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.

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. 

Find out more about Laparoscopic surgery…

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.

Find a specialist

Expert advice on Endometriosis

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.