The Hindu : Tamil Nadu / Chennai News : Rising incidence of endometriosis an “enigma”

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Monday, Apr 06, 2009
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Tamil Nadu

Tamil Nadu - Chennai

Rising incidence of endometriosis an “enigma”

Staff Reporter

CHENNAI: Doctors call the increase in the incidence of endometriosis an “enigma,” because its exact cause continues to be unknown, but they attribute its rise to the trend of women marrying and conceiving at a later age.

Endometriosis, the presence of endometrial (uterine) tissue or cells outside the uterus, is a problem that affects 10 per cent of the reproductive population. Delivering the Prof. Dr. R. Nanjunda Rao Endowment lecture at the Tamil Nadu Dr. MGR Medical University here recently, V. Madhini, former Director and Superintendent of the Institute of Obstetrics and Gynaecology, Chennai, said that over the years the occurrence of this condition has probably escalated, because couples now get married at an older age, and are thus older at the time their first child is conceived, compared to earlier generations.

“Women with a family history of endometriosis are six to seven times more likely to get it, and it might be avoidable if they get married around the age of 21 or 22,” she said.

That is why endometriosis is more prevalent in the urban, upper class populations, she said. Women in the rural areas, who may not pursue higher education, tend to get married at an earlier age and have children sooner. Avoiding alcohol and caffeine, regularly exercising, and even opting for the oral contraceptive pill in some cases, may also help decrease the likelihood of being affected.

Although 25-30 per cent of patients are asymptomatic, Dr. Madhini said that symptoms for the other 70 per cent include pelvic pains, infertility, and irregular menstrual cycle. Once diagnosed via ultrasound, MRI or laparoscopy (minimally invasive surgery using telescopic lens and video camera), patients have quite a few treatments to choose from, depending on the severity and location of the endometrial abnormalitiesHowever, Dr. Madhini added that, as a rule, women should expect some continued pain and the chance of recurrence if they opt for these conservative treatments. Only hysterectomy, the surgical removal of the uterus, fallopian tubes and ovaries, can completely thwart the risk of recurrence, but she said that this “radical” procedure is not as common because the removal of the ovaries eliminates the chances for reproduction and the ovaries’ other hormonal functions. In such cases, she advises that patients be put on a low-dose hormone replacement.

“Endometriosis is a progressive and debilitating disease,” Dr. Madhini said, adding that “although the treatment range is wide, there is no optimum approach.”

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