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Frequently asked questions about endometrioma?

Prof. Dr. R. K. Mishra

What are endometriosis?

During monthly menstruation, the feminine body sheds the endometrium - uterine lining - in the process commonly known as a "menstrual period". In females and females who've endometriosis, a few of these menstrual fluids are retained in the body and abnormally implant in areas outside of the uterus where it should not be present. These abnormal implants, or nodules, eventually accumulate on the bladder, bowel, ovaries, cul de sac, along with other nearby organs, resulting in the introduction of adhesions, scarring and invasive nodules. This can cause symptoms that change from painful periods, chronic pelvic pain, infertility, pain associated with intercourse and intercourse to painful bowel movements, rectal pain and urinary pain or difficulty.

A typical myth among general public about endometriosis is that the more endometrial cells accumulated in body outside of the uterine cavity, the more pain it causes for the woman. Anywhere of endometriosis may cause pain, and also the disease does not need to be advanced to result in significant symptoms. Likewise, higher stage 3 and 4 disease sometime could cause little to no symptoms in some women. However, situations vary; moderate growth can trigger intense pain in some women while advanced growth causes less severe pain in other people. Every woman's situation is exclusive and therefore expert medical evaluation is absolutely essential.

What are the symptoms of endometriosis?

Endometriosis is much more than simply called killer cramps. It can cause in many woman symptoms varying from painful periods called dysmenorrhea, to pain with sexual activity known as dyspareunia, to gastrointestinal and urinary tract difficulties in certail group of female respectively referred to as dyschezia and dysuria.

Infertility can also be prevalent in female with endometriosis, affecting more than half of women who've the disease. Some characteristic signs and symptoms of endometriosis include:

  1. Chronic or intermittent pelvic pain
  2. Painful menstruation
  3. Irregular vaginal or uterine bleeding and rregular vaginal clotting
  4. Large, painful ovarian cysts called endometriomas or "chocolate cysts"
  5. Sometime infertility, miscarriage, ectopic (tubal) pregnancy
  6. Pain associated with intercourse
  7. Nausea/vomiting, gastrointestinal cramping, diarrhea/constipation, particularly with periods
  8. Rectal pain if it has involved the rectum or colon
  9. Blood within the urine; urinary frequency, retention, or urgency
  10. Fatigue, chronic pain, allergies and other immune-related issues will also be commonly reported complaints in individuals with endometriosis

What is endometrioma?

Endometrioma is also callled as chocolate cyst of ovary. An endometrioma, endometrioid cyst, endometrial cyst, or chocolate cyst is caused by endometriosis, and formed when a tiny patch of endometrial tissue the mucous membrane that makes up the inner layer of the uterine wall which bleeds and sloughs off during menses, becomes transplanted, and grows and enlarges inside the ovaries. It forms an ovarian cyst filled with chocolate like material.

How endometrioma present inside abdomen?

Endometriomas usually present like a pelvic mass as a result of growth of ectopic endometrial tissue within the ovary. They typically contain thick brown tar-like fluid and so the popular name is "chocolate cyst" and are often densely adherent to the surrounding structures, like the peritoneum, fallopian tubes, and sometime with bowel.

An endometrioma might be associated with symptoms of endometriosis eg, pelvic pain, dysmenorrhea, and dyspareunia. It is also identified at the time of evaluation for a pelvic mass or infertility during laparoscopic surgery. A lady with a ruptured endometrioma may initially present with peritoneal signs or symptoms, elevated white blood cell count, and low grade fever, similar to patients with acute pelvic inflammatory disease or appendicitis.

How is endometrioma diagnosed?

Histopathology is generally required to create a definitive proper diagnosis of endometrioma. However, a clinical diagnosis can often be made by good gynecologists with a higher amount of certainty in a woman with histologically confirmed endometriosis as well as an adnexal mass, since 50 % of women with endometriosis develop endometriomas, which are generally bilateral. Ultrasound is wonderful for supporting the clinical diagnosis of endometrioma in some patient, but of limited value for diagnosis or determining extent of endometriosis at other sites since it lacks adequate resolution for visualizing adhesions and superficial peritoneal/ovarian implants. However, in many females when there are sonographic signs suggestive of endometriomas, chances are that moderate to severe endometriosis exists. If pain is the presenting problem, extensive laparoscopic surgery are usually necesary for relief of pain.

What is the treatment of Endometrioma?

The therapy for Endometriosis is an intensely debated subject both in the medical profession and among women who suffer this disease. One of the key problems is the fact that no-one really knows what can cause Endometriosis. So looking for a successful remedy for this particular disease is much like attempting to fix something although the cause is simply not known. This can lead to treatment options which are not relevant or safe and carry the risk of serious side-effects. Until a concise answer is found to the reason for Endometriosis, then the treatment being offered is unfortunately no more than a stab in the dark.

Surgical treatment for endometriosis is usually carried out in one of the following situations:

  1. At time of diagnostic laparoscopy for mild to moderate endometriosis
  2. If medical treatment hasn't worked
  3. If subfertility is a concern
  4. If there is moderate to severe endometriosis
  5. When endometriosis recurs

Generally Laparoscopic surgery is done and it may either be conservative or radical. The aim of conservative laparoscopicsurgical treatment is to come back the appearance of the pelvis to normally as possible. This means destroying any endometriotic deposits, removing ovarian cysts, dividing adhesions and removing as little healthy tissue as much as possibly safely gynecologists can.

Radical surgery means doing a hysterectomy with elimination of both ovaries and it is reserved for women with severely symptoms, who have not responded to treatment or conservative operations. Sometimes, if there are other reasons to carry out a hysterectomy it is done sooner than this.

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Prof. Dr. R. K. Mishra.

Minimal Access Surgeon

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