What is endometriosis

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus. Endometrial tissue growing in these areas does not shed during a menstrual cycle like the uterine endometrium does, leading to a build-up of abnormal tissue outside the uterus which causes inflammation and the development of fibrous tissues between reproductive organs. This results in “sticking together’ of the tissues, scarring and painful cysts. Several lesion types have been described:

  • superficial endometriosis found mainly on the pelvic peritoneum
  • cystic ovarian endometriosis (endometrioma) found in the ovaries
  • deep endometriosis found in the recto-vaginal septum, bladder, and bowel
  • in rare cases, endometriosis has also been found outside the pelvis.

Endometriosis diagnosis

Doctors may suspect endometriosis based on your history or a physical exam. There is no lab test, procedure or imaging that can be done to diagnose endometriosis, so the following non-invasive imaging studies are often used to diagnose endometriosis:

  • Ultrasound, where cysts in the ovaries may be diagnosed.
  • MRI for further endometriosis mapping.

A laparoscopy can be carried out for definitive diagnosis and treatment.

Causes of endometriosis

Endometriosis affects up to 10% of women between the ages of 15 and 44 affecting as early as the teenage years. The cause of endometriosis is unknown however there are few theories:

  • Transport through blood or lymph system: Endometrial tissues are transported to other areas of the body through the blood or lymphatic systems.
  • Direct transplantation: Endometrial cells may attach to the walls of the abdomen or other areas of the body after a surgery, such as a C-section or hysterectomy.
  • Genetics: Endometriosis seems to affect some families more often than others, so there may be a genetic link to the condition.
  • Reverse menstruation: Endometrial tissue goes into the fallopian tubes and the abdomen instead of exiting the body during a woman’s period.

There is no known way to prevent endometriosis. It is a chronic disease associated with heavy periods; severe, life-impacting pain during periods, sexual intercourse, bowel movements and/or urination, chronic pelvic pain; abdominal bloating, nausea, fatigue; sometimes depression, anxiety, and infertility. There is currently no known cure for endometriosis and treatment is usually aimed at controlling symptoms with medicines or, in some cases, surgery.

Endometriosis and infertility

Endometriosis is one of the most common conditions linked to female infertility. 24% to 50% of women with infertility have endometriosis. The mechanism of infertility is speculated to be due to the scar tissue from endometriosis affecting the release of eggs from the ovaries or blocking the path of the egg through the fallopian tube so it cannot get to the uterus. Endometriosis may also damage sperm or fertilized eggs before they implant in the uterus. Many women with endometriosis or endometriosis-related infertility can still get pregnant and carry a successful pregnancy.

How can endometriosis be managed?

Medical management

  1. Pain killers in the form of nonsteroidal anti-inflammatory and tranexamic acid reduces the menstrual flow and can be used while trying for a baby as it will be taken during the menstrual cycle.

  2. For people that are not trying for a baby or undergoing fertility treatment, the oral combined contraceptive pill can be used continuously without a break for 2-3 months. Or a hormone coil to reduce the menstrual flow.

  3. Sometimes patients may be given a course of GnRH analogues to suppress the ovaries a mechanism to control the endometriosis and give patients a symptomatic relief from abdominal pain/painful periods.

 

Surgical Management 

  1. Surgical management in the form of laparoscopy (key hole surgery) could be offered to improve symptoms and could add the benefit of improving natural pregnancy. Some surgeries for endometriosis are more extensive than others depending on the nature of the problem, particularly for those suffering with deep infiltrating endometriosis involving the bowels and other organs. This needs involvement of bowel surgeons and other specialities, and would be offered mainly for pain.

  2. Surgery usually doesn’t improve IVF outcomes and should be carefully considered especially in the presence of ovarian endometriosis (endometrioma) and cysts. The size of endometrioma as well as your ovarian reserve should be assessed before considering surgery. Fertility preservation may be considered before removal of endometriomas. Removal of endometriomas can affect ovarian reserve especially when present on both ovaries. Removal of large endometriomas can improve access to the follicle on the ovary during egg collection.

What fertility options do I have if I have endometriosis?

In the case of mild endometriosis where you did not manage to fall pregnant naturally, or are diagnosed with severe endometriosis, In Vitro Fertilisation (IVF) is offered which may help women to become pregnant. If the woman is not ready to start a family, she can consider fertility preservation (egg freezing) to avoid this progressive condition especially women with bilateral endometriotic cysts which may affect woman’s ovarian (egg) reserve.

Talk to your doctor about your fertility goals when discussing your endometriosis treatment plan. Or if you’d like to discuss your fertility options with us then please email the team at info@lfclinic.com.

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