Endometriosis is a prevalent gynaecological condition that may cause severe period pain and fertility challenges.
Endometriosis affects approximately one in 10 Australian women. While it is often associated with painful periods, endometriosis can also affect fertility, quality of life, and overall wellbeing. It can be challenging to receive an accurate diagnosis and effective treatment, partly due to many women normalising or downplaying their symptoms.
Endometriosis occurs when glandular tissue similar to the lining of the uterus grows elsewhere in the pelvis. These growths, known as endometriotic lesions, deposits, or implants, can develop on the ovaries, the outer surface of the uterus, fallopian tubes, bowel, bladder, or other nearby structures.
Like the lining of the uterus, this tissue responds to hormonal changes throughout your menstrual cycle. However, unlike the normal tissue inside the uterus, these lesions are unable to be properly shed from your body during a period, and over time, can cause inflammation, scarring, and adhesions (fusing of tissues that are normally separate). Depending on the location of the endometriotic lesions, this may cause damage and distortion to structures important for conception and pregnancy, resulting in infertility. There is also some evidence that endometriosis may cause reduced ovarian reserve and egg quality.
Not all women with endometriosis will notice symptoms. In those that do have symptoms of endometriosis, the severity of these symptoms can range from mild to debilitating.
Endometriosis symptoms may include:
Although having endometriosis may increase your risk of encountering difficulties falling pregnant, many women with endometriosis are still able to conceive naturally while others find fertility treatments are needed to help them on the road to parenthood.
Endometriosis is associated with a delay in diagnosis averaging six years from first noticing symptoms to finally receiving an accurate diagnosis and treatment. This challenge is in part due to many women believing their symptoms are just a normal experience, but also because endometriosis symptoms are variable and non-specific, and can overlap with other conditions.
In confirming an endometriosis diagnosis, Dr Anna may:
It is important to note that while an ultrasound can confirm the presence of endometriosis, it cannot definitively exclude it. If your symptoms are strongly suggestive of endometriosis, even in light of a negative ultrasound scan or MRI, Dr Anna may recommend laparoscopy. This minimally invasive surgical procedure is the gold standard for diagnosing endometriosis, with the added advantage of being able to treat lesions by removing them at the same time.
Treatment depends on your symptoms, age, fertility goals, and the extent of the condition. Some women seek treatment primarily for symptom relief, while others are focused on improving fertility.
For women experiencing debilitating pelvic pain, treatment may involve pain-relieving medications or hormone therapies, physiotherapy, diet modification, and psychological support. In addition to reducing pain, hormone-based medications are often effective at preventing endometriotic lesions from developing further. However, as these hormone therapies are also often used as contraception – such as the progesterone-only pill or progesterone-secreting intrauterine devices (IUD) – other treatment options will be more suitable if you are trying to fall pregnant.
In some cases, surgery may be recommended to remove endometriotic lesions, scar tissue, or adhesions. Surgical treatment may improve symptoms and, in certain cases, fertility outcomes. Endometriosis surgery is most commonly performed laparoscopically, which involves keyhole incisions in your abdomen often only a couple of centimetres long.
If endometriosis is affecting your ability to conceive, fertility treatments can offer hope. Dr Anna will discuss your options in detail, guided by the results of a comprehensive assessment of your fertility status. Management of infertility must be individualized to the grade of endometriosis, age of the woman, presence of any sperm abnormalities and the length of time infertility has been present. Dr Anna will discuss what options are available to you and the likely success of each option, and you can determine which treatment is your preference. If one treatment option doesn’t work well, the other available options will be rediscussed – this may mean you undertake a laparoscopy prior to commencing a second cycle of IVF, for example.
IVF is often used as an effective first line management of infertility in the setting of endometriosis, as it bypasses the fallopian tubes, which can be damaged from endometriosis deposits/chronic inflammation.
In those women who prefer less intervention, IUI with ovulation induction can be used, but monthly success rates are lower in women with endometriosis, compared to those without.
For individuals with pelvic pain or painful periods, surgery may be recommended to hopefully improve pain symptoms, and then natural conception may be possible.
With an emphasis on clear communication and shared decision-making, Dr Anna may offer more than one viable treatment option for you to consider, or guide you toward one particular fertility treatment if she believes it will offer significantly superior success rates in your situation.
