Endometriosis Treatment in Ahmedabad

Endometriosis can now be identified on symptoms and a scan long before a laparoscopy is needed — and the plan for pain is not the same as the plan for pregnancy.

Endometriosis is tissue like the lining of the uterus growing where it does not belong — on the ovaries, behind the uterus, on the ligaments that hold it, sometimes on the bowel or bladder. It bleeds a little each month with no way out, and the inflammation that follows is what causes the pain, the scarring and, for some women, the difficulty conceiving. The World Health Organization puts it at about 10% of women of reproductive age, roughly 190 million worldwide; a 2025 review in the Journal of Obstetrics and Gynaecology of India estimates 42 million of them are in India.

Why it so often takes years to be named

The symptoms are common ones, and each of them has a dozen other explanations. The disease announces itself as period pain that stops a woman going to work or college, pain during or after intercourse, pain opening the bowels around the period, blood in the urine at the same time each month, or infertility alongside any of those. WHO records the average time from first symptom to diagnosis as four to twelve years.

Most of that gap is not caused by difficult medicine. It is caused by the pain being treated as ordinary, by a normal scan being read as an all-clear, and by nobody putting the cyclical bowel or bladder symptoms together with the period.

How it is diagnosed now, and what changed

For years the answer was that only a laparoscopy could prove endometriosis. That is no longer the position. The 2022 ESHRE guideline moved imaging to the front of the work-up and states plainly that laparoscopy is no longer the diagnostic gold standard — it is recommended where imaging is negative and where hormonal treatment has not worked or is not appropriate.

What that means for a woman sitting in the consulting room is that the first visit is a history, an examination and an ultrasound, not an operation. ESHRE also warns that clinical examination alone has low diagnostic accuracy, and that the work-up should go on even when the examination is normal. NICE NG73 is blunter still: do not exclude endometriosis if the examination and the scan are both normal.

Two different questions, and two different plans

This is the part that is most often got wrong, and it decides everything that follows. Treatment aimed at pain and treatment aimed at pregnancy are not the same treatment, and in one respect they point in opposite directions. Hormonal treatment is the mainstay for pain — and NICE states that hormonal treatment, alone or with surgery, should not be offered to a woman who is trying to conceive, because it does not improve the chance of spontaneous pregnancy. ESHRE says the same of ovarian suppression in infertile women with endometriosis: do not prescribe it to improve fertility.

So the first question at the consultation is not which drug. It is: what is she asking the next twelve months to deliver?

Treatment when pain is the problem

ESHRE’s strongest recommendation on pain is also its simplest: offer hormone treatment as one of the options. Within that, the choices differ in how long they can be continued and in what they cost the body.

None of these removes the disease. They control it, and in most women they control it well enough that no operation is needed. That is worth saying plainly, because the fear of surgery is often what keeps a woman from coming at all. More on the symptoms and the day-to-day picture is in our article on endometriosis symptoms and treatment options.

When surgery is the right answer

Surgery earns its place when medication has not controlled the pain, when there is a cyst that needs dealing with, or when a woman trying to conceive has early-stage disease that can be cleared. It is done by keyhole surgery. Two technical points from ESHRE are worth a patient knowing in advance, because they are the difference between a good operation and an average one: endometriosis is better excised than burned, and an ovarian endometrioma is better removed as a cyst wall (cystectomy) than drained and coagulated, because drainage lets it come back.

The counterweight is the ovary. ESHRE’s recommendation on endometrioma surgery is that specific caution is used to minimise ovarian damage — and that surgery on an endometrioma should not routinely be done before IVF, because it shows no benefit to live birth and is likely to reduce ovarian reserve. For a woman of 36 with a small endometrioma and a plan to start IVF, the right answer is often not to operate at all.

Hysterectomy, with or without removing the ovaries, is an option for a woman who has finished her family and has not responded to anything more conservative — with all visible disease excised at the same operation. ESHRE requires that she is told it will not necessarily cure the symptoms. Where the disease involves the bowel, bladder or ureter, the operation has to be planned before theatre rather than discovered during it. Deep endometriosis involving the bowel, bladder or ureter is operated on here at Cosmic, with that planning done beforehand. Robot-assisted surgery, which ACOG names as one of the situations where the robotic platform has a real advantage, is performed by Dr. Rahul Khatri at Apollo Hospital, Gandhinagar, where he is attached; there is no surgical robot at Cosmic. What is done here is described procedure by procedure on our laparoscopic surgery page, and what a keyhole operation is actually like is set out in keyhole gynaecological surgery: what to expect.

Endometriosis and getting pregnant

Up to half of women investigated for infertility are found to have endometriosis, so this is not a side issue. The guideline position is pragmatic rather than heroic:

• In early-stage (rASRM I/II) disease, operative laparoscopy with excision and adhesiolysis improves the chance of conceiving naturally, and can be offered.
• The decision to operate is made on pain, age, previous surgery, other fertility factors, ovarian reserve and the Endometriosis Fertility Index — not on the stage alone.
• In early-stage disease, IUI with ovarian stimulation gives better pregnancy rates than waiting or than IUI alone.
• IVF is the route where the tubes are affected, where there is a male factor, where the fertility index is low, or where other treatment has not worked.
• ESHRE’s reassurance, at its strongest evidence grade, is that IVF does not make endometriosis recur more often than it would otherwise.

Fertility and IVF at Cosmic are led by Dr. Bhargavi Khatri; the programme and what a cycle involves are on our IVF centre in Naroda page.