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Endometriosis is a common condition affecting about 20% of young women. It is a disease where every month when the menstrual period comes, there is also bleeding inside the pelvis. Over a period of time, this causes thick dark chocolate coloured blood to accumulate in the ovaries called Chocolate Cyst or Endometriotic Cyst. This old blood can accumulate anywhere and can cause pelvic organs to get stuck up, distorted and damaged. Bleeding can even happen within the walls of the womb or uterus, and this is called adenomyosis.
Unfortunately, this is a progressive condition and will keep on increasing with time. The main complaints that the women have are that lower abdominal pain before and during the periods or sometimes continuous pelvic pain. There can also be heavy bleeding during menses. Some women come with the inability to become pregnant.
The diagnosis is made by clinical examination and good pelvic sonography; blood tests such as CA125 can be raised in this condition. Sometimes an MRI may be needed for diagnosis.
The treatment depends on the age of the woman, how severe are her symptoms and if she is planning a pregnancy or not. As long as the menstrual period continues to come, the disease will keep on increasing due to bleeding inside the pelvis, and so periods have to be stopped by some method in order to stop the progress of the disease.
In young girls, continuous hormone pills work very well. They stop the menses temporarily, thus giving pain relief as well as preventing the progression of the disease. In older women, injections can produce temporary menopause and give relief to the patient once a month.
If the patient does not desire pregnancy, an intra-uterine hormone device put inside the womb for five years can give good relief. If the woman wants to become pregnant, she can try for pregnancy with medicines for a few months. Often she requires laparoscopic surgery if the disease is severe. The endometriotic cysts can be removed through this keyhole surgery, and the pelvic organs can be cleaned up. After this, if the fallopian tubes are open, she can try for pregnancy naturally. However, if the tubes are damaged, treatments such as test tube baby or IVF may be necessary.
Once the woman has finished her family and if her endometriosis or adenomyosis is severe, the final treatment is the removal of the uterus and the ovaries. If complete removal is not done, the disease can recur. However, after menopause, once the periods stop, usually the disease starts to reduce.
The most important thing is for the woman suffering from painful periods to see a gynaecologist early, get a proper diagnosis, and start treatment soon to prevent the disease from progressing.
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