Endometriosis in Gurugram

Tissue similar to the lining of the uterus growing outside it, most often on the lining of the pelvis, on the ovaries and in the ligaments behind the uterus, and sometimes on the bowel or bladder. It responds to the same monthly hormones as the lining does, which is why the pain so often follows the cycle. It affects roughly one woman in ten of reproductive age.

Longer than it should. Across studies the average delay between symptoms starting and a diagnosis is about six and a half years, and Indian guidance describes a usual range of four to eleven years. The delay is spread across the whole pathway: getting to a doctor, getting referred, and then getting a diagnosis once referred.

Two reasons above all. Severe period pain gets normalised, by families and sometimes by doctors, so women wait years before mentioning it. And when they do, a clear ultrasound is often taken as an all-clear, when the commonest form of endometriosis cannot be seen on any scan.

No, and this is the biggest change in recent guidance. Laparoscopy used to be the only route to a diagnosis. Since 2022, European guidance reserves it for women whose imaging is inconclusive and in whom treatment has been unsuccessful or is inappropriate, and Indian guidance says the same. Treatment can be started on the strength of the history and a scan.

No. Guidance states explicitly that negative imaging does not exclude endometriosis, particularly superficial peritoneal disease, which is the commonest form and is invisible on both ultrasound and MRI. A clear scan rules some things out. It does not rule this out.

No. Indian guidance says CA-125 is not of much value for diagnosing endometriosis or for follow-up, and that a negative result does not rule it out. European guidance recommends against using any blood, tissue or fluid biomarker to make the diagnosis. It is one of the most commonly ordered and least useful tests in this condition.

A transvaginal ultrasound requested specifically for endometriosis, rather than a routine pelvic scan. The difference is what the operator looks at: ovarian mobility, the pouch behind the uterus, the bowel wall. For an ovarian endometrioma, transvaginal ultrasound is very accurate, with sensitivity around 93% and specificity around 96%.

Mainly when deep infiltrating disease is suspected and surgery is being considered, because it maps where the nodules sit. It is also useful for telling an endometrioma from other kinds of cyst. It detects lesions above about five millimetres, and like ultrasound it does not see superficial peritoneal disease.

Three. Superficial peritoneal disease sits flat on the pelvic lining and is invisible on scans. An ovarian endometrioma, or chocolate cyst, is a collection of old blood within the ovary and is what scans see best. Deep infiltrating endometriosis burrows more than about five millimetres into tissue and is what causes deep pain during sex and cyclical bowel or bladder symptoms.

Not in the way people assume. The staging system scores how much disease is visible and how stuck things are; it was designed to describe anatomy at operation, not to predict pain. Stage I disease can cause severe, life-limiting pain and stage IV can be found almost incidentally. A low stage is not evidence that your pain is exaggerated.

Because pain depends on where a deposit sits rather than how much of it there is. A small deposit on or near a nerve hurts more than a large patch somewhere with few nerve endings. Inflammation and, over years, sensitisation of the nervous system itself both add to it.

Endometriosis is lining-like tissue growing outside the uterus. Adenomyosis is lining tissue growing into the muscle wall of the uterus itself. Adenomyosis typically causes heavy periods with severe cramping in a woman in her late thirties or forties. They frequently coexist: adenomyosis is found alongside endometriosis in around a third of cases and alongside deep infiltrating disease in around half.

Hormonal treatment. Both European and Indian guidance name the combined pill, progestogens including dienogest, and GnRH treatment as options for endometriosis pain, with the combined pill and progestogens as first-line. Anti-inflammatory painkillers, taken properly, sit alongside them.

For endometriosis pain, usually yes. Indian guidance prefers continuous use over cyclical dosing, and the logic is simple: if the pain arrives with the bleed, removing the bleed removes the pain. It is worth asking about specifically, because the default prescription is often cyclical.

A progestogen given at 2 mg daily and licensed specifically for endometriosis. It has good evidence for reducing endometriosis-associated pain and improving quality of life, and it suits women who cannot take oestrogen. Like all these treatments, it prevents pregnancy while it is being taken.

Yes, and it is underused. Studies place the hormonal coil on a par with GnRH treatment for endometriosis pain, without the menopausal side effects, and Indian guidance names it a first-line option including in sexually active adolescents. It also lowers the rate of recurrence after surgery. In the Indian setting we plan on five years per device.

No. They work, but they induce a temporary menopausal state, so they are given with add-back hormone therapy and used for a limited period, typically to settle severe symptoms or in the run-up to surgery. They are not a treatment to stay on indefinitely.

When medical treatment has failed or cannot be tolerated, when pain is disabling, when anatomy is significantly distorted, in some cases of infertility, and in emergencies such as a ruptured cyst. It is not the first step, and current guidance does not treat it as one.

Guidance suggests excising rather than ablating, on the grounds that it gives better relief of endometriosis-associated pain. It is more technically demanding surgery, which is part of why it is not done universally, and it is a reasonable thing to ask about before consenting.

Removed. Guidance recommends removing the cyst wall rather than draining and coagulating it, because that lowers recurrence and relieves pain better. The same guidance separately insists that specific caution be used to minimise damage to the ovary, and both halves of that matter.

It can. Removing the cyst wall takes some healthy ovarian tissue with it, and surgery on an endometrioma is known to reduce ovarian reserve. Repeated operations on the same ovary compound it. If fertility matters to you, that trade-off belongs in the conversation before the operation, not after.

It is worth pausing on. Indian guidance states plainly that recurrent surgeries are counterproductive and lead to more harm. The questions to ask are what will be different this time, and what medical treatment is planned for afterwards, because surgery without a plan for the following two years tends to lead to the next operation.

Medical treatment, and it is the step most often skipped. Guidance recommends a hormonal coil or a combined pill for at least 18 to 24 months after surgery to prevent the pain and the disease returning. Being operated on and sent home on nothing is a recognised route back to theatre.

No, and guidance requires that women be told so: hysterectomy will not necessarily cure the symptoms or the disease. Endometriosis lives outside the uterus, so removing the uterus does not remove it. It has a place for some women who have completed their family and exhausted other options, but it is not the cure it is often presented as.

For most women, no. It is found in around 40 to 50% of women being investigated for infertility, but a great many women with endometriosis conceive without any assistance. It can reduce the chance in any given month, which matters more the longer you have been trying and the older you are.

Not while you are trying, because every effective medical treatment for endometriosis pain also prevents pregnancy. That is a genuine tension and it needs deciding deliberately with your doctor rather than by default. Say at the first appointment that conception is the goal, because it changes the whole plan.

Usually the pain settles considerably once the ovaries stop producing oestrogen, since the deposits depend on it. It is not universal, and hormone replacement therapy can occasionally reactivate symptoms, so it is worth mentioning a history of endometriosis if HRT is being considered.

There is a familial tendency. Having a mother or sister with endometriosis raises your own risk, which is why it is worth asking about and worth mentioning at an appointment. It is not a simple inherited condition, and plenty of women with it have no family history at all.

They have a genuine place alongside treatment, particularly where pain has been present for years. Pelvic floor physiotherapy, regular exercise, heat, sleep and structured help for chronic pain all help some women meaningfully. They work best as additions to medical treatment rather than as replacements for it.

A record of the pain if you can keep one for a few weeks: when it comes, how long it lasts, and what it stops you doing. Any previous scan reports and, if you have had surgery, the operation notes. And the names, doses and durations of anything you have already tried.