 Hello everybody, I am Dr. Mukthi Harne Paitankar, consultant obstetrics and gynaecology at Manipal Hospital Gurgaon. Today we will be talking about endometriosis and the reason we need to discuss this because the prevalence is around 6 to 10 percent. That is in a group of 10 women, around 1 to 2 women are suffering from endometriosis. The term endometriosis means lining of the uterus present outside the uterus. That is the uterus has an inner lining called as endometrium. Now these endometrium cells when present outside the uterus, they act exactly like the endometrium. Like in every cycle the uterus is preparing itself for a childbirth. It is preparing itself for a baby and when it doesn't happen it sheds in the form of menstrual cycle. These cells which are present outside the uterus, the endometrial cells, they also act like the endometrium and they swell or form a cyst or they irritate the peritoneum causing pain. There are few studies or few theories that explains endometrium. Few of them are retrograde menstruation, lymphatic drainage, vascular spread or silamic metaplasia. Now these are all theories which explains endometrium but particular causes are unknown. What are the risk factors or predisposing factors for endometrium? One of them is if the family history is having a positive history for endometriosis it runs in the family and the female is exposed for endometriosis. Also if the female is exposed to high estrogen level or high estrogen therapy. Now there are some symptoms that the presentation where the female presents with number one is dysmenorrhea that is she has a lot of pain during menstrual cycle. Then dysperinia that is painful intercourse dysuria that is pain during passing urine dysfunctional uterine bleeding that is it she has an abnormal cycle or irregular cycle that is she is bleeding in between two cycles. So and the most common is dyschronic pelvic pain that is she has pain in her lower abdomen even if she's been treated for infections. Now according to the signs there are also correlating symptoms and signs that we see. The most common is the ovarian endometrioma or cyst over the ovary. Now this cyst has collection of chocolate colored fluid which is also called as chocolate cyst. Along with the signs and symptoms we come to a diagnosis of endometriosis which is confirmed by imaging. Some imaging like ultrasound and MRI gives a better picture of what is going inside the body. But the diagnostic or the gold standard is a laparoscopic surgery in which we put a probe inside the abdomen just to see where the other lesions are present of the endometrium which emits as endometriosis. According to the signs and symptoms we divide the diagnosis into minimal, mild, moderate and severe. Now the treatment that we give the patient depends on medical management and a surgical management. Not all patients require surgical intervention. The ones requiring medical management fall in the category of minimum to mild endometriosis. Now these have a lesion, size lesion is less than 4 centimeter and have a fewer symptoms. Medical management include hormonal therapy which is in the form of progesterones, estrogen and progesterone as a combination and gonadotropin releasing hormone as a combination. Now this can be given together or separately depending upon patient to patient. If the size of the lesion is more than 4 to 5 centimeters then we have a surgical intervention. Surgical intervention means we remove the cyst or the endometrium or any other form of lesion that mimics the endometrium that is done by either a lesion or some simply doing a cystic to me. What are the take home messages in endometriosis? Well if there is a family history of endometriosis then the childbirth should not be prolonged. Family planning should be done earlier in life. Second there should not be a PV examination or pelvic examination during menstruation. And thirdly there should not be overuse or abuse of hormones taken orally. Well the need of governing and awareness of this disease is required to decrease the prevalence. Thank you.