By Dr. Raewyn
You’ve probably already been experiencing regular menstrual cycles for some years now, so it’s important to be armed with information about what may impact your cycle and future fertility. In this month’s column, we’re going to tackle the tricky topic of endometriosis.
Endometriosis is a common condition that affects about one in 10 women. For many, it can be quite painful, but for a few women, there can be no symptoms at all. This is why it’s good to have some basic knowledge about the condition, so you can see your GP and/or gynaecologist to discuss ways of handling it – and your future fertility.
Q: What actually is endometriosis?
A: Endometriosis is a pretty challenging condition, which can be both physically and emotionally draining – and on a monthly basis. In many cases, it can cause infertility when you’re trying for a baby.
Women who have the condition have cells that are like the ones lining the uterus (a.k.a endometrial cells) actually growing in other parts of the pelvis (think: ovaries and fallopian tubes, or even in the bladder, bowel and other pelvic areas).
When your hormones trigger monthly menstrual bleeding, the tissue breaks down, but because it’s not in your womb it has nowhere to go, so it causes the area to become inflamed and painful. Over time, this tissue builds up, which means the condition worsens and the pain becomes worse.
Q: How do I know if I have endometriosis?
A: As mentioned, it’s a fairly painful condition for most women, so that is your first indicator.
You may begin to experience cramping as much as two weeks prior to your period. Then, when your monthly menstrual bleeding starts, it can feel as though your pelvis is on fire, or you may experience sharp and prolonged stabbing pains in the pelvic region.
Your periods will likely be very heavy, with a lot of bleeding that is really dark to begin with.
You might also experience pain during intercourse, lower back pain around the time of your period and uncomfortable bowel movements or urination. For some women, these symptoms are very mild. For others, they can be excruciating.
Because endometriosis is progressive – which means it gets worse with time – there may be moderate symptoms in the early stages of the disease. For instance, you might only experience mild pain for one or two days of your period. However, as it progresses, symptoms become more severe and last longer, and can even be present before or after your period.
Endometriosis can kick in with your first ever period, but because you’re very unlikely to be trying to have a baby at that age, the condition is often left undetected until later in life.
This means we mostly diagnose women aged around 30, who are trying to have a baby (and are unsuccessful). It’s also why it’s important that you become endometriosis-aware, to help get a handle on the condition as early as possible.
Q: What are the dangers of endometriosis?
A: While it’s rarely life-threatening, if left untreated it can cause painful inflammation and scarring, cysts or lesions on your fallopian tubes and bowels. This is because the tissue that has broken down in your monthly cycle remains trapped outside the womb, in other areas of the pelvis. Endometriosis can also cause infertility - even in very mild cases.
As with most medical conditions, the symptoms can also impact your life and emotions, making you anxious and depressed and at times even having to take days off work.
Q: What causes endometriosis?
A: We are still trying to fully understand why this condition presents itself, but one theory is ‘Retrograde Menstruation’. This is where the menstrual blood that is meant to flow through the uterus and out through the cervix of the womb and vagina, actually flows back through the fallopian tubes and into the pelvic region, rather than out of the body.
Another theory is that it is caused by ‘coelomic metaplasia’ which is where the cells lining the pelvic organs change structure and begin to act in the same way as endometrial cells within the womb. We believe it’s triggered by puberty or oestrogen surges.
A third theory is that it has to do with immunity deficiencies.
Finally, we do see many cases where there is a family link. So, if someone’s mother or aunt has it, they might be up to seven times more likely to present with the condition too.
Q: What can I do if I am diagnosed?
A: We can certainly help you! Endometriosis is treatable with medication or in some cases an operation, in which we experience a reasonable success rate.
Q: Will I be able to have a baby?
In most cases, we say probably yes.
It is thought that the reason endometriosis hinders conception is that the endometrial cells release chemicals that make it difficult to get pregnant or affect the development of the embryo in its early stages.
Endometriosis can also disrupt ovulation, as it distorts the fallopian tubes and ovaries. If scar tissue or cysts have developed from the condition, they can also block the egg’s release or affect the transportation of sperm.
On a happier note, while endometriosis is a common cause of infertility, in most cases we can correct the condition to help you potentially have a happy, healthy baby.
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Firstly, we use medications that relieve pain, combined with hormone-based treatments that reduce oestrogens. However, they work only as long as you continue to take them, so the endometriosis may recur once you stop medications.
The best way to both diagnose and treat endometriosis is with a surgical procedure called laparoscopic surgery (a.k.a ‘Keyhole Surgery’).
It’s minimally invasive and it involves the surgeon viewing the abdominal cavity through a small incision in the navel. This way, we can confirm endometriosis, as well as treat it at the same time. Often this surgery is the only treatment required to increase your chances of falling pregnant naturally, but it can also improve the success rates of reproductive treatments like IVF, should you need to go down that path.
Q: Is there anything I can do to naturally fix the condition?
A: Not really, unfortunately. However there are ways to lower your chances of getting it in the first place.
These include limiting your alcohol intake and maintaining a healthy body weight. Regular exercise (at least four hours each week) is also thought to help lower your risk or relieve the pain if you have it.
If you suspect you have endometriosis, you should see your GP immediately. I’d suggest doing this in cases where painful periods prevent you going about your daily activities, if you feel the conditions are becoming worse, or if you are not coping emotionally or mentally.
Also, if you’ve been trying to have a baby unsuccessfully for six months or more, see your GP to discuss endometriosis and ask for a referral to see a fertility specialist.