What is Endometriosis?
Endometriosis is when the cells that line the uterus or endometrium, grow in places outside the uterus (such as the pelvis). Around 10% of women of reproductive age are affected by endometriosis. It is quite a common condition, especially in women over 30 who have not yet had children.
Expert advice on Endometriosis
Endometriosis is a very common female condition especially in women who are over 30 and haven’t had a child. It's a condition where tissues that are very similar to the lining of the uterus, and we call that the endometrium, that lining can also be found outside the uterus within the pelvis, lining tissues such as the ovary, the fallopian tube and other organs such as the bladder and the bowel. It can cause inflammation, scarring, and adhesions within the pelvis. And it can also cause infertility.
Dr Nalini Gayer:
Now there are many ways it can cause infertility. One of the ways is that the ovaries cannot release the eggs. The ovaries can get filled up with large cysts. Sometimes the fallopian tubes can become inflamed, distorted, swollen so that they cannot transport either the eggs or the sperms together. Overall, endometriotic tissue because it's abnormal, it's also toxic to the embryo.
Now what are the symptoms of endometriosis? You may have worsening period pain which is getting worse over the years. You may have heavy periods, sometimes painful sex, bladder pain, bowel pain and some abnormal spotting like brown or black spotting. Some women with significant endometriosis do not have any of these symptoms and may still have endometriosis.
There are medical treatments, there are surgical treatments. All the treatments approach towards eliminating high oestrogens in a woman's body because oestrogens acts as a fertilizer to grow the endometriosis. The medical options include medications taken orally through the mouth, sometimes putting an intrauterine device inside the uterus so that it can act locally on the endometriosis in the pelvis. Sometimes injections, sometimes implants. They all reduce your oestrogens so that endometriosis stops growing.
Dr Raewyn Teirney:
The gold standard for treating endometriosis is a laparoscopic procedure. And this is a minimally invasive procedure that does require a general anesthetic. It is where the surgeon places a very thin telescope through an incision in your belly button. And through that telescope, they can actually have a look at your pelvic organs and check for the presence of endometriosis. They can treat it then and there and at the same time we can also check your fallopian tubes, check the uterus for any fibroids and the presence for any other pathology that could be affecting your fertility. So if you think you've got endometriosis and you're trying to get pregnant, then go and see your GP and get a referral to see a fertility specialist.
- Endometriosis symptoms
Symptoms of endometriosis include painful periods, pain during intercourse and premenstrual spotting.
Factors that could indicate a higher incidence of endometriosis include:
- Early puberty (first period before 11 years of age)
- Advanced maternal age at first child birth
- Heavy, painful periods
- Long periods (more than 5 days) or short cycles (less the 27 days between periods)
- A family history of close relatives with endometriosis
Endometriosis and Emotions:
Research has linked endometriosis to an increased likelihood of anxiety or depression. The chronic pain associated with endometriosis can often become a cyclical link, in which pain can increase anxiety, and yet the anxiety can worsen endometriosis pain.
- How does endometriosis affect fertility?
This is not always clear. Severe endometriosis can distort the tubes and ovaries and can block the egg’s release by causing scar tissue or cysts. However, while mild endometriosis is, in some cases, associated with infertility, how this happens is not known.
It’s also important to remember that many women who struggle with the severe pain of endometriosis can still conceive naturally.
- What causes endometriosis?
Whilst it is unclear exactly what causes endometriosis there are a few theories:
Retrograde (backward) menstruation: During menstruation some of the menstrual blood that carries endometrial tissue cells flows backwards along the fallopian tubes into the pelvis where the cells can then implant and grow.
Coelomic Metaplasia: Suggests that the cells lining the pelvic organs are able to change their structure and function to become endometrial cells when they are influenced by certain conditions. Triggers could include puberty or oestrogen surges.
Altered immunity: Suggests that endometriosis might arise from a change in your immune system’s ability to recognise the presence of endometrial tissue in abnormal locations and eliminate it.
- Diagnosis of endometriosis
At times, your doctor may suggest that you have endometriosis based on your symptoms as well as recognising clinical signs upon physical examination. A detailed history will be taken as well as a pelvic examination to identify the thickening of endometriosis behind the uterus. An ultrasound may also help doctors identify areas of concern that are consistent with endometriosis.
To confirm a diagnosis of endometriosis, a minimally invasive procedure called laparoscopic surgery is required, where a surgeon will look inside the abdominal cavity through a small incision in the navel.
Endometriosis is often classified as mild, moderate or severe or recorded in surgical notes as stage or grade I - IV:
- Mild or stage/grade I endometriosis appears as small patches or surface lesions scattered around the pelvic cavity.
- Moderate or stage/grade I or II endometriosis appears as larger widespread disease starting to infiltrate tissue and often found on the ovaries, uterosacral ligaments and Pouch of Douglas. Sometimes there is also significant scarring and adhesions.
- Severe or stage/grade IV endometriosis affects most of the pelvic organs, often with distortion of the anatomy and adhesions.
It’s important to remember that although these stages are useful, the symptoms and pain experienced within each stage are not always consistent. Furthermore, each stage does not necessarily correlate to how badly endometriosis will affect a woman’s fertility or amount of chronic pain.
A woman who has stage 1 endometriosis, for example, could experience more pain than someone who has been diagnosed with stage 4 endometriosis. It is very much dependent on the individual.
- Endometriosis treatment
Laparoscopic surgery is an effective treatment for the pain of endometriosis, as well as other gynaecological conditions such as fibroids, uterine or tubal problems. The surgeon looks inside the abdominal cavity through a small incision in the navel to confirm endometriosis and can remove the endometriosis at the same time.
Surgery for endometriosis has been shown to improve natural conception rates. However, it is not clear whether surgery for endometriosis will improve the success rate for IVF. In some cases, where the endometriosis has formed a cyst on the ovary, surgery for endometriosis can reduce the number of eggs available for IVF.
- When to see a doctor
If you experience symptoms that might be due to endometriosis and are also having trouble conceiving naturally, you should seek advice from your GP or a fertility specialist.
Suspect you have endometriosis?
If you suspect you may have endometriosis and have been trying to conceive for 12 months (6 months if you are over 35 years of age) you should consider booking an appointment with a fertility specialist.
Appointments are available in the next couple of weeks and will cost approximately $150 for a couple after the Medicare rebate.