Endometriosis is a disease that affects women of reproductive age and that may be associated with both pelvic pain and infertility. Endometriosis is a condition that affects a woman's reproductive organs. It happens when the tissue that lines the uterus grows outside of it. It may be associated with both pelvic pain and infertility. In a simple language, endometriosis happens when the tissue that lines the uterus grows outside of it. Scientific advances have improved the understanding of this benign (non-cancerous) but sometimes debilitating condition. Modern medicine now offers women with endometriosis many treatment options for relief of both pain and infertility.

Causes, symptoms, diagnosis and the options to manage and treat endometriosis including lifestyle, pain relief medications, hormone therapy and different types of surgery are all discussed here below.

What is endometriosis?

Endometriosis is a chronic condition that affects a woman’s reproductive organs. It happens when the lining cells (called the endometrium) of the uterus grow outside of it. Endometriosis most commonly involves ovaries, bowel or the tissue lining the pelvis. Rarely, endometrial tissues may spread beyond the pelvic region and is found in other parts of the body. About 10% of women between the ages of 15-49 are affected by it and around 176 million women worldwide. This tissue can irritate structures that it touches, causing pain and adhesions (scar tissue) on these organs.

Symptoms of Endometriosis

The primary symptom of endometriosis is pelvic pain, often associated with the menstrual period. Though many woman experience cramping during their menstrual period, women with endometriosis typically describe their menstrual pain that's far worse than the usual. They also tend to report that the pain has increased over time. Common signs and symptoms of endometriosis may include:

1. Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before and extend several days into your period and may include lower back and abdominal pain.

2. Pain with intercourse.  Pain during sex or after sex is common in endometriosis.

3. Pain with bowel movements or urination. You're most likely to experience these symptoms during your period.

4. Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleed between periods (menometrorrhagia).

5. Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.

6. Other symptoms. You may also experience fatigue, diarrhoea, constipation, bloat or nausea, especially during menstrual periods.

The cause of endometriosis is not known, although it often runs in families. Numerous biochemical and immunological changes have been identified in association with endometriosis, but it is unclear which may contribute to endometriosis and which simply result from it.

Endometriosis and Infertility

If you have endometriosis, it may be more difficult for you to become pregnant. The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis has difficulty getting pregnant. For pregnancy to occur, an egg must be released from an ovary, travel through the neighbouring fallopian tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development. Endometriosis may obstruct the tube and keep the egg and sperm from uniting. But the condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg. Even so, many women with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise women with endometriosis not to delay having children because the condition may worsen with time.

Endometriosis can influence fertility in several ways: distorted anatomy of the pelvis, adhesions, scarred fallopian tubes, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy and altered egg quality. At the time of surgery, your doctor may evaluate the amount, location, and depth of endometriosis and tell you whether it is minimal, mild, moderate or severe. Different stages relate to pregnancy success. A woman with severe endometriosis which causes considerable scarring, blocked fallopian tubes, and damaged ovaries, experience the most difficulty in becoming pregnant and often require advanced fertility treatment.

Test and Diagnosis

To diagnose endometriosis and other conditions that can cause pelvic pain, the doctor will ask to describe the symptoms, including the location of pain and when it occurs. Tests to check for physical clues of endometriosis include Pelvic exam, Ultrasound, and Laparoscopy. Laparoscopy can provide information about the location, extent and size of the endometrial implants to help determine the best treatment options.

Treatment options when diagnosed with Endometriosis

There is no ‘best treatment’ since treatments will work differently for individual women with endometriosis. One should be aware of the different kinds of treatments, and their possible effects and side effects or complications. A combination of treatments can be used to relieve the symptoms associated with endometriosis. There are many options to manage and treat endometriosis including a healthy lifestyle, pain relief medications, hormone therapy such as the oral contraceptive pill and progestin. Different types of surgery including laparoscopy, laparotomy and hysterectomy are also possible.

In most cases, infertility specialists will recommend the laparoscopy to remove or vaporize the growths as a way to also improve fertility in women who have mild or minimal endometriosis. Although studies show improved pregnancy rates following this type of surgery, the success rate is not clear. If pregnancy does not occur after laparoscopic treatment, in vitro fertilization (IVF) may be the best option to improve fertility.

IVF makes it possible to combine sperm and eggs in a laboratory to make an embryo. Then the resulting embryos are placed into the woman's uterus. IVF is one type of assisted reproductive technology that may be an option for women and families affected by infertility related to endometriosis. It is possible that all women with endometriosis are not able to become pregnant with IVF.

What can be done to maximise future fertility when diagnosed with Endometriosis?

The birth control pill is commonly prescribed to reduce menstrual cramping and help prevent endometriosis recurrence. Preventing endometriosis can help preserve fertility, so the pill is an excellent treatment option following endometriosis surgery if you are not yet ready to become pregnant. Women with endometriosis should consider consulting with a fertility specialist, (a specialist in Reproductive Endocrinology/Infertility), even if she is not yet ready to try to conceive or become a parent. Consulting fertility expert is extremely important if the age of the women is over 30 and is diagnosed decreased ovarian reserve. Fertility in women decreases with age. In addition to age, “ovarian reserve” also helps predict your ability to conceive. Surgery to remove or destroy endometriosis involving the ovaries may also reduce ovarian reserve and thus lower a woman’s chances of pregnancy even with fertility treatment such as IVF. Women with moderate to severe endometriosis may have scarring that can prevent the egg from entering the fallopian tube. Mild and minimal endometriosis are also associated with infertility, so all women with endometriosis need to consider the impact endometriosis may have on their fertility. A newer option for women is to freeze her eggs for possible future use in the event they experience infertility. Though egg freezing is costly, it is always a better option.

Many women believe endometriosis will prevent them from having children. This is a myth. Although some does experience infertility, about 70 percent of women with endometriosis do not. There are no preventive measures to avoid the condition. A woman can manage the symptoms only if she is diagnosed.

Choosing a qualified specialist, the one who is familiar with the latest developments in the management of endometriosis is the best strategy. Finding a doctor with whom you feel comfortable is crucial in managing and treating endometriosis. You may also want to get a second opinion before starting any treatment to be sure you know all of your options and the possible outcomes. The Blossom Fertility and IVF Centre aims to reduce the stress and hassle associated with infertility investigations and treatment, by offering a one-stop diagnostic and treatment service for infertile couples. The specialists team at Blossom have years of experience in providing the comprehensive services in the entire gamut of gynaecological and infertility treatment. We have handled a large number of cases related to IVF, ICSI, Blastocyst Transfer, Donor Eggs, Male infertility, Female infertility and various other complex processes and have achieved remarkable successes in them. Fertility experts here pay individual attention to the patients need and analyse the course of treatment and Reproductive endocrinologists, embryologists, anthologists, and infertility specialists have helped hundreds of couples have babies through Assisted Reproduction.