Conquering the elusive disease

Endometriosis is a mysterious disease as regards to its etiology, pathogenesis, diagnosis and treatment. As per recent estimates by WHO, about 196 million women suffer from Endometriosis globally. Of these, 50 million women belong to India alone!! Endometriosis causes pain and infertility. Average diagnostic delay may vary from 6 to 8 years. Treatment aims at alleviating the pain, preventing the recurrence and promoting the fertility. Patients need lifelong medical management plan and surgery should be minimized. Diagnosis is based on history, clinical examination, imaging modalities like USG, CECT, MRI, biomarkers and trial of treatment, currently there is no role for laparoscopy to diagnose endometriosis. Prevention of endometriosis could be primordial, primary, secondary or tertiary. This aims at prevention of risk factors for endometriosis and life style modifications play a major role in primordial prevention. Identification of the risk factors and regular screening, non-invasive diagnosis, empirical treatment, regular follow up of the patients and intervention at the right time are the modalities for primary prevention. Secondary prevention includes early diagnosis by symptoms, imaging, biomarkers and, empirical treatment which includes COCs, progestins and GnRH analogues. Tertiary prevention includes prevention and treatment of complications like recurrence and pain. Patients who are high risk for endometriosis should undergo primordial and primary prevention even before the disease manifests. Enhanced awareness, followed by yearly checkup and management may slow or halt the natural progression of the disease. Awareness about endometriosis will improve the sexual and reproductive health, quality of life and overall well-being.