Endometriosis affects 1 in 10 women, yet it takes an average of 7-10 years to diagnose. Dr. Sanjana L at Health Nest (HSR Layout) and Raghava Hospital (Attibele) explains the symptoms, stages, and treatment options.
What Is Endometriosis?
Endometriosis is a long-term condition. Tissue like the womb lining grows outside the womb — for example on ovaries, tubes, bowel, bladder, or other pelvic sites.
Each cycle this tissue thickens and bleeds, like a period, but the blood cannot leave the body easily. That leads to inflammation, scars (adhesions), pain, and often fertility challenges.
About 10% of women of reproductive age are affected worldwide (roughly 190 million). Many wait 7–10 years from first symptoms to diagnosis.
Dr. Sanjana L at Health Nest (HSR Layout) and Raghava Hospital (Attibele) diagnoses and treats endometriosis, including advanced laparoscopic surgery when needed.
What Causes Endometriosis?
The exact cause of endometriosis is not fully understood, but several theories exist:
- Retrograde menstruation: Menstrual blood flows backward through the fallopian tubes into the pelvic cavity instead of out of the body. This is the most widely accepted theory.
- Immune system dysfunction: The immune system may fail to recognise and destroy endometrial tissue growing outside the uterus
- Genetic factors: Endometriosis runs in families — you are 6-7 times more likely to develop it if your mother or sister has it
- Hormonal factors: Oestrogen promotes endometrial tissue growth; conditions with high oestrogen exposure increase risk
- Embryonic cell transformation: Hormones may transform embryonic cells in the pelvis into endometrial-like tissue
Symptoms of Endometriosis
Endometriosis symptoms vary widely — some women have severe symptoms with minimal disease, while others have extensive endometriosis with few symptoms. Common signs include:
Primary Symptoms
- Severe period pain (dysmenorrhoea): Pain that is significantly worse than normal menstrual cramps, often starting before the period and lasting several days. The pain may progressively worsen with each cycle.
- Chronic pelvic pain: Persistent pain in the lower abdomen or pelvis that occurs throughout the month, not just during menstruation
- Pain during or after intercourse (dyspareunia): Deep pain during sexual intercourse is a hallmark symptom, especially with deep infiltrating endometriosis
- Pain during bowel movements or urination: Especially during menstruation, suggesting endometriosis involving the bowel or bladder
- Heavy or irregular periods: Menorrhagia or bleeding between periods
Other Symptoms
- Difficulty getting pregnant (infertility) — endometriosis is found in 30-50% of women with infertility
- Fatigue and low energy
- Bloating and digestive issues (sometimes called "endo belly")
- Lower back pain, especially during periods
- Nausea during menstruation
Stages of Endometriosis
Endometriosis is classified into four stages by the American Society for Reproductive Medicine (ASRM):
| Stage | Classification | Description |
|---|---|---|
| Stage I | Minimal | Small, isolated implants with no significant adhesions |
| Stage II | Mild | More implants, deeper involvement, minimal adhesions |
| Stage III | Moderate | Many deep implants, endometriomas (chocolate cysts) on ovaries, some adhesions |
| Stage IV | Severe | Extensive deep implants, large endometriomas, dense adhesions distorting pelvic anatomy |
Important note: The stage does not always correlate with pain severity. A woman with Stage I endometriosis can have debilitating pain, while Stage IV may cause relatively mild symptoms.
How Is Endometriosis Diagnosed?
Clinical Assessment
Dr. Sanjana begins with a detailed history focusing on pain patterns, menstrual history, and fertility concerns, followed by a pelvic examination.
Imaging
- Transvaginal ultrasound: Can detect endometriomas (chocolate cysts) on the ovaries. A specialised ultrasound may also identify deep infiltrating endometriosis.
- MRI pelvis: Useful for mapping the extent of deep endometriosis before surgery, especially when bowel or bladder involvement is suspected.
Definitive Diagnosis
- Laparoscopy: The gold standard for diagnosing endometriosis. A small camera is inserted through tiny incisions in the abdomen, allowing direct visualisation and, if needed, simultaneous treatment (excision or ablation) of endometriotic lesions. At Health Nest, Dr. Sanjana performs diagnostic and therapeutic laparoscopy for endometriosis.
Treatment Options for Endometriosis
Treatment is tailored to each patient's symptoms, severity, age, and fertility goals.
Pain Management
- NSAIDs (non-steroidal anti-inflammatory drugs) for period pain
- Hormonal therapy to suppress oestrogen and slow endometrial growth
Hormonal Treatments
- Combined oral contraceptive pills (taken continuously to suppress periods)
- Progestins (oral, injectable, or intrauterine — such as the Mirena IUS)
- GnRH agonists (to temporarily induce a menopausal-like state and shrink endometriosis)
- Dienogest — a progestin specifically approved for endometriosis management
Surgical Treatment
- Laparoscopic excision surgery: The preferred surgical approach — endometriotic implants are carefully cut out (excised) rather than burned (ablated), which is more effective and has lower recurrence rates
- Ovarian cystectomy: Removal of endometriomas (chocolate cysts) while preserving healthy ovarian tissue
- Adhesiolysis: Releasing scar tissue (adhesions) to restore normal pelvic anatomy
- Hysterectomy: Reserved for severe cases in women who have completed their families and have not responded to other treatments
Fertility Treatment
For women with endometriosis-related infertility, options include ovulation induction, IUI, or IVF. Dr. Sanjana works closely with fertility specialists to provide integrated care.
Endometriosis vs Adenomyosis — What Is the Difference?
Adenomyosis is a related condition where endometrial tissue grows into the muscular wall of the uterus (rather than outside it). Symptoms are similar — heavy periods, severe pain — but adenomyosis typically causes an enlarged, tender uterus on examination. The two conditions can coexist, and Dr. Sanjana evaluates for both during assessment.
Frequently Asked Questions
Can endometriosis be cured?
There is currently no cure for endometriosis, but it can be effectively managed with a combination of medical treatment, surgery, and lifestyle modifications. Symptoms typically improve after menopause when oestrogen levels drop.
Does endometriosis cause cancer?
Endometriosis is not cancer, but studies have shown a slightly increased risk of certain ovarian cancers in women with endometriosis. Regular follow-up and monitoring are important.
Can I get pregnant with endometriosis?
Yes. Many women with endometriosis conceive naturally or with assisted reproduction. The key is timely diagnosis and appropriate treatment. Dr. Sanjana develops a fertility plan tailored to your specific situation.
How long is recovery after laparoscopic surgery for endometriosis?
Most women return to normal activities within 1-2 weeks after laparoscopic surgery. Recovery is much faster than open surgery, which is one of the advantages of the minimally invasive approach Dr. Sanjana uses.
Expert Endometriosis Care at Health Nest, HSR Layout
If you suspect you have endometriosis — or if you have been living with pelvic pain, painful periods, or difficulty conceiving — do not wait years for a diagnosis. Dr. Sanjana L at Health Nest provides thorough evaluation, advanced laparoscopic surgery, and compassionate long-term management.
Health Nest is located in HSR Layout (near Agara Lake), Bangalore, with easy access from Koramangala and BTM Layout. Dr. Sanjana also consults at Raghava Hospital, Attibele, serving Sarjapura, Electronic City, Chandapura, and surrounding areas.
Book your consultation today.
Dr. Sanjana L
MBBS MS ( OBG) Gold Medalist FRM ( RGUHS) FMAS
Gynaecologist & Obstetrician at Health Nest, HSR Layout & Raghava Hospital, Attibele, Bangalore
Dr. Sanjana L has over 10 years of experience in obstetrics and gynaecology. She is known for her compassionate, patient-centred approach and consults in English, Hindi, Kannada, and Telugu. She serves patients from HSR Layout, Attibele, Sarjapura, Electronic City, Koramangala, BTM Layout, Chandapura, and Hosur.