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What is Endometriosis and how can it affect me and my fertility?

Endometriosis is a gynaecological condition that affects women, most commonly in their 30’s and 40’s. We speak to Louise Mitchell, Nurse Manager at LWC Bristol to find out more about the effect of Endometriosis on women and their fertility.

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Endometriosis is a gynaecological condition that affects women, most commonly in their 30’s and 40’s.  It can take a long time to diagnose, as the symptoms are often vague, but according to the Royal College of Obstetricians & Gynaecologists (RCOG) it is the second most common gynaecological condition in the UK.

Endometriosis UK states that the condition possibly affects up to 10% of the worldwide female population (approximately 176 million women) and costs the UK economy £8.2 billion per year in loss of work, treatment and associated healthcare costs.

How can Endometriosis affect my life?

Endometriosis is a long-term condition that can have a lasting impact on women’s lives due to the symptoms that can arise with the condition. 

“Endometriosis occurs because tissue, very similar to the lining of the womb (endometrium), grows in places other than the womb cavity,” says Louise, “it can be found on the ovaries, Fallopian tubes, bowel and bladder. The reason for this is unknown but may be genetic.”

The condition usually causes painful periods, as the womb lining in the wrong place grows with the hormones through the menstrual cycle.  It then becomes inflamed when the hormone levels fall with a period. This constant inflammatory process can then lead to scarring in the pelvis.

What are the symptoms of Endometriosis?

Symptoms of Endometriosis include:

  • - Pelvic Pain (pain in lower back and stomach).

  • - Irregular or Heavy periods

  • - Pain during and after sexual intercourse

  • - Pain when passing urine or faeces (you may also have blood in the stool)

  • - Severe period pain – not normally relieved with painkillers

  • - Infertility

  • - Lethargy

  • - Some women may suffer no symptoms

How can Endometriosis be treated?

“Currently there is no cure for Endometriosis,” says Louise, “but some treatments are available to help relieve the symptoms.”  These treatments tend to fall into 4 categories:

  • - Painkillers including anti-inflammatories such as ibuprofen.

  • - Hormonal medications which suppress the normal ups and downs of hormones during the menstrual cycle thus suppressing the growth of the patches of endometriosis. This includes   the oral contraceptive pill, progesterone only pill, the contraceptive patch, the Mirena coil or the GnRH analogue medication, for example Zoladex injections, which can cause hot flushes.

  • - Natural suppression of periods with pregnancy, breastfeeding and the menopause will also suppress endometriosis.

  • - Surgery which can either be to relieve symptoms, excising the patches of disease, usually with keyhole surgery, or definitive with removal of the womb and ovaries.

What should I do if I think I have Endometriosis?

Endometriosis can be difficult to diagnose as the symptoms can be very similar to conditions such as Irritable Bowel Syndrome (IBS) or Pelvic Inflammatory Disease (PID).  According to the Royal College of Obstetricians and Gynaecologists it can take up to 7.5 years to diagnose.

“It is important to seek the help of your GP if you think you may be suffering from this condition.” recommends Louise, “Resources can be found online from organisations such as Endometriosis UK who can provide diaries to help you log and keep track of your pain and symptoms”.

If your GP suspects that you have endometriosis, they may refer to you to see a specialist gynaecologist.  They can carry out tests such as an ultrasound scan and laparoscopy which can lead to a definitive diagnosis.

A Ca 125 blood test is sometimes done to look for Endometriosis as it can be raised in the condition. Unfortunately, there are a lot of other causes for a raised Ca 125, so it is not generally recommended as a diagnostic test.

How can Endometriosis affect my fertility?

Endometriosis UK states that infertility in women with Endometriosis can be between 30-50%.

Women with Endometriosis can suffer from adhesions which causes tissue to become stuck together in the pelvis.  Some women also may develop blood filled cysts on the ovaries called endometriomas a result of the condition.

Confusingly a lot of the treatment used to try and help with symptoms are contraceptive medication.  Surgery for endometriosis can improve the chances of conception but may also cause problems such as infection and bleeding.  It can also cause potential damage and scarring of the ovaries and Fallopian tubes which can in turn further affect your chances of conception.

How can London Women’s Clinic help?

“If you are experiencing infertility and suspect endometriosis, then as part of your initial consultation at the clinic, we will perform a pelvic ultrasound scan to see any obvious signs of Endometriosis.” suggests Louise.

If your symptoms suggest the condition, then you can be referred to a gynaecological surgeon for a laparoscopy.  During the procedure a telescope is introduced into the abdominal cavity whilst you are anaesthetised, and the extent and severity of the Endometriosis can be seen and treated at the same time.

In-Vitro Fertilisation (IVF) can be an effective treatment for women with Endometriosis who want to conceive.  This is a good treatment option for the condition as it bypasses any pelvic scarring and makes the most of the eggs that the ovary can produce.” says Louise.

However, if you suffer from moderate to severe endometriosis then your chances of success with IVF treatment will be reduced due to the long-term damage to the ovaries from surgery and inflammation.

For more information on Endometriosis you can find out more from NHS UK, Endometriosis UK and the Royal College of Obstetricians and Gynaecologists.  If you are concerned about Endometriosis and your fertility, please contact us to find out how we can help.

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