Endometriosis is a noncancerous condition in which tissue similar to the endometrium (uterine lining) grows outside your uterus and adheres to other structures, most commonly in the pelvis, such as on the ovaries, bowel, fallopian tubes or bladder. Rarely it implants in other places, such as the liver, lungs, diaphragm and surgical sites. It is a common cause of pelvic pain and infertility.
Historically thought of as a disease that affects adult women, endometriosis is increasingly being diagnosed in adolescents, as well.
The most common symptoms are painful menstrual periods and/or chronic pelvic pain.
Diarrhea and painful bowel movements, especially during menstruation
Severe menstrual cramps
Excessive menstrual bleeding
Pain in the pelvic region with exercise
Painful pelvic examinations
It is important to understand that other conditions aside from endometriosis can cause any or all of these symptoms and other causes may need to be ruled out. These include, but are not limited to, interstitial cystitis, irritable bowel syndrome, inflammatory bowel disease, pelvic adhesions (scar tissue), ovarian masses, uterine abnormalities, fibromyalgia, malabsorption syndromes and, very rarely, malignancies.
When endometriosis tissue grows outside of the uterus, it continues to respond to hormonal signals—specifically estrogen—from the ovaries telling it to grow. Estrogen is the hormone that causes your uterine lining to thicken each month. When estrogen levels drop, the lining is expelled from the uterus, resulting in menstrual flow (you get your period). But unlike the tissue lining the uterus, which leaves your body during menstruation, endometriosis tissue is essentially trapped.
With no place to go, the tissue bleeds internally. Your body reacts to the internal bleeding with inflammation, a process that can lead to the formation of scar tissue, also called adhesions. This inflammation and the resulting scar tissue may cause pain and other symptoms.
Recent research also finds that this misplaced endometrial tissue may develop its own blood supply to help it proliferate and nerve supply to communicate with the brain, one reason for the condition's severe pain and the other chronic pain conditions so many women with endometriosis suffer from.
The type and intensity of symptoms range from completely disabling to mild. Sometimes, there aren't any symptoms at all, particularly in women with so-called "unexplained infertility."
If your endometriosis results in scarring of the reproductive organs, it may affect your ability to get pregnant. In fact, 30 to 40 percent of women with endometriosis are infertile. Even mild endometriosis can result in infertility.
Researchers don't know what causes endometriosis, but many theories exist. One suggests that retrograde menstruation—or "reverse menstruation"—may be the main cause. In this condition, menstrual blood doesn't flow out of the cervix (the opening of the uterus to the vagina), but, instead, is pushed backward out of the uterus through the fallopian tubes into the pelvic cavity.
But because most women experience some amount of retrograde menstruation without developing endometriosis, researchers believe something else may contribute to its development.
For example, endometriosis could be an immune system problem or local hormonal imbalance that enables the endometrial tissue to take root and grow after it is pushed out of the uterus.
Other researchers believe that in some women, certain abdominal cells mistakenly turn into endometrial cells. These same cells are the ones responsible for the growth of a woman's reproductive organs in the embryonic stage. It's believed that something in the woman's genetic makeup or something she's exposed to in the environment in later life changes those cells so they turn into endometrial tissue outside the uterus. There's also some thinking that damage to cells that line the pelvis from a previous infection can lead to endometriosis.
Some studies show that environmental factors may play a role in the development of endometriosis. Toxins in the environment such as dioxin seem to affect reproductive hormones and immune system responses, but this theory has not been proven and is controversial in the medical community.
Other researchers believe the endometrium itself is abnormal, which allows the tissue to break away and attach elsewhere in the body.
Endometriosis may have a genetic link, with studies finding an increase in risk if your mother or sister had the disorder. No specific genetic mutation has been clearly linked with the disease.
Diagnosis - Endometriosis
Gynecologists and reproductive endocrinologists, gynecologists who specialize in infertility and hormonal conditions, have the most experience in evaluating and treating endometriosis.
The condition can be very difficult to diagnose, however, because symptoms vary so widely and may be caused by other conditions.
Among the ways doctors diagnose the disease are:
Laparoscopy. Currently, laparoscopy is the gold standard for the diagnosis of endometriosis and is commonly used for both diagnosis and treatment. Performed under general anesthesia, the surgeon inserts a miniature telescope called a laparoscope through a small incision in the navel to view the location, size and extent of abnormalities (such as adhesions) in the pelvic region.
However, merely looking through the laparoscope can't diagnose deep endometriosis disease, in which the endometrial tissue is hidden inside adhesions or underneath the lining of the abdominal cavity. More extensive dissection is needed to diagnose and treat this type of disease.
Many women have a combination of both deep and superficial (in which the endometrial tissue can be easily seen) endometrial disease.
Peritoneal tissue biopsy. During the laparoscopy, the doctor may remove a tiny piece of peritoneal tissue (the inner layer of the lining of the abdominal cavity) or other suspicious areas to help establish the diagnosis of endometriosis. This is recommended by the American College of Obstetricians and Gynecologists (ACOG), which notes that only an experienced surgeon familiar with the appearance of endometriosis should rely on visual inspection alone to make the diagnosis. A biopsy, however, is not mandatory to diagnose endometriosis, and a negative biopsy does not rule out the presence of this disease in other areas within the abdomen.
Ultrasonography, MRI and CT scan. An ultrasound uses sound waves to visualize the inside of your pelvic region, while an MRI uses magnets and a CT scan uses radiation. While these tests can occasionally suggest endometriosis, particularly ovarian endometriotic cysts called "endometrioma," or rule out other conditions, none can definitively confirm the condition.
At this point, there is no established noninvasive method to diagnosis endometriosis, which is frustrating for both women and their health care providers.
Pelvic exam. Your doctor will perform a physical examination, including a pelvic exam, to aid in the evaluation. The examination will not diagnose endometriosis but may allow your doctor to feel nodules, areas of tenderness or masses on the ovaries that may suggest endometriosis.
Medical history. A detailed medical history may offer your health care professional the earliest clues in making the correct diagnosis.
Fathima hospital, backed by specialists from multiple disciplines, specialises in handling high risk pregnancies. It is important to note that women, who are diagnosed with high-risk issues, mostly go on to have a normal pregnancy and a healthy delivery.
Fathima hospital offers pain relief programs that are globally applied to ease pain during labour. There are a number of options to ensure painless delivery, many of which pregnant women here are not aware of.
Fetal medicine focuses on the care of pregnant women where there is a need to monitor the health and wellbeing of the unborn child (fetus). This includes monitoring the rate of the baby’s growth, as well as diagnosing and managing fetal disorders and abnormalities using both invasive and non-invasive methods.
Our specialized fertility experts are highly experienced, and their technology and strict processes ensure high success rates. IVF (In-Vitro Fertilization) is a type of assisted reproductive technology which involves a series of procedures to treat fertility and assist with the conception of child.
Fathima Hospital has customized Antenatal programmes designed to make you feel safe, good and happy, these programmes educate you on the process of childbirth and the different stages of labour - in all, encouraging natural birthing as much as possible.
Postnatal exercises are important for you. They help you regain the strength of your abdominal muscles and help prevent lower back injury and other complications like abdominal organs from "drooping forward" due to lack of support. They also help you regain a flat stomach.
Our OB/GYN surgeons offer a variety of traditional and minimally invasive surgical procedures: Tubal ligation, removal of ovarian cysts, fibroids, growths from the cervix, Removal of the uterus (hysterectomy), ovaries, Hysteroscopy etc.
Fetal medicine, which is an extension of the branch of Ultrasonography, treats the fetus as a patient in utero for any problems it might have. It comprises of Fetal scanning, Procedures such as Amniocentesis, chorionic villus sampling, and cord blood sampling, Screening tests and interpretation of the results.
When it comes to your little one’s health, you need to be extra sure. Hence, you want to know all the whys and when of vaccinations to be administered to your child from the time of birth. Keeping that in mind, we hand you over a vaccination schedule for your baby with all the mandatory and optional vaccines prescribed from the time of birth.
Each pregnancy is unique and you have the right to be involved in all decisions affecting you and your baby. A good relationship with your maternity care provider can make a big difference in planning your pregnancy care. At Fathima hospital, Department of Obstetrics includes a team of expert gynaecologists, foetal medicine Specialist, physiotherapists, and trained and experienced nursing staff. Our hospital is equipped with advanced neonatal care team supported by state-of-the-art NICU infrastructure to ensure that complex and high-risk pregnancies can be managed including extremely premature birthings.
At Fathima Hospital, we provide comprehensive consultations, lab testing, ultrasound scan to provide the best possible care during your 1st Trimister to 3rd Trimister. A typical pregnancy lasts 40 weeks from the first day of your last menstrual period (LMP) to the birth of the baby. It is divided into three stages, called trimesters: first trimester, second trimester, and third trimester. The fetus undergoes many changes throughout maturation. A woman will experience many changes during the pregnancy like morning sickness, or nausea and vomiting due to pregnancy, at 6–8 weeks. A pregnant woman might also feel very tired and notice that she is more emotional than usual due to hormonal changes.
Types of Delivery
Few things in life are more exciting than the birth of a new baby. This has been the case throughout human history, but childbirth options for new mothers have advanced to make the experience more safe. Fathima hospital offers comfortable maternity suites that convert into state of the art delivery rooms. An easy birth and a perfectly executed birth plan is ideal. But we know that even the most carefully planned birth can take twists and turns. In those cases, it's important to be prepared for alternative delivery methods.
A range of tests is available if you are pregnant. These tests can confirm your pregnancy and also monitor your baby’s development in the womb. Regular check-ups with your gynecologist, fetal medicine specislists are an important part of pregnancy care, including information and advice about what tests you and your baby will need. Checking the general health of the mother and baby, the different kinds of tests available to pregnant women include: tests to confirm pregnancy, maternal health screening, routine screening tests (these tell you how likely it is that your baby has a certain health condition), diagnostic tests – for pregnancies at increased risk (these tell you more accurately if your baby has a certain health condition).
Complications can arise in pregnancies for many reasons. Sometimes a woman’s existing health conditions contribute to problems. Other times, new conditions arise because of hormonal and body changes that occur during pregnancy. They can involve the mother’s health, the baby’s health, or both. Some women have health problems that arise during pregnancy, and other women have health problems before they become pregnant that could lead to complications. It is very important for women to receive health care before and during pregnancy to decrease the risk of pregnancy complications. If you are receiving treatment for a health problem, your health care provider might want to change the way your health problem is managed.
High Risk Pregnancy
A high-risk pregnancy is one that threatens the health or life of the mother or her fetus. It often requires specialized care from specially trained providers. Some pregnancies become high risk as they progress, while some women are at increased risk for complications even before they get pregnant for a variety of reasons. Early and regular prenatal care helps many women have healthy pregnancies and deliveries without complications. A high-risk pregnancy may be one that involves chronic health problems, such as diabetes or high blood pressure; infections; complications from a previous pregnancy; or other issues that might arise during pregnancy. Treatment for high-risk pregnancy depends on the risk factors and overall health of the mother and fetus.
Ideally, women of child bearing age should be immunized before becoming pregnant to protect their babies against various diseases. Pregnancy should not deter a woman from receiving vaccines that are safe and will protect both her health and that of her unborn child. Extreme care has to be taken to avoid those vaccines that harm the unborn baby. Pregnant women who aren’t up-to-date on their immunizations may be susceptible to diseases that can harm them or their unborn child. If you’re pregnant, talk to your doctor about which vaccines you may need and whether you should get them now or wait until after your child is born.
Bad Obstetric History
Pregnancy loss is a frustrating and challenging problem for couples and clinicians alike. Miscarriage is often associated with guilt, embarrassment and depressive states. This is particularly true when the patient presents with subsequent pregnancy with added concerns of primary or secondary infertility, irregular menses, absent or irregular ovulation, a known history of uterine fibroids, a family history of miscarriage, advancing age, medical history and a prior history of pregnancy complications. It certainly warrants a detailed consultation and reassurance with a practitioner committed to pregnancy loss evaluation.
Ectopic / Tubal Pregnancy
Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches to the lining of the uterus. An ectopic pregnancy occurs when a fertilized egg implants and grows outside the main cavity of the uterus. An ectopic pregnancy most often occurs in a fallopian tube, which carries eggs from the ovaries to the uterus. This type of ectopic pregnancy is called a tubal pregnancy. Sometimes, an ectopic pregnancy occurs in other areas of the body, such as the ovary, abdominal cavity or the lower part of the uterus (cervix), which connects to the vagina. An ectopic pregnancy can't proceed normally. The fertilized egg can't survive, and the growing tissue may cause life-threatening bleeding, if left untreated.
A multiple pregnancy occurs when one egg (ovum) splits before implanting or when separate eggs are each fertilized by a different sperm. Identical twins or triplets occur with the fertilization of a single egg that later divides into two or three identical embryos. Identical twins or triplets have the same genetic identity, are always the same sex, and look almost exactly the same. Fraternal multiples develop from separate eggs that are each fertilized by a different sperm. Fraternal twins might or might not be of the same sex and might not necessarily resemble each other any more than two siblings from the same parents might.
Your pregnancy is one of the most exciting times of your life. At Fathima hospital, we will help you enjoy the journey with the support of our expert team, in modern private surroundings.
Families have trusted us for generations at this special time, and we have an enviable international reputation for private maternity care.
Our expertise enables us to safely look after you and your baby, whether it is your first child, your third child, you are expecting twins, or if you or your little one has additional health needs. Whatever your situation, we have the right team to support you. Our packages have been devised with you in mind, to give you the time and attention you need to make the birth of your child as special as possible.
Your pregnancy journey has begun! When is your due date?
Fathima hopsital - Maternity care facilities Process Chart
The best practices to ensure the that a mother gets utmost care during pregnancy and labor. Here is a list of our resources enabling to help you prepare for everything, from conception to delivery and beyond. Fathima hospital is fully equipped to comply with the maternity care Process chart.
Treatments and Procedures
The Department of Obstetrics & Gynaecology has the capability and facilities to deal with a diverse range of cases and complexities in partnership with specialty services such as Foetal Medicine, Anaesthesia, Critical care, high risk, painless labour, Gynaecological surgeries for fibroid, prolapsed, endometriosis, ovarian cysts, Laparoscopic and hysteroscopic surgeries