Endometriosis is a disease that affects at least 1 in 10 women during their youth and middle age, which is 247 million women worldwide, and 42 million in India alone.[1][2]
To understand this condition, we must first understand the tissue involved, endometrium. This is the innermost lining of the uterus, which responds to hormonal changes during a woman’s menstrual cycle.
In endometriosis, tissue resembling endometrium is noted outside the uterine cavity, invading the uterine muscles, fallopian tubes, ovaries, rectum, ureters, and connective tissues of the pelvis. Rarely, endometriosis can also affect distant organs, such as the brain and lungs, causing involuntary jerking, convulsions and coughing of blood every time the woman enters the menstrual phase of the reproductive cycle.
The disease is often progressive and highly debilitating. In more severe forms it causes extreme menstrual pain, pelvic pain beyond menstrual cycles, heavy menstrual bleeding, and acute pain during sexual intercourse. It can also cause damage to vital pelvic organs, with associated bleeding from the rectum and pain while opening bowels, or damage to kidneys due to invasion into the ureters.
Endometriosis also leads to subfertility due to the extensive distortion of internal anatomy it causes.
Assisted reproduction technologies are less successful in women who have endometriosis than in those who are sub-fertile due to other causes.
Unfortunately, research on this condition is largely unexplored and heavily underfunded compared to the magnitude of the problem. There is a general lack of awareness about this condition amongst the scientific community and the public, particularly policymakers and political leaders. Women with this condition are often dismissed as malingerers and attention seekers and suffer silently. The lag period from onset of symptoms to diagnosis is, on average, 4-5 years[3][4], implying that patients with endometriosis suffer for long before they receive treatment; and the treatment itself is quite inadequate.
Shortcomings of current treatments :
Even if diagnosed early, endometriosis treatment is limited to excision surgery and hormonal pills.The success rate of surgery is low and inconsistent, and surgeon’s
lack of experience can damage vital organs in the peritoneal cavity.Further, the cost of surgery in India is between $3,000 – $3,700[4] in private healthcare, which is a huge sum for most patients. This price assumes that the surgery is without complications, which isn’t always true. Surgery can have a recurrence rate of 50%, requiring multiple surgeries.[6]. Endometriosis is responsible for 25-50% of cases of subfertility[7], and surgery could contribute by diminishing the ovarian reserve and damaging the fallopian tubes.
Hormonal therapy often renders the patient unable to conceive, and prolonged use of hormonal pills has been linked to an increased risk of breast cancer[8]. Further, the effectiveness of such drugs is often not confirmed.
Hence, the need of the hour is to develop a treatment that doesn’t alter the hormonal environment of the patient and is affordable and accessible to the masses.
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