Understanding Endometriosis
Endometriosis is a chronic condition in which tissue similar to the uterine lining (endometrium) grows outside the uterus — on the ovaries, fallopian tubes, the lining of the pelvis, and, in some cases, other organs. This tissue responds to the menstrual cycle just as the normal endometrium does: it thickens, breaks down, and bleeds. Unlike menstrual blood, however, it has no way to leave the body, resulting in inflammation, scar tissue (adhesions), and often severe pain.
Endometriosis affects approximately 1 in 10 women of reproductive age. Despite being so common, it is frequently under-diagnosed or misattributed to "normal" period pain. Dr. Unnati Mamtora specialises in both the medical and surgical management of endometriosis, with a particular focus on preserving fertility and improving quality of life.
Symptoms of Endometriosis
- Painful, heavy periods (dysmenorrhoea)
- Chronic pelvic pain between periods
- Pain during or after intercourse (dyspareunia)
- Pain with bowel movements or urination during menstruation
- Bloating and abdominal discomfort
- Difficulty conceiving (infertility)
- Fatigue, especially around menstruation
- Spotting or bleeding between periods
Note: The severity of symptoms does not always correlate with the extent of disease. Some women with extensive endometriosis have mild symptoms; others with minimal disease experience significant pain.
How Endometriosis Affects Fertility
Endometriosis is one of the leading causes of infertility. It can impair fertility through several mechanisms:
- Distortion or blockage of the fallopian tubes by adhesions
- Formation of ovarian endometriomas (chocolate cysts) that reduce ovarian reserve
- Altered pelvic environment affecting egg quality and implantation
- Inflammation that can impair fertilisation and early embryo development
Women with endometriosis are not automatically infertile — many conceive naturally. However, those who have been trying for 6–12 months without success should be evaluated promptly, as early intervention significantly improves outcomes.
Treatment Options
Medical Management
Hormonal therapies (GnRH agonists, progestins, combined oral contraceptives) suppress endometriosis growth, reduce inflammation, and relieve pain. Best suited for women not immediately trying to conceive.
Laparoscopic Surgery
Minimally invasive keyhole surgery to excise or ablate endometriotic lesions, remove adhesions, and drain endometriomas. Often the most effective treatment for moderate-to-severe disease and fertility-related surgery.
Fertility Treatments
For women trying to conceive, treatment is tailored to stage and ovarian reserve — ranging from ovulation induction and IUI for mild disease to IVF/ICSI for more severe cases or reduced ovarian reserve following cyst surgery.
Long-Term Management
Endometriosis is a chronic condition. After treatment, a suppressive strategy is often continued to prevent recurrence, protect ovarian reserve, and maintain quality of life. Dr. Unnati develops individualised long-term plans for each patient.