Written by Dr Jireh Serfontein, originally published on Baby Yum Yum.
Endometriosis is one of the most common chronic gynaecological disorders, affecting an estimated 10% of women in the reproductive age group (usually 15-49 years old).
It is defined as the growth of endometrial-like tissue (the inner lining of the uterus) outside the uterus. Although its exact cause is unknown, it is hormone mediated and is believed to be due to retrograde menstruation.
It is a long-term condition causing pelvic pain, painful periods, infertility and other symptoms that affect a woman’s quality of life. Research has shown that 38% of women and 87% of women with chronic pelvic pain have underlying endometriosis.
How to live with endometriosis
The most common symptom of endometriosis is pain. Living with endometriosis might mean that you struggle with lower abdominal pain, painful periods and/or painful sex. So the main focus is to alleviate that pain. Pain medication avoids the use of hormones, so it does not prevent the growth of endometriosis; however, the management of pain is an important part of managing the condition. One can start off with Panado and add NSAIDs if needed.
Hormonal treatments are often added to the management. These treatments are used to act on the endometriosis and stop its growth by putting the woman into a pseudo-pregnancy. Pregnancy is characterised by higher levels of progesterone, thus taking progestogens (the synthetic form of progesterone) mimics the state of pregnancy. During pregnancy, the endometrium is thin and also inactive.
Drugs used that mimic pregnancy:
- Combined oral contraceptive pill
- Mirena IUS ®
As a treatment for endometriosis, surgery can be used to alleviate pain by removing the endometriosis, dividing adhesions, or removing cysts. Surgery is also used to diagnose the disease and can be used to improve fertility.
Living with endometriosis can be very difficult. Many women struggle with chronic pain which can cause sexual dysfunction. This can also lead to relationship problems. It is important to talk to your partner so that you can deal with this together.
How can endometriosis affect my fertility?
Although endometriosis can have an effect on your chances of getting pregnant, most women who have mild endometriosis are not infertile. An estimated 70% of women with mild to moderate endometriosis will get pregnant without treatment.
The exact nature of the link between infertility and endometriosis is unclear but the severity of the condition and location of the tissue appears to have an effect. It seems that the inflammation and irritation caused by the endometriosis is the cause of infertility.
Inflammation of the fimbria, the part of the fallopian tube that picks up the egg and transports it, causes swelling and scarring so the egg may not reach its destination. It has also been found that the inflammation damages the sperm and eggs when they are exposed to the unfriendly environment caused by the endometriosis. In more severe cases, the endometriosis starts to cause adhesions, and the pelvic organs become stuck to each other, resulting in decreased function.
For those with mild endometriosis surgery could improve fertility by removing the visible endometriosis and dividing adhesions.
Endometriosis is common and it can be debilitating, it can affect your relationship and decrease fertility. If you suspect that you may be suffering from endometriosis, talk to your doctor to get the necessary treatment.