Ahmedabad (Gujarat) [India]: Dr Sandeep Sonara, an advanced gynaecology laparoscopic surgeon and ‘endometriosis’ specialist based in Gujarat, emphasised the need for awareness among women, stating that India’s large population contributes to it having the highest number of patients suffering from this condition.
In an interview with media, Dr. Sandeep cited World Health Organisation (WHO) data, which shows that endometriosis affects around 10 per cent of women of reproductive age globally.
“Regarding India, given its population size, 25 per cent of the global burden of women suffering from endometriosis falls here,” he explained.
When asked about symptoms and the impact on women, Dr Sandeep said, “Endometriosis causes pain, infertility, and in some cases, if undiagnosed for years, it may progress to malignancy, where abnormal cells grow and spread uncontrollably.”
“Patients experience pain during menstruation, urination, and backaches. Even post-menstruation, pain can persist. Some young women are restricted from household and professional work due to the condition. Post-marriage, it can lead to infertility, and in one per cent of cases, endometriosis progresses to malignancy,” he added.
On the situation in India, Dr Sandeep noted that social taboos often prevent young girls from discussing menstrual issues with doctors.
“In India, societal taboos mean young girls often avoid consulting doctors about menstrual pain. Instead, they take painkillers during menstruation, neglecting symptoms, which can ultimately disrupt their lives,” Dr Sandeep explained.
He also pointed out that this condition is a contributing factor to marital discord, as it can lead to infertility.
When asked why the disease is difficult to diagnose, Dr Sandeep cited a lack of awareness, technology, and expertise within the current healthcare system.
“The exact cause of endometriosis is unknown, but scientific theories exist. One theory suggests retrograde menstruation, where menstrual blood deposits in the abdomen, cause inflammation. Another theory is genetic. A third theory likens it to cancer, with the disease potentially spreading to the lungs and brain. The fourth is called coelomic metaplasia.
These complex pathophysiologies make diagnosis and treatment challenging,” he said.
“We can’t claim it is fully curable, as it stems from physiological processes like menstruation. However, we can manage the symptoms to allow women to lead fulfilling lives,” he added.
Dr. Sandeep shared his breakthrough research, in which he diagnosed and treated an exceptionally rare presentation of endometriosis–the first such case in humans globally.
“I recently published research on a rare endometriosis presentation. The patient, who suffered from pain and infertility for 14 years, had consulted orthopaedic surgeons, gynaecologists, and pain specialists without a diagnosis,” he explained.
“When the patient visited us, we identified an unusual cyst location. This endometriosis cyst, found beneath the uterus, was surgically removed and diagnosed as a mesonephric cyst endometrioma. Previously, this condition had only been identified in dogs, with three recorded cases worldwide. After six months post-surgery, the patient successfully conceived,” Dr. Sandeep added.
The expert also highlighted the Multidisciplinary Endometriosis Care Centre, staffed with specialists to address various aspects of the condition.
“The centre includes IVF specialists for infertility, as well as a gastroenterologist, urologist, anaesthetist, and radiologist. A psychotherapist provides counselling and pain management support,” he noted.
Discussing the importance of an expert team, Dr. Sandeep recounted a patient from Bangalore who suffered from lung endometriosis, leading to blood vomiting.
“A dedicated team is essential to deliver comprehensive treatment for such complex cases,” he stressed.
Dr. Sandeep also shared that he received accreditation from the Surgical Review Corporation (SRC) in the United States for his contributions to endometriosis care.
“I received the Master Surgeon accreditation in Multi-Disciplinary Endometriosis Care from SRC, which evaluated my surgical quality and patient recovery outcomes. I am the only doctor in Gujarat with this accreditation,” he said.
Calling for more awareness of endometriosis, he advocated for establishing multidisciplinary care units across India.
“Awareness about endometriosis is crucial. While the condition is treatable, India’s treatment centres are limited. Many gynaecologists can treat endometriosis but do not follow international guidelines and protocols,” he concluded.