Endometriosis and its risk to fertility

Endometriosis can cause discomfort, pain and can affect fertility. Learn why it’s so important to get checked for endometriosis while experiencing the symptoms, your treatment options and what it means for your hopes of becoming pregnant, as explained by Mr Borase, a gynaecologist and fertility specialist.

Why is endometriosis such a challenging condition to live with?

Endometriosis is when tissue that is similar to the lining of the uterus (clinically called the endometrium) grows outside the uterus. This can occur anywhere in the pelvis or abdominal area. It’s such a challenging condition to live with because it takes a long time to diagnose. On average, the duration from first symptoms to full diagnosis could be up to eight years.

Furthermore, the condition is different for everybody: symptoms and severity of the condition don’t go hand in hand. For example, one patient may have a very severe form of endometriosis but not feel symptoms. On the contrary, another patient may have horrible symptoms to cope with but a very mild form of the condition.

Symptoms can be quite vague and overlap with other conditions, making endometriosis even more difficult to suspect. These are:

• Lower abdominal pain
• Heavy periods
• Blood spotting between periods
• Blood spotting after sexual intercourse
• Pain during or after sexual intercourse

Sometimes these symptoms improve by means of medication and this is usually through contraceptive measures, such as the contraceptive pill, and these can be offered by a GP. Often, it’s not until a woman struggles to get pregnant that they seek help from a fertility specialist and by this time, it can sometimes be too late to prevent any damage to the ovaries.

If you show any of these symptoms and you plan on becoming pregnant one day, you’re highly advised to seek help sooner rather than later to protect your fertility or at least have a discussion regarding your fertility and potential options available to preserve it for the future.

The long road to diagnosis

A lot of women suffer with the condition for so long because of the previously mentioned symptoms. The fact that there are very few ways to get a clear and definite diagnosis of endometriosis  often increases women’s suffering.

The endometrium tissue won’t show on scans, but a specialist can look for the diagnosis as well as perform treatment via surgery. Alternatively, if the patient has a big cyst (clinically called an endometrioma), then the condition can be picked up on a scan. Sometimes, we can see nodules between the rectum and the vagina that are affected by endometriosis, but this only occurs when the condition has progressed and is very serious.

Why causes it?

They say that it is a “disease of theories” regarding endometriosis. There are plenty of theories but none have been proven yet. However, the most accepted theory is that of retrograde menstruation. This means that during periods, the menstrual blood goes into the pelvis through tubes and the endometrium-like tissue most commonly lodges on to the ovaries and to the back of the uterus due to gravity. It starts growing there and can lead to various symptoms. Endometriosis is incredibly complex and because of this, it’s unlikely that the true cause or a complete cure will be discovered in the near future. Fortunately, however, we have treatments to reduce symptoms and preserve your fertility.

How will I be treated for endometriosis

Treatment is based on your future goals regarding pregnancy.

Treatment (with no ambition to become pregnant)

If a patient is suspected to have endometriosis and has no plans of becoming pregnant in the future, we recommend medical treatment. This is in the form of contraceptives. We often advise women to take the contraceptive pill in a way that we call the “tricycle” and this simply involves taking three packs without a break. Other methods are:

• The mini pill
• Contraceptive injections (such as Depo-Provera)
• Contraceptive implant
• The Mirena coil

By taking a method of contraception, the objective is to stop the periods or lessen their frequency to reduce regulate the menstrual cycle and painful symptoms.

Treatment (with the ambition to become pregnant)

If a patient hopes to become pregnant at the time of diagnosis or in the future, surgery is offered. Surgery is usually laparoscopic (a minimally invasive procedure involving a small incision and a thin tube) and this gives the specialist a full assessment of pelvic organs and fallopian tubes at the same time.

After the assessment, we can treat endometriosis with either laser or diathermy treatment to burn the tissue. If there is a cyst in the ovary, we conduct a cystectomy to remove it (although this depends upon the size of the cyst).

When the bowels are affected

When endometriosis reaches a later stage (stage 4), the bowels are involved. If the bowels are involved then a joint procedure is conducted with a bowel surgeon. The objective of this is to reduce symptoms that affect the bowel and it’s not for improving fertility.

I’m worried I can’t become pregnant. Can I?

We use an endometriosis fertility index to consider a patient’s likelihood of becoming pregnant. We take many factors into consideration to determine where a patient is on the index, such as:

• The stage of endometriosis
• Medical history
• The level of function of the fallopian tubes

The higher the score you have, the more you can benefit from IVF (in vitro fertilisation) sooner rather than later. In any case, all patients are encouraged to try natural conception for a time before trying IVF. Your specialist will determine where you are on the endometriosis fertility index based on your specific case.

If you are experiencing any symptoms, seek help now rather than later to diagnose or rule out endometriosis. The long duration between experiencing the first symptoms and a diagnosis means that the ovarian reserve is negatively affected by the time treatment is offered. Furthermore, if you would like to become pregnant now or in the future, you will greatly benefit from visiting a fertility specialist rather than a general gynaecologist.

Mr Borase is renowned for helping patients with their fertility and for performing fertility surgical procedures. Get in touch with him by booking a consultation via his profile.