Endometriosis is not just a reproductive disease; it affects every aspect of a woman’s life.
Beyond physical suffering, endometriosis significantly impacts personal and professional lives. Many women experience painful intercourse, leading to marital issues, while the chronic pain and fatigue contribute to anxiety and depression.
Endometriosis, a debilitating condition affecting one in 10 women worldwide, continues to be widely misunderstood and often dismissed disease. Despite impacting over 4.2 crore women in India alone, awareness remains alarmingly low, leading to delayed diagnoses and prolonged suffering.
Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus. It affects the ovaries, rectum, and ureters. It also impacts the bowels, bladder, and even the lungs and diaphragm in severe cases. The disease can be silent. Nearly 40 per cent of patients show no symptoms. They are only diagnosed through routine imaging.
Symptoms
Painful periods and chronic pelvic pain are among the most common symptoms. Other symptoms include infertility, painful bowel movements, and painful urination. Recurrent urinary tract infections (UTIs), nausea, and vomiting are also common. Severe fatigue can occur as well. Unfortunately, menstrual pain is often dismissed as normal, with many women advised that marriage or childbirth will resolve their discomfort. If period pain interferes with one’s daily life, it is not normal. It requires medical attention if it does not subside with over-the-counter medication.
Diagnosis
Early diagnosis is crucial in preventing organ damage, but many patients struggle for years before receiving proper medical attention. Diagnosis begins with symptom evaluation, followed by a pelvic examination and imaging techniques like transvaginal ultrasound or MRI. Still, imaging alone may not always detect the disease, especially if interpreted by non-specialists. Many women are declared healthy due to normal ultrasound or MRI reports, even when they have endometriosis. Proper training for doctors is essential.
Management
The treatment approach varies depending on the severity of symptoms. While some patients can manage with medication, others need surgery. Laparoscopic or robotic surgery is preferred over open surgery, as it allows for better visibility and precision.
When endometriosis infiltrates organs like the bladder or rectum, it is serious. A multidisciplinary team is essential. This team should involve gynaecologists, colorectal surgeons, and urologists. However, incomplete or poorly executed surgeries can lead to residual disease, which is often mistaken for recurrence.
Financially, treatment remains a major hurdle. Complex surgeries can be costly, particularly when multiple specialists are involved. Additionally, many insurance companies do not cover endometriosis-related surgeries, often classifying them as infertility treatments. Medical fraternity are fighting to ensure insurance companies recognise endometriosis as a serious condition requiring coverage.
Stronger government initiatives are necessary to bridge the knowledge gap and improve patient care. Schools can intervene by teaching teenagers about painful periods. This includes both boys and girls. Discussing abnormal symptoms promotes early awareness.
Ensuring that endometriosis surgeries are covered under health insurance policies is crucial. There should be no long waiting periods. This makes treatment accessible to women. Also, updating curricula in medical colleges to emphasise the latest diagnostic and treatment approaches for endometriosis is required at this level of prevalence.
Designate it as a separate super specialty in colleges. Students can opt for Endometrial Surgery in their post-graduate years.
Dr Naresh Purohit ( Advisor – National Reproductive And Child Health Programme (NRCH) The views and opinion expressed in this article are those of the author)