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Adolescent endometriosis causes girls to live in chronic pain and miss classes; There is potential for better health outcomes with comprehensive treatment.
Early diagnosis and the right treatment can change lives.
Endometriosis is a chronic condition affecting around 247 million women worldwide and 42 million women in India. It is caused when tissue resembling the lining of the uterus grows outside it, resulting in unbearable pain, infertility, and various complications.
Adolescent endometriosis is a rising concern both globally and in India, where most of the sufferers present with severe dysmenorrhoea and school absenteeism. Pain is one of the greatest tell-tale signs of endometriosis, and yet, it is often the most discounted symptom. Many young girls are told that their pain is simply a part of being female or a result of “normal” menstrual cycles. However, for those with endometriosis, this pain is far more severe and can have a significant impact on their daily lives, affecting their work, relationships, and mental health.
However, with comprehensive treatment using the right techniques, those suffering from endometriosis can be given a new lease of life.
One of the most misunderstood, misdiagnosed and under-diagnosed conditions.
Endometriosis is a common gynaecological condition affecting one out of every seven women. It is arguably more common than diabetes! Yet, it is also one of the most under-diagnosed and misunderstood maladies, especially in India. The diagnosis is often delayed in adolescent girls for a period of more than 6-8 years, leading to years of suffering.
Many practitioners empirically treat for pelvic inflammatory disease, which is actually quite rare, rather than considering endometriosis as a potential diagnosis, especially in cases lacking imaging evidence of cysts or similar indicators. This misdiagnosis remains a significant challenge not only in India but globally, leading to delays in proper treatment and worsening outcomes for patients with this complex disease.
Patients, especially those with bowel symptoms, are often misdiagnosed with IBS and given ineffective medication that only suppresses hormones without addressing the root cause. Women are told that pregnancy can help relieve symptoms, which is misleading and does nothing to “cure” the condition. Many others are given medication and pushed into unnecessary IVF treatments, and later on advised uterus removal. Long-term therapies like hormonal suppression are also prescribed, but these can cause bone loss, menopausal symptoms, and other issues, especially in young women.
When it comes to diagnostics, most ultrasounds and MRIs focus on the uterus and ovaries, missing crucial details like the rectum or organs stuck together, which are key to identifying endometriosis. As a result, imaging for endometriosis has become a subspeciality, with only a few centres and radiologists able to accurately diagnose it.
When general gynaecologists perform surgery for endometriosis but only remove the cysts while leaving the deeper nodules behind, recurrence rates can be misleadingly high, often cited at 50-80%. For example, focusing only on the cyst can be a mistake, especially when it has been blocking the ureter and causing kidney failure. In this case, saving the kidneys can be difficult. With timely intervention, the disease could have been treated properly and the organ could also have been saved.
Comprehensive treatment can offer permanent relief
In patients with deep-infiltrative endometriosis, tissue grows under or on the surface of the abdominal lining, often infiltrating nearby organs like the rectum, bladder, or ureters. Thus, there are high chances of recurrence due to incomplete removal of lesions, as these can be small, hidden, or mimic normal tissue, making them hard to identify and excise completely.
But these recurrence rates can drop to as low as 2-3% when the endometrial nodules are removed completely using the right methods of surgical excision, which remains the only approach capable of offering long-term relief, especially for women seeking to conserve fertility and/or preserve organs.
Robotic-assisted surgery is one of the ways this can be achieved. It focuses on the precise and complete removal of endometrial nodules, scar tissue, and adhesions. The process also involves minimal pain, blood loss, and has a shorter recovery period, which means that women can bounce back to a better life soon after surgery.
For example, in cases of bowel endometriosis with nodules infiltrating the rectum, robotic surgery offers a distinct advantage over conventional laparoscopy due to its superior visualisation and highly articulated instruments. The enhanced precision allows for a more radical removal of diseased tissue while conserving the affected organ, which is crucial in complex areas like the pelvis. Unlike straight laparoscopic instruments, robotic arms can bend and curve, enabling surgeons to operate with greater accuracy around vital structures like nerves. This ability to manoeuvre delicately reduces the need for excessive retraction and minimises the risk of damage to critical anatomy, making robotic surgery significantly more effective in such intricate procedures.
(With inputs by Dr. Abhishek Mangeshikar, Director at The Indian Centre for Endometriosis (ICE), Mumbai)
