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.
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.
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.
What causes endometriosis and how does it affect fertility?
Welcome to Fertile Minds. I'm Dr. Raewyn Teirney, CREI fertility specialist with IVFAustralia.
What causes endometriosis? Well, we're not exactly clear on what causes endometriosis. We know that about one in 10 women have endometriosis. There are a few theories around as to the nature of the cause of endometriosis.
And the top three theories, the first one is Sampson's theory and this is retrograde menstruation. And the theory goes that when we bleed, blood cells, the uterine cells and endometrial cells, can retrograde, flow backwards from the uterus through your fallopian tubes into your pelvis. And those endometrial cells can then implant into the uterus. And this is one theory.
There is another theory called coelomic metaplasia and here it is where cells that are on your tissues in the pelvis undergo some form of change where they change from one cell into an endometrial cell, and then start growing and implanting under the influence of the female hormone, estrogen.
A third theory is an immune theory, and it is based on your altered immunity that somehow doesn't pick up that there are these cells here because our immune system usually knows if there's something wrong and can then take it out of the system. However, when there's altered immunity, it allows for these endometrial cells to implant further and extend further causing quite severe endometriosis. So these are three possible theories but really are not clear.
How does endometriosis affect fertility? There are a variety of ways. When you have endometriosis what can happen is it can distort the tissues within your pelvis. So it can block fallopian tubes and therefore prevent egg and sperm from meeting. It can distort the anatomy where the fallopian tube cannot even pick up the ovulated egg. It can also distort the ovary and form a cyst within the ovary preventing ovulation or the ovulated egg from coming out as well. This tends to be the more severe endometriosis.
In cases where there is only mild endometriosis, where there are just a few spots and there is no distortion of anatomy, well, then how does it cause infertility then? And some of the theories are based on special mediators that are released by the endometriosis that can have some detrimental factor on egg and sperm interaction and possibly even affect implantation. Again, these are all theories with the stage one and stage two endometriosis, but certainly we know it does affect a person's fertility. And you need to speak to your doctor further about that if you suspect you might have endometriosis.
I'm often asked, does the diagnosis of endometriosis automatically mean that, I'll be in fertile?
Well in fact, that's not the case at all. And many women with endometriosis do go on to conceive naturally. However, if you have endometriosis and you're under the age of 35 and you've been trying for longer than 12 months, then certainly you do need to see your fertility specialist and seek help. Even more so, if you're over the age of 35 and you have endometriosis and you're trying to get pregnant and you haven't been successful for the past six months or longer, then you too must seek specialist fertility help and advice around that.
So when it comes to infertility or when it comes to endometriosis, there are some treatment options. And none of this means that you'll be infertile. Some treatment options would include just surgery. And many women only require a laparoscopic surgery to remove endometriosis. And then many go on to conceive within the next six months after that. However some women may need fertility treatment to help them conceive. And IVF is certainly a great fertility treatment for women with endometriosis.
And so will you always be infertile? The answer is no, because there are certainly very good treatments out there to help women with endometriosis conceive. If you suspect that you might have endometriosis, then my advice to you would be to seek help earlier. Don't wait. I would go and either visit your family doctor or a specialist gynecologist. Sit down with them, let them take your history, possibly examine you and organise for further testing such as a pelvic scan and blood tests.
And the reason why you want to seek help is, because if you do have endometriosis, treatment can occur much earlier. And that can be started pretty quickly. And especially if you're someone who may be having pain, then pain management can occur and start earlier for you. If you're someone who is trying to get pregnant and you think you might have endometriosis, that even this is an even better reason why you should be seeking help earlier and seeing your doctor or fertility specialist.
I hope you found this video helpful. And always remember that fertility specialists like myself are here to help provide support and guidance for you. Thanks for watching. And don't forget to hit the subscribe button (to our channel).
*All opinions expressed on the Fertile Minds YouTube Channel belong to the individual doctors, scientists and specialists, not the Virtus Health group.
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.