Endometriosis treatment in Mumbai is provided by Dr. Vaishali Joshi, FRCOG, Senior Consultant Obstetrician & Gynaecologist at Kokilaben Dhirubhai Ambani Hospital, Andheri West, who holds a European University Diploma in Gynaecological Operative Endoscopy from the University of Auvergne, France. Endometriosis is a condition in which tissue resembling the lining of the uterus grows outside it, causing pain, inflammation and scarring. It is common, frequently diagnosed late, and treatable — and the right treatment depends on whether your priority is pain, fertility, or both.
The most striking fact about endometriosis is how long it typically takes to diagnose. Studies across several countries consistently find a delay of several years between a woman first reporting symptoms and receiving a diagnosis. The reasons are depressingly consistent too: severe period pain is normalised, both by women themselves and by those they consult, and the condition is invisible on the routine investigations that are usually done first.
So the first thing worth stating plainly is this. Period pain that stops you working, studying or functioning is not something to be endured, and it is not something you are exaggerating. It warrants proper assessment.
What are the symptoms of endometriosis?
- Painful periods (dysmenorrhoea) — typically pain that begins a day or two before bleeding and is severe enough to interfere with normal activity or to require regular painkillers.
- Chronic pelvic pain — pain present outside menstruation, often described as deep, dragging or burning.
- Pain during or after intercourse (dyspareunia), characteristically felt deep rather than at the entrance.
- Difficulty conceiving — endometriosis is found in a substantial proportion of women investigated for subfertility, and is sometimes the first indication of the condition.
- Bowel and bladder symptoms that worsen cyclically around periods — painful bowel movements, painful urination, bloating, or a change in bowel habit.
- Heavy or irregular bleeding, and fatigue that is often underestimated as a symptom.
The severity of symptoms does not predict the extent of disease. A woman with a small amount of superficial endometriosis can be in severe pain, and a woman with extensive disease can have few symptoms until she has difficulty conceiving. This is one of the reasons the condition is so often missed — and a reason not to dismiss symptoms because a scan looked normal.
How is endometriosis diagnosed?
Assessment begins with a careful history, because the pattern of pain in relation to the menstrual cycle is often the most informative single piece of evidence. Examination may reveal tenderness, nodularity behind the uterus, or a fixed, retroverted uterus suggesting adhesions.
Imaging
Transvaginal ultrasound in experienced hands reliably identifies ovarian endometriomas — endometriotic cysts on the ovary, sometimes called chocolate cysts — and can suggest deep infiltrating disease. MRI is used where deep disease involving the bowel, bladder or ureters is suspected, and is valuable for planning surgery.
The important limitation: a normal ultrasound does not exclude endometriosis. Superficial peritoneal disease, which can be severely painful, is generally invisible on any scan. A normal scan means no cyst was found; it does not mean there is nothing there.
Laparoscopy
Direct visualisation at laparoscopy, with biopsy for histological confirmation, remains the definitive diagnosis. Current practice, however, is no longer to send every woman for a laparoscopy simply to obtain a diagnosis. Where the clinical picture is characteristic, medical treatment is often started first, and laparoscopy is reserved for women who do not respond, in whom the diagnosis is unclear, or where surgery is indicated in its own right — for an endometrioma, or for fertility.
How is endometriosis staged?
The most widely used system, from the American Society for Reproductive Medicine, assigns a stage from I to IV based on the location, depth and extent of disease found at laparoscopy and the presence of adhesions.
Stage I — minimal
A few superficial implants, no significant adhesions.
Stage II — mild
More implants, some slightly deeper, still limited adhesions.
Stage III — moderate
Multiple deep implants, endometriomas on one or both ovaries, and filmy adhesions.
Stage IV — severe
Many deep implants, large endometriomas, dense adhesions, and often obliteration of the pouch of Douglas behind the uterus.
Stage is useful for planning surgery and for discussing fertility prospects. It is a poor guide to how much pain a woman is in, and it should never be used to decide whether her pain is real.
Medical management: controlling the disease
Where pain is the primary problem and immediate pregnancy is not the goal, medical treatment is usually tried first. It works by suppressing the hormonal cycle that drives the endometriotic tissue.
- Analgesia — non-steroidal anti-inflammatory drugs taken pre-emptively, starting before pain becomes established rather than after.
- Combined hormonal contraception, often used continuously without a break, which for many women substantially reduces pain.
- Progestogens — oral, injectable, or the levonorgestrel intrauterine system, which is particularly useful where heavy bleeding is also a feature.
- GnRH agonists, which induce a temporary medical menopause. Effective, but used for limited periods and usually with add-back hormone therapy to protect bone density.
- GnRH antagonists — elagolix and similar agents, taken by mouth. They suppress oestrogen more predictably than the older injections and act quickly, without the initial symptom flare agonists can cause.
- Newer combined preparations pair a GnRH antagonist with built-in add-back hormone therapy in a single tablet, which protects bone density and limits menopausal side effects — allowing treatment to continue for longer than was previously possible.
Two things to be clear about. Medical treatment suppresses; it does not remove disease, and symptoms commonly return when treatment stops. And hormonal suppression is contraceptive — it is not a treatment to be on while trying to conceive.
Laparoscopic surgery for endometriosis
Surgery is considered where medical treatment has not controlled symptoms, where there is an endometrioma of significant size, where deep infiltrating disease is affecting bowel or bladder, or where fertility is the goal. Laparoscopy is the standard approach: it gives magnified visualisation of the pelvis, allows precise treatment of disease, and involves markedly less pain and a shorter recovery than open surgery.
What surgery involves
- Excision or ablation of endometriotic implants. Excision — cutting the disease out — is generally preferred for deep disease, as ablation may not reach its full depth.
- Cystectomy for ovarian endometriomas, removing the cyst wall while conserving as much healthy ovarian tissue as possible. This balance matters: overzealous surgery on the ovary can reduce ovarian reserve.
- Adhesiolysis — dividing scar tissue to restore normal anatomy, particularly important for tubal function in women wishing to conceive.
- Excision of deep infiltrating disease involving the uterosacral ligaments, rectovaginal septum, bladder or bowel. This is complex surgery and, where bowel or ureter is involved, is best done in a unit with colorectal and urological support available.
Recovery after uncomplicated laparoscopic surgery for endometriosis is usually a same-day or overnight stay, with a return to routine activity over one to two weeks depending on the extent of what was done.
Endometriosis and fertility
Surgery for endometriosis can improve the chance of natural conception, particularly in earlier-stage disease and where adhesions are distorting the tubes and ovaries. The decision is genuinely individual: it depends on your age, ovarian reserve, how long you have been trying, whether there is a male factor, and the extent of disease. For some women surgery first is right; for others proceeding directly to assisted conception is the better route, and for a woman with reduced ovarian reserve, repeated ovarian surgery may do more harm than good.
Endometriosis is a long-term condition, not a single operation. Recurrence after surgery is well recognised. The most durable results generally come from combining well-judged surgery with a plan for what happens afterwards — hormonal suppression where pregnancy is not immediately intended, and continuing review.
Living with endometriosis
Alongside medical and surgical treatment, pelvic physiotherapy, attention to bowel symptoms, and support for the chronic-pain dimension of the condition all have a genuine role. Years of unexplained, disbelieved pain leave a mark, and treating the pelvis while ignoring that is incomplete care. Ask about it; it is a reasonable thing to raise.
Frequently asked questions
Can endometriosis be seen on an ultrasound scan?
Sometimes, but not reliably. Transvaginal ultrasound in experienced hands identifies ovarian endometriomas well and can suggest deep infiltrating disease. However, superficial peritoneal endometriosis — which can cause severe pain — is generally invisible on any scan. A normal ultrasound therefore does not exclude endometriosis. If your symptoms are characteristic, a normal scan is a reason to continue investigating, not to stop.
Do I need a laparoscopy to be diagnosed with endometriosis?
Not always. Laparoscopy with biopsy remains the definitive diagnosis, but current practice does not send every woman for surgery simply to obtain one. Where the history is characteristic, medical treatment is often started first and the response itself is informative. Laparoscopy is reserved for women who do not respond to medical treatment, where the diagnosis is genuinely unclear, or where surgery is indicated anyway — for an endometrioma, deep disease, or fertility.
Does endometriosis always cause infertility?
No. Many women with endometriosis conceive without any difficulty. Endometriosis is, however, found in a substantial proportion of women investigated for subfertility, and more extensive disease with adhesions distorting the tubes and ovaries has a greater effect. Where fertility is affected, options include laparoscopic surgery to restore anatomy and assisted conception; the right choice depends on your age, ovarian reserve, duration of trying and the extent of disease.
Will endometriosis come back after surgery?
Recurrence is well recognised, which is why endometriosis is best thought of as a long-term condition rather than something a single operation ends. The most durable outcomes generally come from combining well-judged surgery with a plan for afterwards — hormonal suppression where pregnancy is not immediately intended, and continuing review. Excision of deep disease, rather than ablation alone, is generally associated with better symptom control.
Does the stage of endometriosis tell me how bad my symptoms will be?
No, and this surprises many women. The ASRM staging system from I to IV describes the extent of disease found at surgery, not the severity of pain. A woman with minimal Stage I disease can be in severe pain, while a woman with Stage IV disease may have few symptoms until she has trouble conceiving. Stage is useful for planning surgery and discussing fertility; it is not a measure of suffering.
Does a hysterectomy cure endometriosis?
Not by itself, and it is not a first-line treatment. Endometriosis is disease outside the uterus, so removing the uterus alone does not remove it; symptoms can persist if deposits are left behind. Hysterectomy, with or without removal of the ovaries, is considered only in women with severe disease who have completed their family and where other treatments have failed — and even then, thorough excision of the disease itself is what determines the result.
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Written & medically reviewed by Dr. Vaishali Joshi, FRCOG CCT MD DNB DGO FCPS — Senior Consultant Obstetrician & Gynaecologist, Kokilaben Dhirubhai Ambani Hospital, Mumbai.
Last reviewed . This article is general information and is not a substitute for individual medical advice. Please discuss your own circumstances at consultation.