Endometriosis: the facts
Endometriosis can make conceiving more difficult, but a variety of treatments can help improve fertility.
What is it?
Endometriosis is a condition in which some of the tissue that lines the uterus – called the endometrium – escapes through the Fallopian tubes during menstruation, going on to grow on other organs. It most commonly involves the ovaries or the Fallopian tubes, but can also implant on the back and front of the uterus, bowel, bladder and urinary tract.
According to The Royal Woman's Hospital in Victoria, endometriosis affects around 10 per cent of women.
What are the symptoms?
Women with endometriosis often complain of pain in the pelvis, which is worse during menstruation and ovulation, as well as during sexual intercourse. Pain can also be felt with bowel movements or during urination, and can spread to areas such as the back and legs.
Other symptoms can include:
- heavy blood flow during menstruation, and possible spotting before and after the menstruation cycle
- diarrhoea, constipation or other intestinal problems
Laparoscopy (keyhole surgery) is considered the 'gold standard' for diagnosing endometriosis, but it may also be diagnosed on a pelvic ultrasound, or colonoscopy.
How does it affect fertility?
Endometriosis is one of the known causes of infertility in women. It can distort the pelvic anatomy by creating ovarian cysts, pelvic adhesions and scar tissue, and can block the Fallopian tubes. It can also possibly affect egg and sperm interaction and embryo implantation.
It's not known why some women experience endometriosis while others don't. Some doctors say there may be a genetic cause, which could explain why women with a family history are the ones most likely to suffer from it, but no candidate gene has been found as yet.
What’s the treatment?
After being diagnosed with endometriosis, and having any damage to the ovaries and Fallopian tubes assessed, fertility treatment can be tailored towards increasing reproductive chances.
Treatment options can include laparoscopy and excision of the endometriosis deposits to decrease pain and improve fertility. The Fallopian tubes can be inspected and flushed at the same time.
Oddly enough, pregnancy is a good treatment for endometriosis, because the growths can shrink while a woman is expecting.
To improve pregnancy chances, treatment may include assisted reproductive fertility treatments, such as intra-uterine insemination (IUI) and invitro fertilisation (IVF). It can also help to use drugs that assist with stimulating egg production and ovulation.
When endometriosis is severely affecting the health of a woman, other options can include the use of hormones to suppress the growth of endometriosis, or the use of a Mirena IUD.
If a woman has completed her family, doctors may also suggest a hysterectomy and removal of the ovaries, which can end the production of endometrial tissue, in the same way as the onset of menopause.
Does it affect the baby?
Women with a history of endometriosis are more likely to require an assisted and/or Caesarean section delivery, so will be monitored more closely by their doctor during their pregnancy.
Some women find they redevelop endometriosis after their pregnancy is over. They may want to consider having all the children they’d like to have earlier in life, rather than later, as the condition will inhibit fertility as they age. This can also be beneficial as there’s a higher success rate of falling pregnant the sooner it can be done following treatment and surgery.
Facts verified by Dr Raewyn Teirney. Dr Raewyn Teirney is gynaecologist, obstetrician and fertility specialist and a visiting medical officer at the Royal Hospital for Women in Sydney, and also consults from her private rooms at Maroubra and Kogarah.
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