Endometriosis treatment in Chennai

Every month the lining of the uterus thickens and then bleeds away as a period. In endometriosis, patches of the same tissue sit outside the uterus. They respond to the same hormones, so they bleed too, but the blood has nowhere to go. The body reacts with inflammation, then scar tissue, which can bind the ovaries, tubes and bowel together. On the ovary, the trapped old blood forms a cyst filled with dark fluid, the chocolate cyst (endometrioma).

The pain has a pattern. It starts a day or two before the period and is worse than ordinary cramps, often with pain deep inside during intercourse, pain on passing motion during periods, and in later stages a dull pelvic ache through the month. Some women have severe disease with little pain, and find out only when they cannot conceive. Endometriosis is behind roughly a third of infertility in women.

Adenomyosis is a close relative: the same tissue growing into the muscle wall of the uterus itself, causing heavy, painful periods and a bulky, tender uterus. It is treated along similar lines and is often found together with endometriosis.

The history carries most of the diagnosis: when the pain comes, what it stops you doing, pain with intercourse or motion, your periods, and your plans for children. A pain diary kept over two cycles is worth bringing.

The examination, in the separate examination room with the lady attender present, looks for tenderness behind the uterus, a uterus that is fixed rather than mobile, and an enlarged ovary. A transvaginal ultrasound picks up chocolate cysts and adenomyosis reliably; it cannot see small patches on the pelvic lining, so a normal scan does not rule endometriosis out. An MRI is used before surgery for deep disease near the bowel, at a diagnostic centre.

The only way to be certain is to look, by laparoscopy, and that is no longer needed before starting treatment. If the history and examination fit, treatment starts on that basis, and laparoscopy is reserved for women whose pain does not settle, who have a cyst that needs removing, or who are trying to conceive. A blood test (CA-125) rises in endometriosis but also in many other conditions, so it is not used to diagnose it.

There is no treatment that removes endometriosis for good, but pain can be controlled and fertility protected in most women. Treatment is matched to two questions: how bad is the pain, and are you trying to conceive now, later, or not at all.

Pain relief done properly

Anti-inflammatory tablets (mefenamic acid, naproxen or ibuprofen) started a day before the period is due and taken on a schedule, not only when the pain peaks, control the pain of mild disease. Heat, regular exercise and enough sleep help; they are not a substitute for treatment.

Hormonal treatment

Endometriosis feeds on oestrogen and monthly bleeding, so stopping the cycle starves it. Combined pills taken continuously without the break, progesterone-only tablets such as dienogest, the hormonal IUD, or the three-monthly progesterone injection all reduce pain within two to three months and shrink small cysts. They can be continued for years and are the mainstay for women not trying to conceive. Hormone injections (GnRH analogues) that switch the ovaries off for a while are used for severe pain or before surgery, for a few months at a time, with add-back treatment to protect the bones.

Keyhole surgery

Laparoscopy is used to remove chocolate cysts, cut away or burn patches of endometriosis, free organs that are stuck together and check that the tubes are open, in one sitting. It relieves pain in most women and improves the chance of a natural pregnancy in mild and moderate disease. Cysts are removed with their wall (cystectomy), which lowers the chance of them coming back, while keeping as much healthy ovary as possible. Dr. Ragavi performs these operations herself; see laparoscopic gynaecological surgery in Chennai.

Trying to conceive

Hormonal treatment stops ovulation, so it is paused while you try. Depending on your age, the stage of the disease and the state of the tubes, the plan is timed intercourse, ovulation induction with follicle monitoring at the clinic, or a referral for IVF, which is not done at RV Clinic. Surgery before IVF is advised only for large cysts. The infertility treatment in Chennai page covers the evaluation of both partners.

When the family is complete

For a woman with severe disease, adenomyosis and pain that has not responded to anything else, removing the uterus, and sometimes the ovaries, is the last option and a considered one; it is discussed on the hysterectomy (uterus removal) page. Endometriosis, like fibroids, is a reason many women take a second opinion from a gynaecologist before agreeing to surgery, and that is welcome here.

Consultation, examination, scans, medicines, the hormonal IUD, follicle monitoring and follow-up happen at RV Clinic Madipakkam or RV Clinic Thalambur, whichever is closer to you. Laparoscopy for cysts or endometriosis, and any hysterectomy, are done by Dr. Ragavi herself at Unittas Multispeciality Hospital, which is 21 km from the Madipakkam clinic and 5 km from the Thalambur clinic, usually with a one-night stay. RV Clinic is an outpatient clinic. No operation is done at either clinic address. Thalambur, off OMR, has evening hours.