The growth that affects motherhood

Dr Neena Bahl

Endometriosis, a deviant growth of tissues outside the uterus, primarily expected to line the inside walls of the organ, creates a barrier in getting pregnant. Estimated 25 million Indian women suffer from endometriosis. A large number of women with this condition have struggled to get pregnant.

Understanding the process

Endometrium is the inner epithelial layer in the ovary. Endometriosis is a disorder where endometrium, primarily lining the inner walls of uterus, starts growing outside the uterus wall. Often this deviant development takes place on the ovaries, fallopian tubes, and tissues around the uterus and ovaries. In rare circumstances the growth can take place in some other part of the body.

Causes 

The causes behind this painful condition are not known, as reasons vary from person to person. However, certain factors increase the risks of the disorder. 

Hereditary: Women who have a family history with relative having the condition are up to seven to 10 times more likely to develop endometriosis. Also, identical twins are prone to share the disease. 

Retrograde menstruation: During menstruation the blood flows out of the body through gentile but retrograde menstruation or backward bleeding that takes back the blood containing endometrial cells through fallopian tube to pelvic cavity.

Metaplasia: Under this condition, pelvic tissues are converted into endometriosis. 

Other than these, the occurrence of menarche before the age of 11, prolonged menstrual period of heavy bleeding (more than five days), a cycle of less than 27 days or even shorter, first pregnancy in late age, low-body weight and alcoholism are some of the other factors behind endometriosis.

Don’t ignore these symptoms 

Pain: It is a warning sign of this condition. The severity of pain does not define danger; however, the location of the endometrial tissues does. The condition is characterised by severe, debilitating pain, usually in the abdomen, lower back or pelvic areas. During the menstrual period, pain usually occurs on day one or day two, but in endometriosis, the pain can persist up to three, four days and gets worse. A woman can feel pain before and during periods, pain during or after sex, abdominal, back and/or pelvic pain; pain during urination or bowel movement, ovulation pain passing through thigh or leg.

Heavy bleeding and pattern: Another sign is the pattern of bleeding which includes heavy bleeding, with or without clots, irregular bleeding, with or without a regular cycle, bleeding longer than normal, and bleeding before due date.

Nausea, vomiting, bloating, problem in bowel movements, tiredness, mood swings and spasm or tightness of pelvic floor during intercourse too is a warning sign.

Infertility issues

A large number of women with the condition face difficulty in getting pregnant. Endometriosis tampers with the uterus. It does not necessarily make a woman infertile but clearly constitutes a hindrance in getting pregnant naturally. The excess adhesion caused by tissue growth can confine the egg and stop it from moving down the fallopian tube which in turn prevents a natural pregnancy.

The tissue development scars the fallopian tube, ovaries and affects the quality of the eggs. It also creates problems in the implant of the embryo in the uterus wall. The tube can also be damaged by the swelling and cause changes in organs in the pelvis such as adhesions with scarred pelvic tissue and blockage of the fallopian tubes. 

Endometriosis can be accompanied by a number of mood disorders in the woman Such as anxiety, stress, depression, etc. 

There is no cure but there are ways to manage the pain. Doctor can sometimes prescribe lifelong use of oral contraceptives for women not wanting to have children and short-term use for those who do. Besides medication, some healthy lifestyle choices can keep the pain under control. Affected women should opt for a low-sugar diet and strengthen pelvic muscles with regular exercise.

In severe cases, especially when endometriosis spreads to several organs, the doctor can advise a laparoscopy to remove the scarred tissue. The surgery can also provide young woman with time to conceive. In some cases while pregnancy may occur naturally, some women may need assisted reproductive techniques like in vitro fertilisation to be able to have a baby.

It is important to remember not all women with endometriosis are infertile. With a timely diagnosis and treatment, pregnancy can happen.

Untreated,it is a risk for premature birth, mostly before 40 weeks; bleeding after the 24 weeks of pregnancy; preeclampsia or high blood pressure and even miscarriage. Hence, timely treatment is must.

So, understanding the disease, identifying the symptoms and timely treatment can help women overcome this painful condition and improve chances of motherhood.

— The writer is director, Obstetrics & Gynaecology, Fortis Lafemme, New Delhi