Exploring the role of imaging and understanding progesterone resistance in endometriosis

Written by: Dr Anu Chawla
Edited by: Aoife Maguire

Endometriosis affects millions of women worldwide, causing debilitating pain and impacting daily life in profound ways. Despite its prevalence, there remains a lack of understanding and awareness surrounding this condition. By raising awareness, we can empower individuals to seek proper diagnosis, treatment, and support, ultimately improving the quality of life for those living with endometriosis. Together, we can break the silence, educate others, and advocate for better care and research to ensure that no one suffers in silence.


Distinguished senior fertility specialist Dr Anu Chawla explores endometriosis, explaining the role of imaging in the diagnosis and treatment, alongside the role of progesterone resistance in the condition.



What are the latest updates in endometriosis treatments?


At the recent Edinburgh conference on endometriosis research, several notable updates emerged. Researchers presented promising findings regarding novel treatment approaches, including targeted therapies aimed at reducing inflammation and pain associated with endometriosis.


Additionally, the presentation emphasised progress in diagnostic tools and techniques, offering hope for earlier and more accurate detection of the condition, and conversations underscored the importance of interdisciplinary collaboration and patient-centred care in driving progress forward.


Overall, the conference provided a platform for exchanging ideas and fostering collaborations to improve outcomes for individuals affected by endometriosis.


What is the role of imaging in endometriosis?


Imaging plays a crucial role in the diagnosis and management of endometriosis. Techniques such as transvaginal ultrasound (TVUS), magnetic resonance imaging (MRI), and occasionally computed tomography (CT) scans can help visualise endometrial lesions and assess their size, location, and extent.


These imaging modalities aid in surgical planning, allowing for more precise and targeted treatment. Additionally, advances in imaging technology, such as high-resolution MRI and three-dimensional (3D) imaging, are enhancing our ability to detect subtle lesions and improve diagnostic accuracy. Incorporating imaging into the diagnostic process enables clinicians to better understand the extent of disease and tailor treatment strategies to individual patients, ultimately improving outcomes and quality of life.


What is the link between progesterone resistance and endometriosis?


Progesterone resistance is a key factor in the development of endometriosis. Normally, progesterone works to regulate the menstrual cycle and inhibit the growth of endometrial tissue outside the uterus. However, in individuals with endometriosis, there is evidence of decreased progesterone responsiveness in ectopic endometrial tissue. This resistance leads to uncontrolled growth, inflammation, and continued survival of endometrial implants, contributing to the persistence and progression of the disease.


Several mechanisms underlie progesterone resistance in endometriosis, including alterations in progesterone receptor expression, dysregulation of signalling pathways, and crosstalk with inflammatory mediators. Progesterone resistance not only promotes the survival of ectopic endometrial tissue, but also contributes to symptoms such as pain, infertility, and menstrual irregularities. Understanding the mechanisms of progesterone resistance is crucial for developing targeted therapeutic approaches aimed at restoring progesterone sensitivity and mitigating the progression of endometriosis.


Therapies targeting progesterone resistance offer hope for improving symptom management and fertility outcomes in individuals with endometriosis.


How can a doctor help with endometriosis management?


Seeing a doctor is crucial for alleviating symptoms, and managing endometriosis effectively. A healthcare provider can provide an accurate diagnosis, offer treatment options tailored to individual needs, and help monitor the progression of the condition. Early intervention can prevent the worsening of symptoms and potential complications such as infertility or organ damage. Furthermore, a doctor can offer guidance on pain management strategies, hormone therapy, and surgical options if necessary.


They can also provide emotional support and connect patients with resources such as support groups or mental health services. Regular check-ups with a doctor allow for ongoing evaluation of treatment effectiveness and adjustments as needed. Overall, seeking medical care empowers individuals with endometriosis to take control of their health and improve their quality of life.





If you are concerned about endometriosis and would like to book a consultation with Dr Chawla, do not hesitate to do so by visiting her Top Doctors profile today

By Dr Anu Chawla
Fertility specialist

Dr Anu Chawla is a highly-experienced senior fertility specialist, practicing Advanced Reproductive Medicine, in London

Her area of expertise is in Advanced Fertility PracticeRepeated IVF failures, Polycystic Ovarian Syndrome, PCOSEndometriosis (Current Chairperson of Endometriosis Committee of FOGSI), Reproductive Immunology, Egg Freezing, Fibroids, Male Factor Infertility.

Dr Chawla qualified in medicine in Gujarat University in 2007 and then went on to pursue a Master's degree in obstetrics and gynaecology.  She became a member of the Royal College of Obstetricians and Gynaecologists, London, in due course.  

She also obtained a diplomate of the National Board in Obstetrics and Gynaecology. She holds Three Post Graduation Degrees in Obstetrics and Gynaecology, one from UK, two from India, from reputable universities. In addition, she did Advanced Fellowship in Minimal Access Surgery and another Fellowship in Reproductive Medicine.

She trained in Advanced Level 3D Pelvic Ultrasounds with Prof Stuart Campbell, in London.

She went to the United States to do a Reproductive Medicine Observership Programme at National Institutes of Health, Bethesda, Shady Grove Fertility Clinics in Bethesda, Maryland, USA, and in IVF Department at the EVMS Jones Institute in Virginia, USA, Centre of Reproductive Medicine New York, New Hope Fertility Centre New York.  

Dr Chawla has been previously appointed as a clinical lead consultant in Advanced Fertility Department at various leading teams in India, where she also founded the esteemed IVF department at the Fortis Memorial Research Institute at Gurgaon in Delhi Region.

Her high success rate and clinical excellence in Fertility Practice, with global expertise and perspective, brought her an offer to come back to London and join St. Bartholomew’s Hospital and the Queen Mary University, London Hospital as a Senior Fertility Specialist, where she did huge numbers of egg collections, embryo transfers etc.

She worked at Create Fertility, St. Paul’s, London and The Fertility and Gynaecology Academy, London.

Combining clinical expertise in both gynaecological Fertility Enhancing Surgery and Reproductive Medicine, Dr Chawla's patients benefit from her sensitive, comprehensive and continuous care throughout their conception journey. 

Dr Anu Chawla's has been actively contributing to the various gynaecology associations, like Royal College of Obstetrics and Gynaecology, RCOG, London, The International Federation of OBGYN, FIGO, and the Federation of Obstetrics and Gynaecological Societies in India (FOGSI), amongst others.  

Dr Chawla is a regular invited faculty speaker, at various international and academic key fertility and OBGYN conferences around the world. Most recently, she was invited to chair a film festival session on the topic of Sexual and Reproductive Health and Wellbeing at the XXIV FIGO World Congress of Gynecology and Obstetrics. She was additionally actively involved in campaigning to extend the time span of egg freezing for women in the UK, an amendment which has now been successfully enacted in to law. Dr Chawla also regularly conducts charitable medical projects in India, providing low cost reproductive and gynaecological care for those in need.

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