What is endometriosis?

Endometriosis is a common gynaecology condition where cells similar to the ones in the lining of the womb (uterus) are found elsewhere in the body.

It is a chronic and often debilitating condition that can cause painful or heavy periods and pain while having sex. It may also lead to infertility, backache, bowel and bladder problems.

Every month a woman’s body goes through hormonal changes. Hormones are naturally released which cause the lining of the womb to increase in preparation for a fertilized egg.  If pregnancy does not occur, this lining will break down and bleed – this is then released from the body as a period. 

In endometriosis, cells similar to the ones in the lining of the womb grow elsewhere in the body. These cells react to the menstrual cycle each month and also bleed. However, there is no way for this blood to leave the body. This can cause inflammation, pain and the formation of scar tissue.

Is there is a permanent cure for endometriosis?

Currently, there is no permanent cure for endometriosis.

What causes endometriosis?

The actual cause of endometriosis is unknown. There are several theories about the cause of endometriosis, but none fully explains why endometriosis occurs.It is possible that a combination of the factors could be causing endometriosis to develop in some women.

Does endometriosis affects women of all ages? 

Endometriosis can affect all women and girls of a childbearing age, regardless of race or ethnicity. 1 in 6 women of reproductive age have endometriosis.  The impact can also be felt for life. It is more aggressive between 20 and 35 years of age.

Endometriosis can have a significant impact on a person's life in a number of ways, including chronic pain, fatigue, depression, anxiety, problems with a couple’s sex life / relationships, inability to conceive and difficulty in fulfilling work and social commitments

However, with the right endometriosis treatment, many of these issues can be addressed, and the symptoms of endometriosis made more manageable.

How is endometriosis diagnosed?

Getting diagnosed with endometriosis may take some time. The symptoms of endometriosis are very similar to other common conditions.The only definitive way to diagnose endometriosis is by a laparoscopy - an operation in which a camera (a laparoscope) is inserted into the pelvis via a small cut near the navel.

Scans, blood tests and internal examinations are not a conclusive way to diagnose endometriosis. A normal scan, blood test and internal examination do not mean that you do not have endometriosis.

How does endometriosis impact on fertility?

Endometriosis does not necessarily cause infertility but there is an association with fertility problems, although the cause is not fully established. In some cases it may be because the disease distorts a woman’s reproductive organs.

Even with severe endometriosis, natural conception is still possible. 60-70% of women with endometriosis can get pregnant spontaneously.

What are the treatment options for endometriosis and infertility?  

Currently, there is no cure for endometriosis. The different treatments available for endometriosis aim to reduce the severity of symptoms and improve the quality of life for a woman living with the condition.

For those with endometriosis who do experience fertility issues, a proportion will get pregnant after medical assistance, either surgery to remove endometriosis or through assisted reproduction technologies (IVF).                  

Treatment optionsfor endometriosis are as follows:

1) Laparoscopy and fulguration and removal of endometriosis.

2) Ovulation induction and timed intercourse for minimal and mild endometriosis  

3) Intrauterine insemination for minimal and mild endometriosis 

4) In vitro Fertilisation for moderate to severe endometriosis

Does endometriosis cause problems in pregnancy?

Pregnancy complications are not increased due to endometriosis.

Will surgery or having a laparoscopy increase my chances of falling pregnant?

For those with superficial endometriosis (where tissue attaches to the peritoneum) there is evidence that laparoscopic surgery can improve the chances of becoming pregnant naturally if you have had problems conceiving.

For those with deep endometriosis (where the bowel, bladder or ureter is involved) there has been little research on the effect of surgery on pregnancy rates.

Will I still experience endometriosis pain whilst I am pregnant?

In general, pain improves during pregnancy and breast feeding as the periods are not happening.

Does pregnancy cure endometriosis?

No, and pain can return after giving birth as your period returns.

Is endometriosis familial or has genetic inheritance?

Endometriosis tends to run in families and affects certain ethnic groups than others.

Does endometriosis increase the likelihood of having a miscarriage?

Miscarriage is a common problem in all pregnancies, regardless of whether or not you have endometriosis. Miscarriage rate does not increase with endometriosis.

Does endometriosis increase the likelihood of ectopic pregnancy?Ectopic pregnancies happen in 1% of pregnant women, with endometriosis, the risk is more than doubled.

What is the treatment for endometriosis for non-fertility reasons?

Currently, there is no cure for endometriosis. The different treatments available for endometriosis aim to reduce the severity of symptoms and improve the quality of life for a woman living with the condition. Treatment include:

  1. Pain killers: such as diclofenac, Ibuprofen and Paracetamol
  2. Hormonal medicines and contraceptives: Combined Oral contraceptive pills, Progestin medication, Intra Uterine System (Mirena coil) and Injections gonadotropin releasing hormone agonist (GnRH analogue).
  3. Surgery to remove the area of patches of endometriotic tissue.
  4. Surgery to remove the ovaries and womb in cases of severe cases.