Manual of Endometriosis Kanthi Bansal
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Kanthi BansalMD DGO FICOG Director, Safal Fertility Foundation, Ahmedabad, Gujarat, India Chairperson, Endometriosis Committee FOGSI Clinical Secretary ISAR Chairperson Accreditation Committee ISAR Secretary Gujarat Chapter ISAR Secretary ISAR 2014 Peer Reviewer JOGI Peer Reviewer JRSCB Special Invitee AOGS Editor AOGS E-mail: Website: ForewordRoy Homburg
A FOGSI Publication
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© 2013, Federation of Obstetric and Gynaecological Societies of India
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Manual of Endometriosis
First Edition: 2013
Printed at
5Dedicated to
My son Aditya6
7Contributors 11Foreword
The very mention of the word endometriosis conjures up a series of questions. What is the etiology and pathophysiology? Why is the diagnosis so often missed or delayed? How should it best be treated? Do the milder forms of endometriosis cause infertility? What is the significance of adenomyosis?
As with many enigmatic diseases, there is a plethora of hypotheses and therapeutic possibilities. In this Manual of Endometriosis, Dr Kanthi Bansal has gathered and presented the evidence which will undoubtedly provide an excellent guide to the practicing gynecologist.
The evolution of endometriosis is first explained leading to a description of the wide clinical spectrum. Does it really start from retrograde menstruation and, if so, why do some suffer from this and some not? All the problems of the diagnosis, and there are many, are then dealt with. Regarding the clinical spectrum and diagnosis, so much seems to depend on the location of the lesions. What should be done with ovarian endometrioma? When should they be surgically removed, punctured or left well alone? To what extent does endometriosis interfere with fertility? Is it only in the advanced stages? When should medical management be used and when is surgical management called for? These are various questions asked every day in practice. In this manual the contributors have rounded up the questions and answered them in a way which will provide an excellent guide.
Dr Kanthi Bansal is to be congratulated in having the courage and taking the bull by the horns by presenting and answering all the problems involved with this enigmatic disease. The readers of this manual will be the beneficiaries.
Roy Homburg
Professor of Reproductive Medicine
Maccabi Medical Services and Barzilai Medical Center, Israel
Head of Research
Homerton University Hospital
Queen Mary, London University
London, UK12
It gives me immense pleasure to write a few words for the Manual of Endometriosis. It must have been a simple and easy-to-understand format on such a difficult and complicated subject. I must congratulate Dr Kanthi Bansal for making such a great effort. All the chapters are carefully selected and written very methodically. There is clarity of thought and understanding of the subject which is evident in the writing of all the chapters.
This book will immensely help the medical practitioners and members of FOGSI.
I wish Dr Kanthi Bansal, Chairperson of Endometriosis Committee, FOGSI and her team all the very best for their future endeavors. I will appreciate feedbacks and constructive critism from readers to present better reading material in future.
PK Shah
Federation of Obstetric and Gynaecological
Societies of India (FOGSI)14
This Manual of Endometriosis, dealing with the various aspects of the clinical, preventive and research aspects of the condition, I am sure, will highlight and answer a number of important questions related to the enigmatic condition that endometriosis has always been. I appreciate and applaud the efforts of the Endometriosis Committee of FOGSI and especially Dr Kanthi Bansal in bringing out this issue.
Dr Kanthi Bansal and the Endometriosis Committee are to be congratulated for their innovative advocacy work for the women affected by the condition. The philosophies, treatments, and lifestyle approaches are discussed in this manual they have brought to us, seem logical and have benefited many.
Unfortunately, the vast majority of physicians are unfamiliar with the big-picture view of the disease. And, many women with endometriosis have turned to alternative medicine for validation and treatment. It is time for better awareness and early precise diagnosis of the condition, to help both, the clinician and the patient. The contents of this manual demonstrate the extraordinary resources that can be made available to both.
Nandita Palshetkar
md fcps ficog
First Senior Vice President of FOGSI (2011)
Indian Association of Gynecological Endoscopists and Mumbai Obstetrics and Gynaecological Society
Member, Managing Committee of ISAR
Consultant IVF Expert
Fortis Bloom IVF Center, New Delhi/Mohali/Vashi and Lilavati Hospital, Mumbai
Trustee, DY Patil Medical College
Mumbai, Maharashtra, India16
Knowledge rests not upon truth alone, but upon error alsoCarl G Jung
Endometriosis is an enigma and so many women suffer the pain of endometriosis and that affects the quality of life. All of us work individually for the betterment of women's health but joint effort is required by Government of India (GOI), medical associations, doctors and all the stakeholders for catalytic effect in improving reproductive health of our patients.
This book Manual of Endometriosis is essentially covering all the important topics from origins of endometriosis to the therapies. Modern management of endometriosis, endometriosis and infertility, surgery in endometriosis, pain management in endometriosis, surgical management of endometriosis, management of endometrioma, rectovaginal endometrioma, recurrent endometriosis and so many more well-covered topics make this book a must read.
This book on “endometriosis” is edited by Dr Kanthi Bansal, Chairperson of Endometriosis Committee of FOGSI has successfully managed to address all these issues related to endometriosis and I congratulate her on this excellent book and highlighting the importance of endometriosis.
Mandakini Parihar
md dgo ficog
Vice President of FOGSI (2012)
Director, Mandakini IVF Center, Mumbai
Chairperson, Family Welfare Committee, FOGSI
Honorary Associate Professor
Department of Obstetrics and Gynecology
KJ Somaiya Medical College and Hospital
Mumbai, Maharashtra, India18
It is a matter of great pride and privilege for Ahmedabad Obstetrics and Gynaeocological Society (AOGS) as an organization that one of its most respected member with illustrious academic career, Dr Kanthi Bansal has penned a Manual of Endometriosis. This disease is distressful condition for women suffering from it. The manual is such as, an epic book of endometriosis, where you find all the required answers for your queries related with the disease.
On behalf of AOGS, we wish her all the good luck for the warm acceptance by universe of academicians, including—private consultants, teachers, undergraduate and postgraduate students.
Dipesh Dholakia
Ahmedabad Obstetrics and Gynaecological Society
Ahmedabad, Gujarat, India
Hemant Bhatt
md llb
Honorary Secretary
Ahmedabad Obstetrics and Gynaecological Society
Ahmedabad, Gujarat, India20
The journey of life is mysterious, but the disease endometriosis is more mysterious than life itself! All aspects of endometriosis are still an enigma, right from incidence, diagnosis and management.
The Federation of Obstetric and Gynaecological Societies of India has taken a very important decision in giving this important field in gynecology, by forming a committee. I would like to thank the members, for electing me to be the first and founder Chairperson of this prestigious committee.
There are several activities organized by the endometriosis committee such as continuing medical educations (CMEs), workshops, international collaborations, adolescent health education for endometriosis, research and publications. Under the heading of publications, two important publications including the bulletin, Endometriosis Gen, a yearly publication and this book Manual of Endometriosis are published.
The book is drafted in a way to make it very interesting at the same time giving complete details in the topics to cover the subject in total. Almost all the topics related to endometriosis are covered from evolution, structure to function, diagnosis, endometrioma, infertility, adolescent endometriosis, recurrence, adenomyoma, scar endometriosis, rectovaginal endometriosis, coping with endometriosis to future thoughts.
I believe this book will be truly beneficial to postgraduate students, teachers and practicing doctors.
I feel this is a humble approach trying to unfold the mystery that is endometriosis.
Kanthi Bansal22
My sincere thanks to all the contributors of this book for making it a dream come true for me. I am indebted to them for devoting their time in writing chapters for this manual despite their hectic schedule.
I thank Ms Khushboo Patel, for doing the coordinating work during the shaping up of this book.
Ms Aarti Vadinkar, deserves to be appreciated, for her input towards this book. I am glad that I have such an understanding family to back me. I thank my husband Dr Mukesh Bansal, my lovely children Suma and Aditya, for being so patient with me when I give their time to academic work.
The editorial staff of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, have done a wonderful job, my heartfelt thanks to them.
Kanthi Bansal