Endometriosis is the tissue lining the inside of the womb (uterus) is known as the endometrium. When this tissue is found outside the uterus, the condition is known as endometriosis.
Dr Sneha Sathe, Fertility Consultant, Nova IVF Fertility, Mumbai, shares inputs on the causes, symptoms, treatment and all other important information of endometriosis.
What causes endometriosis?
We don’t really know what exactly causes endometriosis. The possible causes include:
- Problems with menstrual flow
- Genetic factors
- Immune system problems
- Hormones
- Scar endometriosis (Surgery)
What are the symptoms of endometriosis?
- Pain is the most common symptom. Women with endometriosis can have varying types of pain.
- Very painful menstrual cramps
- Chronic (long-term) lower back and pelvic pain
- Pain during or after sex
- Abdominal pain
- Painful bowel movements or pain when urinating during menstrual periods.
- Bleeding or spotting between menstrual periods.
- Heavy bleeding with or without clots. Bleeding may be irregular and/or prolonged.
- Infertility
- Digestive problems like diarrhea, constipation, bloating or nausea, especially during menstrual periods.
- Many women with endometriosis have no symptoms.
How does endometriosis affect fertility?
If you have endometriosis, you may find it difficult to become pregnant. Up to 30% to 50% of women with endometriosis experience infertility. Endometriosis can affect fertility in several ways:, adhesions leading to scarring and blockage of fallopian tubes and distortion of pelvic anatomy, inflammation of the pelvic organs, altered immune system, altered egg quality, impaired implantation etc
How is it diagnosed?
The doctor will take a detailed medical history and will also do a physical examination. If your doctor suspects endometriosis you will most likely be recommended to have an ultrasound. Ultrasound may show if you have endometriotic cysts (endometriomas) on the ovaries or nodules of deep endometriosis. Ultrasound cannot detect superficial (surface) endometriosis. A definitive diagnosis can only be made if you have a laparoscopy or open surgery.
Managing and treating endometriosis
- Regular physical exercise can help to ease pain.
- Yoga, mindfulness and/or meditation are good ways to manage the stress associated with endometriosis.
- Anti-inflammatory drugs and pain medication.
- For women not trying to get pregnant, contraceptive pill, progestins or hormonal IUD (intrauterine device) is generally the first step in treatment. This may help to reduce the pain and severity of endometriosis.
- The aim of surgery is to diagnose and remove as many patches, nodules and cysts of endometriosis; endometriomas (chocolate cysts) and adhesions as possible.
- Severe pain during periods is not normal. If you have severe, debilitating pain or you are having to miss school, work and other activities, please seek help.
Treatment of Infertility
- For infertile women with suspected minimal or mild endometriosis, a decision needs to be made about whether to perform laparoscopy before starting fertility treatment. Factors such as the woman’s age, duration of infertility, any pain symptoms etc must be considered. Other infertility factors may co-exist and impact success rates and treatment outcome. If pain is a concern, laparoscopy and surgical treatment seem prudent. Laparoscopy and possible laparotomy (large incision) are recommended when moderate or severe endometriosis is suspected and no other cause of infertility is found.
- Medical therapy is effective for relieving pain associated with endometriosis, but there is no evidence that medical treatment with contraceptive pills, progestins, GnRH analogs, or danazol improves fertility. Medical treatment before or after surgery may unnecessarily delay further fertility therapy. Nevertheless, medical treatment is effective in reducing pelvic pain and painful intercourse associated with endometriosis.
- ‘Expectant management’ or ‘watchful waiting’ may be an option for younger women (with no other infertility factors) after surgery for endometriosis. Up to 40% of women are able to conceive within the first year after surgery. As an alternative to expectant management or if pregnancy fails to occur within a reasonable time frame, fertility-enhancing treatments may be offered. A woman’s age is an important factor in deciding upon specific treatment.
- Controlled Ovarian Stimulation (COS) and Intrauterine Insemination(IUI). Several studies have shown that this enhances fertility in women with minimal or mild endometriosis.
- Success rates with In Vitro Fertilization in women with endometriosis are similar to those for couples with other causes of infertility.
