone signals.

• This medical option helps shrink endometrial growths and is useful for moderate to severe symptoms.

• Possible side effects include hot flashes, mood swings, and bone thinning if used for a long time.

d. Aromatase Inhibitors and Other Advanced Therapies

• Aromatase inhibitors block oestrogen production in the body and are often used with other hormone therapies.

• Other emerging options include selective progesterone receptor modulators and targeted oral medication.

• These are usually reserved for resistant or recurrent endometriosis.

3. Duration of Hormonal Treatment

• Most hormonal therapies for endometriosis are continued for 6 to 12 months.

• The length of treatment depends on the severity of symptoms, the response to medication, and individual risk factors.

In some cases, hormone therapy may be used long-term to prevent recurrence.

Surgical Treatment by Expert Gynecologists

When medicines do not work well for the treatment of endometriosis causes, surgery may be the best choice. 

There are different types of surgeries for endometriosis. The type of surgery depends on how bad the condition is and whether the woman wants to have children in the future.

Laparoscopic Excision

Instruments and a camera are used through small cuts to remove endometriotic lesions and adhesions. This helps reduce pain and scar tissue, and may improve fertility.

Ovarian Endometrioma Surgery

Also called “chocolate cyst” surgery, this often involves cystectomy (removing the cyst) while trying to preserve ovarian tissue. Recurrence occurs in about 5–20% of cases.

Hysterectomy 

In women who do not wish to conceive or have severe deep disease, removing the uterus with or without ovaries may be considered, but only after expert counselling.

Fertility Treatments

Endometriosis related infertility can be treated with options like laparoscopic surgery, ovulation induction with IUI, and IVF. In severe cases, IVF offers the best chance, while egg freezing is advised for fertility preservation. Hormonal therapy before IVF may improve success. Consulting a fertility specialist ensures personalized care based on age, disease severity, and ovarian reserve.

Risks and Benefits of Endometriosis Treatments

Treating endometriosis is not the same for all. Here is a comparison of the major treatment options with their key benefits and associated risks:

Choosing the Right Treatment for Endometriosis

The best treatment for endometriosis is different for every woman. It depends on:

• Her age

• If she wants to get pregnant

• How bad the symptoms are

• How deep or severe the endometriosis is

Medical or Surgical?

Most experts (like ESHRE and NICE) say to start with medical treatment like painkillers or hormone therapy for mild cases.

If the pain is too strong or if the disease is deep, surgery may be needed.

Team Approach Helps More

Endometriosis is complex. That is why a full care team works best. This includes:

• Gynecologists

• Fertility specialists

• Pain doctors

• Nutrition experts

Together, they give the best care and help improve pain, fertility, and overall health.

How to Prepare for Endometriosis Surgery

Getting ready before surgery can help the patient feel calm and heal better. Here are some easy things to do:

1. Prepare a Thoughtful Hospital Bag with Essentials 

Make a small bag with items the patient will need during and after the hospital stay:

• Sanitary pads (for light bleeding)

• Heating pad or cold pack (to ease pain)

• Soft snacks and healthy drinks (like juice or coconut water)

• Loose and comfy clothes (easy to wear after surgery)

• Soft cotton undergarments (not too tight)

• Clean bedsheets and blankets at home

• A small soft pillow (for the back while sitting or lying)

2. Arrange for Someone to Take the Patient Home

Even if the surgery is done in a day (outpatient), the patient will not be allowed to drive. Ask someone kind and helpful to:

• Take home after surgery

• Stay for a day or two.

• Help with small tasks like cooking or cleaning.

3. Eat Light Before Surgery

The doctor will tell the patient what to eat the day before. Usually, it is best to eat:

• Plain food (not oily or spicy)

• Light meals like soup, rice, and toast

Drink water, but follow the doctor’s advice about fasting.

Recovery and Results

Endometriosis treatment often reduces pain and improves daily life. Some women also have better chances of pregnancy. Recovery and results vary by treatment type and severity of the condition.

Effectiveness and Outcomes

• Medical endometriosis treatment reduces pain and improves life quality in 60% to 80% of women, depending on the method used.

• Laparoscopic surgery gives excellent results: many women report lasting pain relief and improved fertility.

How Long Does Recovery Take?

Recovery after endometriosis treatment depends on the type of care:

• For medical (non-surgical) treatment: Relief can begin in a few weeks, but the full effect may take 3–6 months. Side effects like mood changes, bone thinning, or irregular periods may occur during treatment.

• For laparoscopic surgery: Most women can go home the same day or the next day. Full recovery usually takes 1 to 2 weeks, depending on the surgery’s extent.  

Things to Keep in Mind & Risks of Endometriosis Treatment

Even though endometriosis treatment works well, there are some risks and challenges:

• Ovarian reserve (egg supply) may decrease if healthy ovarian tissue is accidentally removed or if blood flow to the ovary is disrupted during surgery. To avoid this risk, it is important to choose expert surgeons who can perform the procedure with precision and care, ensuring maximum safety and preserving fertility. (en.wikipedia.org).

• Recurrence of endometriosis can happen in 20% to 40% of cases, even after successful treatment.

• Standard surgical risks include:
  • Bleeding

  • Infection

  • Damage to nearby organs

• Reactions to anesthesia
  

After Endometriosis Surgery: Aftercare Tips

Once the patient is home after surgery, the body will need time to rest and heal. Here are a few easy steps to take care of:

1. Take Enough Rest

• Rest as much as possible for the first few days.

• Avoid climbing stairs, lifting heavy things, or doing hard work.

• Try to sleep well and keep the body relaxed.

2. Eat Healthy and Drink Water

• Eat soft, healthy meals like fruits, soup, boiled rice, and vegetables.

• Drink plenty of water or healthy drinks like coconut water or juice.

• Avoid junk food, oily food, and carbonated drinks.

3. Manage Pain and Discomfort

• Use the pain medicine prescribed by the doctor.

• A heating pad on the belly can help with cramps.

• Wear loose clothes that don’t press on the stomach.

4. Keep the Surgery Area Clean

• Follow the doctor’s instructions on how to clean the stitches or wounds.

• Don’t touch or scratch the area too much.

• Call the doctor if redness, swelling, or pus is observed.

5. Move Slowly

• Walk gently around the house to avoid stiffness.

• Don’t rush to go back to work or daily chores.

6. Continue Ongoing Communication with the Doctor

• The patient should attend their check-up as advised by the doctor.

Inform the doctor in case of heavy bleeding, fever, or too much pain.

Cost of Endometriosis Treatment

The cost of treatment for endometriosis can be different for every woman. It depends on many things, like:

• The type of treatment (medicines or surgery)

• The hospital or clinic

• City or location

• The doctor’s experience

Estimated Cost of Endometriosis Treatment in India