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Endometriosis - the facts

All you need to know about endometriosis, from its symptoms to possible treatments and its likely impact on fertility and pregnancy
What is endometriosis?

During each menstrual cycle endometrial tissue develops in the womb in preparation for the implantation of a fertilised egg, if conception doesn't occur this lining is then shed as part of menstruation.

Endometriosis is a condition in which endometrial tissue develops outside the womb, most frequently in the fallopian tubes, ovaries, on the outer side of the womb and on the ligaments that support the uterus, however it can also develop outside the pelvis on the bowel, bladder, intestines, vagina or rectum and less frequently in other areas of the body.

Throughout a menstrual cycle the endometrial tissue that develops outside the womb goes through the same changes as tissue in the womb, progressively thickening and then shedding. Problems occur because when this tissue is shed at the end of a cycle it doesn't have any way of leaving the body and so irritates surrounding tissue, causing scar like 'adhesions' to form. It is the build up of these adhesions that cause the pain and discomfort associated with endometriosis.

What are the symptoms of endometriosis?

Frequently endometriosis is only diagnosed when a woman experiences trouble conceiving as many of its characteristic symptoms are similar to those associated with other conditions.

The type and extent of symptoms experienced as a result of endometriosis vary from woman to woman and aren't necessarily indicative of the severity of the condition as, depending on the location of the adhesions, mild endometriosis can cause extreme discomfort and vice versa.

Symptoms typically associated with endometriosis include:
  • Severe pelvic pain before and during menstruation

  • Pain during intercourse

  • Painful bowel movements often with symptoms of irritable bowel syndrome and bleeding from the rectum, this tends to be at its worst just before and during menstruation

  • Pain urinating especially before or during a period

  • Irregular periods, prolonged bleeding, spotting or very heavy periods

  • Lower back pain with pain in the abdomen, buttocks and legs

  • Depression, extreme tiredness and a lack of energy
What causes endometriosis to develop?

Currently there is no one definitive explanation as to why endometriosis develops, although a number of theories have been put forward as explanations. These include:
  • A genetic predisposition to endometriosis that is passed down through generations and makes some women more susceptible than others to this condition.

  • Retrograde menstruation where blood flows backwards into the fallopian tubes during a period causing endometrial tissue to implant outside the uterus.

  • Exposure to environmental toxins such as dioxins.

  • An immune dysfunction that means some women's bodies are unable to block the growth of endometrial tissue outside the womb.
How is endometriosis diagnosed?

On average it takes 8 years for endometriosis to be diagnosed, according to charity Endometriosis UK, simply because there are no symptoms specific only to this condition. However, despite this statistic it's important to get diagnosed as soon as possible, especially if you are trying to conceive as more endometrial tissue develops each menstrual cycle that passes, so the longer its left without treatment the more severe it becomes.

If you think you could be suffering from endometriosis its recommended that you keep a diary of your symptoms for at least three months so that your doctor can see patterns in the discomfort you're experiencing and has a more solid platform from which to begin diagnosis.

Diagnosis is likely to begin with a physical examination and is often followed with an ultrasound scan to check for cysts. However, the only certain way to diagnose endometriosis is with a laparoscopy. This involves keyhole surgery where an examination of the internal abdominal organs is performed using a microscopic camera. Laparoscopies are usually performed under general anesthetic but tend only to be an outpatient operation. Where endometriosis is diagnosed it is possible to administer treatment during the same procedure however your doctor will discuss this with you before surgery.

How will endometriosis affect my chance of conceiving?

Endometriosis can cause problems conceiving however just because you've been diagnosed it doesn't meant that you won't be able to get pregnant naturally. The impact endometriosis has on your fertility will depend on the location and severity of the tissue growth outside the womb. It will have a larger impact if it is present in the reproductive organs as it can block fallopian tubes and damage ovaries. Current estimates suggest that 30 - 40% of women with endometriosis have difficult conceiving however after treatment this figure reduces significantly.

It's often recommended that those with endometriosis try to conceive naturally for up to 6 months before seeking further assistance. However where natural conception is not possible, assisted conception will be available.

How is endometriosis treated?

If you are trying for a baby the suggested treatment for endometriosis is likely to be very different that if you are not looking to get pregnant. For mild to moderate endometriosis your doctor may initially suggest that you only take pain medication to moderate the condition while you try to conceive. However, if you suffer with more severe endometriosis surgery is likely to be recommended.

If you are not trying to conceive, hormone based treatments are likely to be suggested, these work by reducing the production of oestrogen in the body and halt the menstrual cycle by tricking the body into thinking its pregnant or going through the menopause. The oral contraceptive or progesterone only pill are often used to control this condition however alternative options such as the Mirena coil (an iud), GnRH analogues and testosterone based therapies are also available.

Surgery will also be an option and procedures other than a laparoscopy may be discussed in certain cases. As endometriosis will continue to develop after surgery in severe cases where no further pregnancies are planned more extreme measures such as hysterectomies may be offered.

How can I cope?

Endometriosis is classed as a chronic condition as for some the pain it causes can be debilitating. Your doctor will be able to advise you how best to manage the discomfort associated with endometriosis on a daily basis, however it is also recommended that endometriosis sufferers a follow a healthy, balanced diet and take gentle exercise such as yoga or pilates that will help with relaxation and minimise stress.

In terms of more immediate relief from discomfort, a warm bath or hot water bottle held on the abdomen may help. It is also really important to have a good support network in place, especially if you are trying to conceive. Your doctor should be able to put you in touch with a local support group and it can be useful to get in touch if only to chat with other people who understand what you're going through.

Whether you suffer with endometriosis or not why not visit the AskBaby forums and share your ups and downs with other members who are trying to conceive.

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