What is Endometriosis and how does it affect fertility?

Endometriosis is a medical term that we are seeing more and more frequently nowadays. There are more people talking about it to help normalise conversations around this medical condition that is quite common, yet poorly understood.

 

 

What is Endometriosis?

In a woman’s monthly cycle, endometrium thickens to prepare for a pregnancy when it happens; when a pregnancy does not happen, this lining then sheds and gets discharged out of the body as the “period”.

When this endometrial tissue is found outside of the uterus, it is called Endometriosis. 

This tissue is often found in the abdominal cavity, it may be attached to other organs like the bowel, bladder, ovaries, or fallopian tubes. In very rare cases, it can be found in areas beyond the pelvis region.

 

 

  

What are the signs and symptoms of Endometriosis?

The endometrial tissues that grow outside of the uterus still act the same as normal endometrium, which thicken and break down each cycle. But due to the abnormal location, the blood cannot come out of the body as menstrual flow, it can gradually develop into scar tissues or adhesions.

In some cases, there may be no symptoms at all. But when there are, it can be a real pain, literally. However, it is good to know that the severity of the pain does not always correlate with the extent or the location of the growth.

Common signs and symptoms of endometriosis include the following:

• Pelvic pain and cramping, especially during menstruation
• Heavy or irregular periods
• Pain during intercourse
• Pain during bowel movements or urination
• Fatigue
• Digestive issues such as diarrhoea, constipation, or bloating

 

Infertility and Endometriosis

Infertility is one of the potential complications of endometriosis. 

Endometriosis can negatively affect infertility in a few ways. The growths can block the fallopian tubes, damage the ovaries, or cause scarring and adhesions, making it difficult for the fertilisation process.

How much infertility is affected by endometriosis is dependent on the extent, location, size, and depth of the growths. Before blaming your difficulty to conceive on endometriosis, as it can be a complex issue, make sure you seek professional advice from a specialist, such as a reproductive endocrinologist, a gynaecologist, or a fertility specialist.

However, despite having several theories, the direct cause-outcome relationship between infertility and endometriosis is not well-established and more research is needed to understand the link.

 

 

What causes Endometriosis?

 

The exact cause of endometriosis is not known, but there are several theories. 

One theory is that the endometrial tissue flows through the fallopian tubes and into the abdominal cavity during menstruation. Another theory is that the immune system does not properly remove endometrial tissue while it is shedding during a period.

Inflammation has also been proposed as a potential cause of endometriosis. Some studies have shown that women with endometriosis have higher levels of inflammatory markers in their blood and fluid in the abdominal cavity. 

Some also argue that inflammation caused by endometriosis leads to the development of adhesions and scarring, and these scar tissues then further exacerbates pain and infertility.

Although it is important to note that more research is needed to fully understand the role of inflammation in endometriosis, it is definitely helpful to try to reduce inflammation in your body for many other health benefits.

 

How is Endometriosis diagnosed?

Diagnosis of endometriosis can be difficult, and it can take a long time. At times endometriosis can be mistakenly diagnosed when the symptoms are presented in other conditions, so it can be really frustrating.

Laparoscopy is considered the gold standard for the diagnosis of endometriosis. It is a minor surgery in which a camera is inserted through a small incision in the belly button to look for the growths. Biopsy samples can then be taken during laparoscopy to confirm the diagnosis

Ultrasound and MRI can be used to identify endometriosis but may not be able to detect when it is smaller or when it is deep in the abdominal cavity.

Sometimes doctors may diagnose clinically based on symptoms, pelvic exam, and medical history, in combination with scans and blood tests; however, it is not always reliable and does not result in a definitive diagnosis. 

How to treat Endometriosis?

 

Treatment options for endometriosis vary depending on the severity of the condition and the individual's symptoms and goals. There is no cure for endometriosis, so most treatments aim to manage symptoms or slow down the growth. It can be removed surgically, but there is still a chance that regrowth can occur.

Here are a few key points on the treatments for endometriosis:

• Medication: Pain medication can be used to manage pelvic pain, and  hormonal therapy, such as birth control pills are commonly prescribed by doctors to help manage the growths of endometriosis and regulate periods.
• Surgery: In cases of severe endometriosis or when it is considered the cause of infertility, surgery such as laparoscopy may be necessary to remove the lesion. When a larger incision is needed, a laparotomy can be performed
• Natural therapy: Many women choose to use natural therapies to manage their endometriosis symptoms such as herbal supplements, teas or acupuncture. Depending on the symptoms, things like heat packs, magnesium, and TENS machines can be very helpful just like how they are used to alleviate pain and cramps from periods. There are also teas that can reduce inflammation, help with gas and bloating, or balance hormones, which are all great natural ways to manage the condition.
• Lifestyle management: A healthy diet, regular exercise, and stress management are also important in managing symptoms and the negative mental effect from endometriosis. 
• Support groups: Support groups are a fantastic way to provide emotional support and a sense of community for women dealing with endometriosis. Here are a few social media accounts that creates a safe space for women to talk all about it:

https://www.instagram.com/endogirlgang/

https://www.instagram.com/endohealthhub/

https://www.instagram.com/the__endo__space/

https://www.instagram.com/livingwithendometriosis__/

 

Endometriosis is a very complex medical condition that can have a significant impact on a woman's life. But the good news is that there are many ways to manage and treat the symptoms of endometriosis. Whether it's through conventional medical treatments, natural therapies, or lifestyle changes, it's important to work with a healthcare professional to find a treatment plan that works for you.

Remember that while endometriosis and infertility are often associated, it's not a direct cause-outcome relationship. It is important to understand that not all women with endometriosis will have difficulty getting pregnant, and not all women who have difficulty getting pregnant have endometriosis.

Living with endometriosis can be challenging, but remember that you're not alone and you can live a full and happy life despite endometriosis.

 

 

References:

1. https://www.nice.org.uk/guidance/ng73
2. https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
3. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/endometriosis-does-it-cause-infertility/#:~:text=Endometriosis%20can%20influence%20fertility%20in,pregnancy%2C%20and%20altered%20egg%20quality.
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941592/
5. https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8836207/
7. https://www.jeanhailes.org.au/health-a-z/endometriosis/management-treatment

 

Images:

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