Endometriosis is a common condition affecting women of reproductive age, especially women over 30 who have not yet had children. Mild endometriosis is often associated with infertility and more severe degrees of endometriosis will have a greater impact on your ability to conceive naturally.
- What is endometriosis?
Endometrial cells line the uterus, and when they grow outside the uterus (almost always in the pelvis, including the ovaries) this is known as endometriosis.
Recent research has shown that in women with endometriosis, the eggs and subsequently the embryos created from those eggs are of poor quality. This means that your chances of becoming pregnant are less likely.
- What are the symptoms of endometriosis?
Symptoms of endometriosis include:
- pelvic pain
- painful periods
- pain during intercourse and premenstrual spotting
Some factors that might indicate a higher incidence of endometriosis include if the woman experienced early puberty (first period before the age of 11); advanced maternal age at first child birth; heavy and painful periods; long periods (longer than 5 days) or short cycles (less than 27 days between periods); or a family history with close relatives also having endometriosis.
- How does endometriosis affect fertility?
It’s not always a straightforward answer. Some women experience severe endometriosis, which can impair egg quality and the egg’s ability to mature. It may also alter the anatomy of the fallopian tubes, thus preventing the egg and sperm from meeting. Others experience mild endometriosis, which in some cases is associated with infertility. How and why this happens isn’t known.
It’s important to remember that even women who struggle with endometriosis can still conceive naturally.
- What causes endometriosis?
Whilst it is unclear exactly what causes endometriosis there are a few theories:
- Retrograde (backward) menstruation: During menstruation some of the menstrual blood that carries endometrial tissue cells flows backwards along the fallopian tubes into the pelvis where the cells can then implant and grow.
- Coelomic Metaplasia: Suggests that the cells lining the pelvic organs are able to change their structure and function to become endometrial cells when they are influenced by certain conditions. Triggers could include puberty or oestrogen surges.
- Altered immunity: Suggests that endometriosis might arise from a change in your immune system’s ability to recognise the presence of endometrial tissue in abnormal locations and eliminate it.
- Endometriosis and mental health
The link between endometriosis and mental health
Endometriosis and Mental Health - Fertile Minds Video
My name is Dr. Haider Najjar, I'm a fertility specialist at Melbourne IVF.
Endometriosis and mental health are very strongly linked. Often, patients with endometriosis, especially those who don't have the treatments efficiently, or on time, or sufficiently, they can suffer mental health issues because of that. Endometriosis can cause pain. And I was astonished when I first found out that, it takes up to eight years for women to, from the time they start having symptoms to the time we arrive to a diagnosis. So you can imagine when patients are suffering pain or difficulty conceiving for many years before they even arrived at a diagnosis and the impact of that on their physical and mental health.
So the first, the first I think crucial step, is to actually arrive to the diagnosis. And I see too often unfortunately in my practise that patients suffer for so long, and I think that accumulated pain and suffering, that can have a huge negative impact on our patient's mental health. Secondly, is dealing with the, with the condition properly. Managing the pain, managing the fertility itself that can cause a huge weight and impact on the mental health. So, the sooner we attend to it, the better the outcomes will be.
And often, when we manage endometriosis, we don't manage it as a fertility specialist or as a surgeon on our own. We have a whole team that we are barely just one part of it. And the team has a physiotherapist, a psychologist, a psychiatrist, you know, even and all sorts of other pain specialists. And we all complete the circle of managing endometriosis. And mental health is such a crucial aspect of it.
So the two main things that can impact on mental health is pain, and the impact of that itself on the patients', you know, work, their a ability to maintain their daily activities, their socialising with their family and friends, all of that will have the impact that is that is quite negative on their, on their mental health. The other aspect of that is fertility, and I think when patients try to conceive and have difficulty in achieving an outcome and endometriosis causing pain and difficulty conceiving, you can imagine that the impact of that on people, they get stressed, and it will definitely be a a bad impact on their, on their mental health. And addressing the issue of fertility, addressing the issue of the pain.
And we believe they are the first sort of key element in helping our patients, as well as, using the amazing people that we have with us in our multi-disciplinary teams in helping our patients. If he found this video useful, please do not hesitate to subscribe to the channel, for all things fertility.
Research has linked endometriosis to an increased likelihood of anxiety or depression. The chronic pain associated with endometriosis can often become a cyclical link, in which pain can increase anxiety, and yet the anxiety can worsen endometriosis pain. If you think you might have endometriosis, and are struggling to cope, we encourage you to book an appointment with your family doctor or meet one of our fertility specialists.
- Diagnosis of endometriosis
Diagnosis is often based on the symptoms you present with, along with recognising clinical signs upon physical examination.
Your doctor will take a detailed history and conduct a pelvic exam to identify the thickening of endometriosis behind the uterus. Doctors may also use an ultrasound to help identify any areas of concern consistent with endometriosis.
Endometriosis is often difficult to diagnose, and in order to confirm the diagnosis a minimally invasive procedure called laparoscopic surgery is required. This involves the surgeon looking inside the abdominal cavity through a small incision in the navel.
- Stages of endometriosis
Endometriosis is often classified as mild, moderate or severe or recorded in surgical notes as stage or grade I - IV:
- Mild or stage/grade I endometriosis appears as small patches or surface lesions scattered around the pelvic cavity.
- Moderate or stage/grade I or II endometriosis appears as larger widespread disease starting to infiltrate tissue and often found on the ovaries, uterosacral ligaments and Pouch of Douglas. Sometimes there is also significant scarring and adhesions.
- Severe or stage/grade IV endometriosis affects most of the pelvic organs, often with distortion of the anatomy and adhesions.
Although these stages are useful, it’s important to note that the symptoms and pain experienced within each stage are not always consistent. It’s also important to be aware that each stage does not necessarily correlate to how badly endometriosis will affect a woman’s fertility or amount of chronic pain.
For example, a woman who has stage 1 endometriosis, could experience more pain than someone who has been diagnosed with stage 4 endometriosis. It is very much dependent on the individual.
- Endometriosis treatment
Treatment for endometriosis may simply consist of medication in the form of tablets, nasal sprays or injections. Medication for endometriosis can suppress ovulation, delaying the chance of pregnancy.
Surgical treatment by laparoscopy is the treatment of choice. This removes the disease and restores normal pelvic anatomy. This is a keyhole operation where the surgeon inspects the abdominal cavity through a small incision in the navel to confirm the diagnosis, and treats it at the same time.
In many cases you may conceive naturally after surgery, and may not need IVF. Laparoscopic surgery could also increase your chance of success with reproductive treatments.
- When to see your doctor
Seek advice from your GP or a fertility specialist if you experience symptoms that might be due to endometriosis and are also having trouble conceiving naturally.