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Early Diagnosis Key to Manage Endometriosis: Dr Mangeshikar

 DTMT NETWORK

There is a sharp rise in endometriosis (a multi-system disorder) cases as many women complain of painful menstruation, cramping, painful sex, constipation, loose motions, bloating, back pain, leg pain, pain while urinating, pain while passing stools, and rectal bleeding.

There are many women who are asymptomatic too. Doctors stressed that the timely diagnosis, appropriate treatment and considerable knowledge about the disease will help women to improve their quality of life.

Miss Heena Shetty (name changed), 20, from Mangalore suffered from severe pain during menstruation and ovulation causing debilitation and loss of quality of life.

Shetty, who is also a MBSS student, reported excruciating pain for at least 10 days out of a month which compromised her ability to perform in a course as demanding as MBBS.

She visited many gynecologists in her home state who were giving her over-the-counter pain medication or telling her to get married and not taking her pain seriously.

She visited Dr Abhishek Mangeshikar, Consultant Laparoscopic and Robotic Gynaecologist, ACI Cumball Hill Hospital, Mumbai. After evaluating her reports it was revealed that there was an endometriosis cyst (chocolate cyst) in the ovary which was attached to her rectum and pelvic sidewall.

The doctor recommended her for a laparoscopic excision of the endometriosis where the disease is cut out or excised which has much better results than the traditional technique of burning the disease.

A laparoscopy gives the patient the benefit of undergoing major surgery through very tiny abdominal incisions which makes recovery very fast. She was discharged from the hospital in 24 hours.

Dr Mangeshikar emphasized that endometriosis affects girls and women of reproductive age and is attached to any organ associated with reproduction. It can be described as an abnormal growth of tissues resembling the uterine lining outside the uterus. The cause of endometriosis is unknown although there are many theories, he added.

The common symptoms of endometriosis include intense pelvic pain, infertility, long menstrual cycles, nausea, or vomiting. The main reason why women should be aware of endometriosis is that the disease is quite common and not rare.

“It affects more women than breast cancer. Many have not heard of it and the disease has not got the attention it deserves typically because it is not terminal. Many women may complain of excessive pain during periods, it is mistaken to be normal and they are asked to be stronger due to the lack of awareness,” explained Dr. Mangeshikar.

He added, “Stage I of endometriosis is minimal wherein the patient may have small adhesions and small amounts of endometriosis tissue on an ovary. It may also include inflammation in or around the pelvic area. Stage II is mild and there are more adhesions on or around the ovaries.”

These adhesions are defined to be “too insignificant” at this stage and are usually too small to be picked up on ultrasound unless the doctor pays attention to probe tenderness in the region while examining the ovary.

“Stage III is moderate where adhesions will be blatantly obvious and usually, there may be cysts on the ovaries. There may be growths in other areas of the pelvis blurring into the territory of stage IV endometriosis,” said Dr Mangeshikar.

“Stage IV is the final stage associated with a large number of cysts and severe adhesions. Most of the cysts will appear on the ovaries while the adhesions will appear over the pelvic lining and may affect the fallopian tubes and bowels. This can make bowel movements terribly uncomfortable and period pain the absolute worst,” explained the gynecologist.

There are many women who are asymptomatic too. Doctors stressed that the timely diagnosis, appropriate treatment and considerable knowledge about the disease will help women to improve their quality of life.

Miss Heena Shetty (name changed), 20, from Mangalore suffered from severe pain during menstruation and ovulation causing debilitation and loss of quality of life.

Shetty, who is also a MBSS student, reported excruciating pain for at least 10 days out of a month which compromised her ability to perform in a course as demanding as MBBS.

She visited many gynecologists in her home state who were giving her over-the-counter pain medication or telling her to get married and not taking her pain seriously.

She visited Dr Abhishek Mangeshikar, Consultant Laparoscopic and Robotic Gynaecologist, ACI Cumball Hill Hospital, Mumbai. After evaluating her reports it was revealed that there was an endometriosis cyst (chocolate cyst) in the ovary which was attached to her rectum and pelvic sidewall.

The doctor recommended her for a laparoscopic excision of the endometriosis where the disease is cut out or excised which has much better results than the traditional technique of burning the disease.

A laparoscopy gives the patient the benefit of undergoing major surgery through very tiny abdominal incisions which makes recovery very fast. She was discharged from the hospital in 24 hours.

Dr Mangeshikar emphasized that endometriosis affects girls and women of reproductive age and is attached to any organ associated with reproduction. It can be described as an abnormal growth of tissues resembling the uterine lining outside the uterus. The cause of endometriosis is unknown although there are many theories, he added.

The common symptoms of endometriosis include intense pelvic pain, infertility, long menstrual cycles, nausea, or vomiting. The main reason why women should be aware of endometriosis is that the disease is quite common and not rare.

“It affects more women than breast cancer. Many have not heard of it and the disease has not got the attention it deserves typically because it is not terminal. Many women may complain of excessive pain during periods, it is mistaken to be normal and they are asked to be stronger due to the lack of awareness,” explained Dr. Mangeshikar.

He added, “Stage I of endometriosis is minimal wherein the patient may have small adhesions and small amounts of endometriosis tissue on an ovary. It may also include inflammation in or around the pelvic area. Stage II is mild and there are more adhesions on or around the ovaries.”

These adhesions are defined to be “too insignificant” at this stage and are usually too small to be picked up on ultrasound unless the doctor pays attention to probe tenderness in the region while examining the ovary.

“Stage III is moderate where adhesions will be blatantly obvious and usually, there may be cysts on the ovaries. There may be growths in other areas of the pelvis blurring into the territory of stage IV endometriosis,” said Dr Mangeshikar.

“Stage IV is the final stage associated with a large number of cysts and severe adhesions. Most of the cysts will appear on the ovaries while the adhesions will appear over the pelvic lining and may affect the fallopian tubes and bowels. This can make bowel movements terribly uncomfortable and period pain the absolute worst,” explained the gynecologist.


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