Endometriosis is a chronic condition affecting about one in nine Australian women where the tissue that is normally found only in the lining of the uterus (the endometrium) grows outside the uterus. Instead of leaving your body during your period like normal endometrial tissue, it gets trapped, causing inflammation and scarring. This may lead to symptoms and complications, including pelvic pain and infertility.
Not all women living with endometriosis will experience noticeable symptoms. For those who do have symptoms, these can be highly variable between individuals.
Common endometriosis symptoms can include:
Endometriosis is often associated with a significant delay in diagnosis, with an average of six years from first symptoms to receiving an accurate diagnosis. Part of this is due to the normalisation of painful periods. Diagnosing endometriosis is a combination of:
Dr Ritu will review your medical history, menstrual cycle patterns, and symptoms. Menstrual periods during endometriosis are often when symptoms such as pelvic pain are at their worst. Periods are considered abnormally heavy if you soak through a pad or tampon every hour or two, including overnight, or if you are passing blot clots larger than a 50c coin. If your periods are preventing you from leaving the house on the heaviest days or engaging in your usual activities, they may also be considered abnormally heavy.
Sometimes an ultrasound scan is sufficient to detect these lesions, especially if performed by a suitably experienced technician. However, laparoscopy remains the gold standard for definitive endometriosis diagnosis. This involves creating keyhole incisions in your abdomen to allow a long tube with a camera and light to be inserted into your pelvic cavity. Laparoscopy provides a direct view of lesions and has the added benefit of facilitating treatment at the same time as diagnosis.
Though not all women living with endometriosis will notice an impact on their fertility, endometriosis is known to interfere with conception in several ways.
Endometriosis can cause ongoing inflammation in the pelvis, which may interfere with the environment around the ovaries and affect egg development.
Endometriosis may lead to adhesions or scar tissue that changes the position or function of the tubes, making it harder for the egg and sperm to meet.
Endometriosis can alter the lining of the uterus and the pelvic environment, which may make it harder for an embryo to implant and grow.
Endometriosis, particularly when ovarian cysts (endometriomas) are present, can sometimes affect ovarian function and reduce the number of eggs available.
Heavy periods, pelvic pain, and cycle irregularity can make it more difficult to identify fertile windows and plan conception.
Not all cases of endometriosis require treatment. The right approach to managing your condition is based on your symptoms, how much endometriosis is impacting your life, your personal preferences, and fertility goals.
Mild pain symptoms may be relieved with simple medications such as ibuprofen. If needed, Dr Ritu can prescribe stronger pain relievers. Hormone-based medications can also be helpful in both addressing pain and heavy periods, and in some cases, can stop your periods altogether. As most of these medications are also used as contraception, such as the pill or intrauterine device (IUD), you will need to consider other options if you’re trying to conceive.
Laparoscopy for endometriosis involves surgically removing endometriotic lesions. This approach addresses pain and inflammation, though it is possible for the lesions to regrow. The laparoscopic technique can also separate adhesions, abnormal bands of scar tissue connecting organs and surfaces within the pelvis that are usually separate.
If you have been trying unsuccessfully to conceive and endometriosis is identified as playing a role in infertility, Dr Ritu may recommend assisted reproductive technologies to support your family building goals.
If your cycles are regular and endometriosis is mild, treatment may start with tracking ovulation so you can identify your most fertile days. Timed intercourse can help make sure you are trying at the right time in the cycle.
IUI may be recommended in selected cases, especially if endometriosis is mild and your fallopian tubes are open. IUI places prepared sperm directly into the uterus around the time of ovulation to improve the chance of fertilisation.
IVF may be a better option if endometriosis is more advanced, if the fallopian tubes are affected, or if pregnancy has not occurred with other treatments. IVF allows eggs to be collected, fertilised in the lab, and transferred to your uterus as embryos.
