What is Endometriosis?

Endometriosis is a common and sometimes painful condition of the reproductive system which can affect up to one in ten women. Endometriosis can cause a wide range of debilitating symptoms such as pelvic, abdominal and back pain, heavy and painful periods, and infertility. 

Endometriosis occurs when the tissue that normally lines the inside of the uterus grows in other parts of your body where it does not belong. This list can include on the ovaries, fallopian tubes, outside surface of the uterus, bowel, bladder and rectum. This extra endometrial tissue behaves the same way as that found in your uterus and also responds to changes in your hormones during your menstrual period. This causes the tissue to break down and bleed into the surrounding area which can cause severe pain and inflammation as well as scarring and adhesions. Endometriosis found on the ovary can also form cysts known as ‘chocolate cysts’. When the cysts bleed during each period not all of the fluid can drain away. This causes the old blood to build up and develop a ‘chocolaty’ appearance. 

When present in the pelvis, endometrial tissue may lead to an inflammatory reaction which has been shown to affect the reproductive process at various levels from egg development and ovulation to fertilisation, embryo travel through the fallopian tube, and uterine implantation. Endometriosis may also lead to scar tissue formation within the pelvic cavity, which in turn may lead to blockage of the fallopian tubes as well as debilitating pelvic pain. Roughly 30% of women with infertility problems have endometriosis.

Endometriosis is highly unpredictable. Some women may have a few isolated implants that never spread or grow, while in others the disease may spread throughout the pelvis. Endometriosis irritates surrounding tissue and may produce web-like growths of scar tissue called adhesions. This scar tissue can bind any of the pelvic organs to one another and may sometimes cover them entirely.

Many women who have endometriosis experience few or no symptoms. In fact, it is often diagnosed when a patient is undergoing pelvic surgery for other reasons. However, in some women, endometriosis may cause severe menstrual cramps, pain during intercourse, infertility or other symptoms. Endometriosis is more likely to be found in women who have never been pregnant. For this reasons, the condition is sometimes labelled a “career woman’s disease”, because working women often delay pregnancy.

While endometriosis is a known cause of infertility, the medications and procedures available to assist you in falling pregnant are well established and effective. It is possible to become pregnant when you have endometriosis.

Endometriosis may present itself in multiple forms of varying severities, and treatment must be customised for each patient based on history, symptoms, and clinical findings. Medfem Fertility Clinic employs safe and proven methods to establish a clear diagnosis of endometriosis and subsequent treatments. Endometriosis patients suffering from infertility are treated with specific stimulation protocols which have superior success rates. In addition, ovarian reserve tests are performed to determine how aggressive fertility treatments should be. Every effort is made to avoid surgical resection of endometriomas in order to prevent deterioration of ovarian reserve and damage to healthy ovarian tissue.

Who Gets Endometriosis?

Endometriosis can affect women from their teenage years to those aged in their 40’s. You are most likely to develop endometriosis if you have the following risk factors:

  • Have not had children
  • Are overweight
  • Have heavy or prolonged periods
  • Had your first period at an early age i.e. before 12 years of age
  • Have a family history of endometriosis 

What causes Endometriosis?

It is not know what exactly causes endometriosis though it has been noted to run in families. 

How is Endometriosis Diagnosed?

The diagnosis of endometriosis cannot be made from symptoms alone. Symptoms such as fertility problems, severe menstrual cramps or pain during intercourse are strong indicators of the condition. During a pelvic examination tenderness in the pelvic region, a fixed or immobile uterus, and enlarged ovaries may all indicate the presence of endometriosis. 

A laparoscopy is the most accurate way to diagnose endometriosis. Under anaesthetic a telescope like instrument in inserted through a small incision under the belly button to examine the pelvic organs. The presence of endometriosis can then be confirmed and its degree of severity assessed. Removal of the endometrial implants and adhesions may be done at the same time during this investigative procedure. If there is any uncertainty a small piece of tissue can be removed for microscopic examination at this time. This is called a biopsy.

What Treatment is Available for Endometriosis?

Treatment can either be surgical or medical (by means of medication). The usual approach is to treat endometriosis surgically at the time of the diagnostic laparoscopy. Deposits of endometriosis can be removed or destroyed laparoscopically and scar tissue can be excised.

Some patients need a combination of medical and surgical treatment. If an infertile woman with endometriosis fails to conceive even after medical and surgical treatment, in-vitro fertilisation may be an option. Even women with extensive disease, whose ovaries are surrounded by adhesions, are candidates for in vitro-fertilisation. In a natural pregnancy, fertilisation takes place in the fallopian tube but for those with damaged tubes due to endometriosis, IVF is able to place the fertilised egg directly into the uterus. The optimal period for falling pregnant via IVF is between six months to one year after surgery. As the symptoms may return there is a limited window in which to conceive.

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