What is endometriosis?
Endometriosis is a condition when tissues similar to the lining of the uterus grow outside the uterus, on your tubes, ovaries, bowels, bladder and peritoneum (the layer which covers all the organs inside your tummy). These tissues also behave in a similar way as the lining of the uterus. That means, they grow and bleed during periods.
When the lining of the uterus sheds, the blood comes out as periods, but when these tissues bleed, the blood cannot come out. It remains inside the body and causes a chronic inflammation (which means your body tries to it fight off). The inflammation causes pain.
Over the course of time scar tissues (adhesions) develop, which can make organs stick together.
This is like a vicious cycle, every month you bleed leading to more inflammation and eventually more scar tissues.
Endometriosis is a condition when tissues similar to the lining of the uterus grow outside the uterus, which bleed during periods, causes a chronic inflammation, adhesion and pain.
In some women it can be quite mild with some spots here and there whereas in others it could be quite severe with extensive adhesions sticking bowels, bladder, uterus, tubes and ovaries all together and causing a frozen pelvis.
The only way to diagnose endometriosis is to see the endometriosis spots during laparoscopy and preferably by taking biopsy from the spots.
Endometriosis can be mild, moderate or severe and the only way to confirm diagnosis is by laparoscopy and taking biopsy.
How common is endometriosis and what are the symptoms?
It is actually quite common. 1 in 10 women in general population have endometriosis. The number could be even higher as many women do not get laparoscopy and remain undiagnosed.
Symptoms are quite variable. Some have no symptoms at all and you might see endometriosis while doing laparoscopy for other reasons.
Others will have pain in the lower abdomen and back, pain during periods, pain during sex, pain during opening bowels. Some women have pain only at the time of periods and sex, while some women can have continuous pain with no breaks at all, which can be quite hard to live with.
Endometriosis is quite common. Some will have no or very mild pain, while others will have constant debilitating pain.
Can endometriosis cause infertility?
While many women with endometriosis (60%-70%) will fall pregnant naturally, getting pregnant can be difficult for some.
For those with severe endometriosis, the likely cause of infertility is pelvic distortion due to the adhesions causing tubal blockage or tubal dysfunction.
However, even in those with mild endometriosis with normal tubes and ovaries, it can sometimes be difficult to conceive. They will be diagnosed as having unexplained infertility.
It is not very clear how endometriosis causes infertility. It is likely that as your body tries to fight with the endometriosis, various chemical substances are produced, which can be toxic to the sperms, eggs and also embryos. They can lower the quality of the eggs, stop sperm moving properly and lower the chances of implantation of the embryo.
30-50% women with endometriosis will have infertility.
How can I get pregnant with endometriosis?
Women with endometriosis with normal tubes and regular periods will get pregnant naturally if they try for 2-3 years, provided their partners have normal sperm. Hence you might wait for couple of years if you are <30 years of age.
However, chances of pregnancy get lower with advancing age. If you are >35 years old, then see a fertility specialist if you are not pregnant by 6 months.
There are various treatment options like surgical treatment, IUI or IVF to help you in getting pregnant.
Most women with normal tubes and ovaries will conceive naturally within 2-3 years. Other factors like women's age, duration of infertility, stage of endometriosis, partner's sperm will also have an impact on the chances of pregnancy
Can I take tablets to get pregnant?
No.
Medical treatment is good to reduce pain but not for pregnancy. Medicines that are used to treat endometriosis are those that are used to stop your ovulation. The idea is to stop your periods and thereby stop the growth of endometriosis. As it stops ovulation, it will also stop you from getting pregnant.
Medical treatment do not improve chances of getting pregnant
Do I need surgery if I wish to get pregnant?
Not always.
Surgical management of endometriosis is to destroy or remove the endometriosis spots as much as possible. In severe endometriosis, where the organs are stuck to each other, the aim of the surgery is to separate them and restore normal anatomy as much as possible. If there were endometriosis cysts in the ovaries, then surgeon would try to remove them or at least drain them as well.
In mild endometriosis, surgical treatment improves chances of getting pregnant.
For women with moderate to severe endometriosis, i.e stage III and IV, there is some evidence of improved chances of getting pregnant after surgery, but no much research have been done.
If you have cyst in your ovaries due to endometriosis, surgical removal of the cyst might improve your chances of getting pregnant, but there is risk of damage to the ovary, loss of egg reserve and in worst circumstances risk of losing the ovary.
The decision for surgery should be taken after discussing with your doctor taking into consideration your age, how long you have been trying to conceive, how much pain you have. Decision to remove ovarian cyst due to endometriosis should be taken very carefully, depending on how big the cyst is and how much pain it is causing.
The decision for surgery should be taken after discussing with your doctor, your age, how long you have been trying to conceive, how much pain you have.
What fertility treatment can I have?
Intrauterine insemination (IUI) with ovarian stimulation can be done for women with mild endometriosis (stage I, II) and patent tubes. If you had surgical treatment for endometriosis, then chances of successful IUI are higher within 6 months after surgery.
IVF should be done for those with severe endometriosis (stage III, IV), blocked tubes, or those trying for long duration >2 years.
IUI with ovarian stimulation can be tried for women with mild endometriosis and normal tubes. Those with moderate to severe endometriosis, blocked tubes, women>37 years or those trying for long duration, should better have IVF.
Are my chances from IUI/IVF success lower due to endometriosis?
Success of IUI/IVF depends of various factors like age, number and quality of eggs and sperm and also embryos. Endometriosis can lower the quality of eggs, embryos and also affect implantation. Hence the success of IUI/IVF can be slightly lower in women with endometriosis.
Success of IUI/IVF are lower in women with endometriosis than those without endometriosis.
Is there an increased risk of complications during pregnancy if I have endometriosis?
Majority of women with endometriosis will have a normal pregnancy without any complication. However, researches have shown that women with endometriosis are at higher risk of preterm birth, pre-eclampsia (high BP in pregnancy), risk of placental bleeding and caesarean section.
Majority of women with endometriosis will have a normal pregnancy without any complication.
Will pregnancy cure my endometriosis?
No. The symptoms of endometriosis can temporarily get better during pregnancy and breast-feeding, as there are no periods. However, once the periods resume, the symptoms of endometriosis return. The severity of pain may or may not be same as before pregnancy.
Pregnancy does not necessarily cure endometriosis.
Summary:
While majority of women with mild endometriosis will conceive naturally, some will struggle to conceive.
If you have normal tubes and ovulation, you might try for 1-2 years before resorting to fertility treatments if you are young <35 years. If you are >35 years old, then see a fertility specialist if you are not pregnant by 6 months.
In mild endometriosis, surgical treatment improves chances of getting pregnant within 6-9 months after surgery
Not everybody will need surgery. The decision for surgery should be taken after discussing with your doctor your age, how long you have been trying to conceive, how much pain you have.
Intrauterine insemination (IUI) with ovarian stimulation can be done for women with mild endometriosis (stage I, II) and patent tubes
IVF should be done for those with severe endometriosis (stage III, IV), blocked tubes, or those trying for long duration >2 years.
Majority of women with endometriosis will have a normal pregnancy without any complication.
Pregnancy does not necessarily cure endometriosis.
Written by: Dr Anupa Nandi
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