{By: Dr Ameet Soni}
Endometriosis was once seen as a rare women’s health problem, but today it is recognised as a serious medical condition that affects both individual health and the broader healthcare system—especially when it comes to fertility and pregnancy. In India, where becoming a mother is often seen as a vital part of a woman’s life, endometriosis creates not just physical and emotional difficulties, but also challenges for doctors and healthcare providers. Many women face delays in diagnosis and limited treatment options.
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What Is Endometriosis And Why It Matters
Endometriosis is a medical condition where tissue similar to the lining of the uterus (called the endometrium) grows outside the uterus. This tissue can be found on the ovaries, fallopian tubes, the lining of the pelvic cavity (called the pelvic peritoneum), and in some cases, even in areas far from the uterus. Although it’s outside the uterus, this tissue still acts like the uterine lining—it thickens, breaks down, and bleeds with each menstrual cycle. But since it has no way to exit the body, it causes inflammation, pain, and scarring over time. This ongoing reaction is driven by the hormone estrogen, which is why it’s called an estrogen-dependent condition. Women are often diagnosed because of symptoms like pelvic pain or trouble getting pregnant, but endometriosis can also affect overall health. This condition is a serious but often overlooked condition that leads to repeated visits to doctors—for pain relief, surgery, and eventually fertility treatment.
The Clinical And Economic Burden
Around 40% of women facing infertility in India are found to have endometriosis, this abnormal tissue growth can change the shape and function of the pelvic organs, block or damage the fallopian tubes, and lower the number and quality of eggs in the ovaries (known as ovarian reserve). It also causes inflammation in the pelvic area, which can affect how eggs develop and how embryos attach to the uterus. As a result, women often need repeated tests, surgeries, and fertility treatments, which can be expensive—especially in India, where most healthcare expenses are paid out-of-pocket. This makes it important to have clear treatment plans focused on managing endometriosis in women trying to conceive.
Diagnostic Delays: A Glaring Industry Gap
In India, it typically takes around 6 to 8 years for a woman to receive a confirmed diagnosis of endometriosis. This long delay happens for several reasons: many women believe that severe period pain is normal, some primary healthcare providers may not recognize the symptoms early, access to specialist gynaecologists is limited in smaller towns, and social taboos make it difficult to openly talk about periods or fertility issues. This delay means women miss out on timely care and early treatment. To close this gap, we need to start menstrual health education at the school level, improve access to gynaecology services in underserved areas, and use digital tools like apps or trackers to help women monitor symptoms and seek help sooner.
Can Pregnancy Occur Naturally With Endometriosis, And How Does It Behave?
Many women with early-stage endometriosis (Stage I or II) are able to get pregnant naturally. However, as the disease progresses to more advanced stages, the chances of conceiving on your own become lower. In such cases, medical treatments or surgery may be needed, and sometimes assisted reproductive techniques like IVF are recommended. It’s important to take a personalised approach based on tests that check ovarian reserve along with a woman’s age and the condition of her fallopian tubes.
It is a common myth that pregnancy cures endometriosis. During pregnancy, the menstrual cycle stops, which can temporarily reduce pain and slow down the activity of endometrial lesions (the abnormal tissue growths), but the condition itself does not go away. In fact, the physical changes caused by endometriosis—like scarring, inflammation, or distorted anatomy—can still affect pregnancy. Studies show that women with endometriosis may have a higher chance of complications such as miscarriage, early delivery (preterm labour), the placenta attaching too low in the uterus (placenta previa), and needing a caesarean section. For these reasons, doctors need to monitor these pregnancies more closely, especially if the woman has had prior laparoscopic surgery (a minimally invasive procedure to remove endometrial tissue), severe internal scarring (adhesions), or conceived through IVF (in vitro fertilisation).
Treatment Framework: A Tiered Clinical Model
Before trying to get pregnant, managing endometriosis should focus on controlling the disease without harming fertility. For women not planning pregnancy right away, doctors may recommend hormonal treatments. These help reduce the size of endometrial lesions and ease pain. But once a woman wants to conceive, the treatment approach needs to change. In some cases, a surgery can increase the chances of natural pregnancy. However, surgery must be done carefully, especially in women with ovarian cysts like endometriomas, since removing too much tissue can lower the number of healthy eggs. To protect future fertility, women—especially those needing repeated surgeries—should monitor their ovarian reserve early through tests and consider options like egg freezing, embryo storage, or planned IVF. IVF helps bypass many of the fertility problems caused by endometriosis and is the most effective method for moderate to severe cases.
The author, Dr Ameet Soni is the Associate Vice President, HoD, Medical Affairs at CORONA Remedies Limited
[Disclaimer: The information provided in the article, including treatment suggestions shared by doctors, is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.]
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