Understanding Your Endometriosis
Specialised in treating Advanced Endometriosis
Minimally Invasive Laparoscopic Surgery
Robotic Surgery for Endometriosis
What is Endometriosis?
Endometriosis is a chronic disease in which endometrial-like tissue is found outside of the uterus. This tissue, which normally lines the uterine cavity, is associated with monthly menstruation and is often characterized by abnormally painful and heavy periods, as well as pelvic pain, severe cramps, and pain with sex (dyspareunia). The lesions are estrogen-dependent, benign, inflammatory, stem-cell driven, and at times progressive.
it affects an estimated 176 million women worldwide. A leading cause of infertility and chronic pelvic pain, it has also been linked to other health concerns, including certain autoimmune diseases and cancers, fibroids, adenomyosis, and interstitial cystitis. It is one of the leading reasons for laparoscopic surgery and hysterectomy in the United States. The economic impact of endometriosis is staggering. Businesses lose billions of dollars each year in compromised productivity and absenteeism because of the disease.
Where does it occur?
It typically develops on the pelvic structures including the ovaries, fallopian tubes, bladder, and bowels (intestines).
It is also common for it to develop on the top of the vagina (anterior cul-de-sac) and in the peritoneal cavity between the rectum and the posterior wall of the uterus (posterior cul-de-sac).
In rare cases, it can spread to the diaphragm, lungs, kidney, appendix, and, surprisingly, the gastrocnemius (calf muscles).
Stages
The American Society of Reproductive Medicine classifies endometriosis according to severity.
| Stages | American Society of Reproductive Medicine Severity Classifications |
|---|---|
| Stage I | Minimal |
| Stage II | Mild |
| Stage III | Moderate |
| Stage IV | Severe |
Classifications
Because the four stages of endometriosis do not necessarily have any correlation to a patient’s symptoms or the nature of the infiltration itself, we often use a more descriptive system:
| Preferred Classification | Description |
|---|---|
| Early peritoneal |
Infiltration of the lining of the abdomen (peritoneum) |
| Ovarian endometriomas |
Large, fluid-filled “chocolate” cysts that form on, and even encapsulate, the ovaries |
| Cul-de-sac obliteration |
Infiltration of the tissue lining the back wall of the uterus and rectum (posterior cul-de-sac), an extension of the peritoneum |
| Deep infiltrating endometriosis (DIE) |
Invasive endo that penetrates the bladder and bowel wall |
| Frozen pelvis |
In this rare condition, deep infiltrative lesions attach to pelvic ligaments, nerves, and muscle tissue. As a result, pelvic organs can be partially or entirely cemented |
Causes of Endometriosis
The exact cause of endometriosis is not known. However, several plausible theories exist, including retrograde menstruation, Meyer’s theory, and more. We remain open to newly developing ideas.
Risk factors
While the following risk factors increase a woman’s risk of developing endometriosis, there are many cases in which women are diagnosed without any of the following:
Family history of the disease, especially in the mother or sister
Age (between 25 and 40)
History of menstrual complications (i.e. long menstrual cycles, frequent periods)
Not having children
High consumption of fats and red meat
Heavy alcohol intake
How does endometriosis affect pregnancy and fertility?
Endometriosis is likely responsible for one-third of infertility cases. The longer a woman has endometriosis, the more risk she has of infertility. However, up to 70% of women with mild to moderate endometriosis are still capable of conceiving
Adhesions on or near the ovaries, uterus, and fallopian tubes impede the transfer of the egg to the fallopian tube and may cause infertility. Moreover, ovarian implants may prevent the release of an egg and cause infertility. Finally, endometriosis can lead to a decrease in the number and quality of healthy eggs.
What is adenomyosis and how is it different from endometriosis?
Adenomyosis is endometriosis strictly within the uterine muscle. However, 50% of adenomyosis patients also have endometriosis.
What conditions can it be related to?
Part of the reason why endometriosis is such a complex and dangerous condition is that it can lead to several other related conditions, including:
Adenomyosis
Adhesions
Chronic Pelvic Pain
Infertility
What can it be misdiagnosed as?
Endometriosis can mask a number of conditions. It is often misdiagnosed and mistaken for the following conditions:
IBS
Appendicitis
Hemorrhagic cysts
Symptoms of Endometriosis
Painful menstrual cramps (dysmenorrhea or “killer cramps”)
Heavy menstrual bleeding (menorrhagia)
Chronic pelvic pain
Pain with intercourse (dyspareunia)
Abdominal pain and bowel dysfunction including painful bowel movements, diarrhea, bloating, gas, or cramps
Bladder dysfunction, such as painful urination
Weakness, numbness, or pain in the nerves (neuropathy)
Fatigue
Infertility
Personality changes (depression, stress, apathy)
Endometriosis Doctor in Mumbai At Kokilaben Dhirubhai Ambani Hospital, India
Dr. Anshumala Shukla – Kulkarni, a Laparoscopic & Robotic Surgeon, is the best and most experienced endometriosis surgeon specialist in the world. She has performed more endometriosis surgeries than any other surgeon. Dr. Anshumala Shukla – Kulkarni specializes in endometriosis treatment in Mumbai, providing exceptional care and advanced surgical techniques to patients.
SEVERE PAIN WITH YOUR PERIODS? YOU MIGHT HAVE ENDOMETRIOSIS
Diagnosis of Endometriosis
What is the first step towards diagnosing?
Before pursuing imaging, you should speak with a GYN physician who is familiar with diagnosing endometriosis and can provide a comprehensive pelvic exam. A physical exam and a discussion about your symptoms and medical history will help a physician determine if imaging tests are necessary.
What imaging tests are available?
In order to properly diagnose a patient with endometriosis and determine whether surgery is necessary, one or both of the following imaging tests must be conducted:
- Ultrasound/sonogram
- MRI
What procedures and tests help definitively diagnose endometriosis?
In an operating room, a well-trained and experienced GYN surgeon will be able to visualize any anatomical abnormalities or endometriosis lesions through the following procedures:
- Hysteroscopy
- Laparoscopy
While a physical exam and other imaging tests can give insight into whether or not a patient may have endometriosis, the only way to definitively diagnose endometriosis is through laparoscopic excision surgery. This must be accompanied by a biopsy sample that is sent to a pathology lab in order to confirm a diagnosis of the disease.
Endometriosis Treatment
There is currently no cure for endometriosis. However, there are surgical and non-surgical treatment options for pain and infertility caused by the disease.
Non-surgical methods to relieve symptoms
It is important to note that the following methods are not treatments for the disease, but rather may help control a patient’s pain and symptoms
Painkillers
Acupuncture
Birth control pills
Anti-inflammatory diet
Medicated IUD
Surgical procedures
There are a variety of surgical treatments that a patient can undergo to treat endometriosis depending on the severity, stage, and quantity of the lesions.
| Technique | Description |
|---|---|
| Laparoscopic Deep Excision Surgery | The “gold standard” for removing all endometriosis in the body, ranging from lesions on the ovaries to the intestine |
| Myomectomy | Removal of fibroids, is necessary only when fibroids develop |
| Hysterectomy | Removal of the uterus, which is only needed in cases of diffuse endometrioma tissue in the uterus such as with adenomyosis |
| Robotic Surgery | If you have endometriosis, robot-assisted surgeries can help in the management of symptoms by eliminating scar tissue and removing endometrial implants |
Our approach
Endometriosis is not an easy condition to diagnose. Our practice provides a number of advantages.
Over 20 years of experience identifying, diagnosing and treating endometriosis
Over 20 years of experience in laparoscopic deep excision surgery
Strong preference for laparoscopic deep excision surgery
Strong preference for excision surgery over robotics or laser ablation
Only performing hysterectomies or oophorectomy as the last resorts
Patented technologies, including the Aqua Blue Contrast technique (ABC)
High-quality surgical imaging
Ready for a Consultation?
Our endometriosis specialists are dedicated to providing patients with expert care. Whether you have been diagnosed or are looking to find a doctor, they are ready to help.
Our Hospital is located on Kokilaben Dhirubhai Ambani Hospital, Rao Saheb, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, 400053
You may call us at 93239 11554.
Endometriosis Treatment in Mumbai
Dr. Anshumala Shukla-Kulkarni is one of the most well-known and well-experienced Endometriosis Doctor in Mumbai, India, and a Laparoscopic & Robotic Surgeon practicing at Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute Mumbai India, offering specialized endometriosis treatment in Mumbai.
Dr. Anshumala has done her advanced training in Singapore and Australia. Previously she has worked with prestigious hospitals like Saifee Hospital, Mumbai, and St. George Hospital, Sydney.
Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute
Kokilaben Dhirubhai Ambani Hospital is a tertiary-care hospital in Four Bungalows, Mumbai, India. The hospital is named after Kokilaben Ambani, wife of industrialist Dhirubhai Ambani, who was the founder of Reliance Industries.
KDAH is one of the top hospitals in Mumbai using all the latest equipment and following international guidelines.
Dr. Anshumala Shukla Kulkarni is a pioneer in robotic surgery and was instrumental in bringing robotic surgery to the hospital. The DaVinci robotic system is one of the most advanced and highly rated robotic technology worldwide. for Endometriosis Treatment in Mumbai book an appointment with Dr. Anshumala.
In The Press
RAS women in India – 5 Robotic GYN Surgeons | Voice of health care
‘I’m trapped in the prison of my body’: The severe, chronic pain of endometriosis
Endometriosis And PCOS: Understanding The Importance Of Early Diagnosis
What Patients Say
Angeline Monteiro & Family, Mumbai
To Dear Dr. Anshumala Shukla Kulkarni, Dr. Shamlee, and all who were there for me.
It takes a lot to go out of the way and help someone. Your gesture has made a big difference in my life. Here’s sending you a note of Gratitude.I wish you reach out to many more, and a big God Bless to you and your family.
Lots of love
Devyani Dalal, Gujrat
Dear Dr Anshumalaji
Next year onwards I shall pay my recognition to you D.r Anshumala, On Doctors day for all your skills, acquisition along with its continual upgradation at mastering minimal invasion,a minimal incision in Gynaecology and thus doing Yeomen service to Women: young and elder, and for redeeming ones faith in her doctor.
Thanks a tonne and more!!!
Mr & Mrs Indira Sharma, Singapore
Dear Dr Shukla,
Thank you for your skill and kindness before during and after my surgery last June. I take the comfort of knowing that the result of the surgery bought us much-awaited joy.
You are a credit to the Medical profession and again we thank you.
Vattikuti Foundation
Robot-Assisted Surgery for Endometriosis
Kokilaben Surgeon Dr. Anshumala Shukla-Kulkarni is connected with the Mother & Child, Robotic Surgery, Gynaecology & Obstetrics, Minimal Access Surgery Departments. She presents a thorough look at her use of the da Vinci Surgical System (robot) for cases of Endometriosis- and the pain patients suffer from endometriosis. She also looks at the underlying causes, and why newer concepts are required to keep up with today’s lifestyles. Lecture, with robotic surgery videos, PPT’s, diagrams. Discussion follows with members of the Robotic Surgeons Council of India