Endometriosis Symptoms, Causes, and Treatments: Everything You Should Know
One of the most common issues related to fertility that you may read about is endometriosis. But what is endometriosis? How common is it? What are the signs and symptoms associated with it that may lead to a diagnosis?
Below, we have provided more in-depth information on endometriosis symptoms and signs, its possible causes and treatments, and how it may be managed in order to improve fertility.
What is Endometriosis?
Endometriosis is a condition in which tissue similar to that of a person’s womb lining grows outside of the womb itself. Other places this endometrial tissue can grow include the fallopian tubes, the ovaries, and the pelvic region. On very rare occasions, the lining may also be found in areas outside of this.
When a patient has endometriosis, the excess tissue will act in the same way as any other endometrial tissue in the body, meaning it will thicken, break down, and form part of the bleed that comes with every menstrual cycle. However, this tissue has no means of exiting a patient’s body and therefore becomes trapped.
If the endometriosis is affecting the ovaries, this may cause cysts called endometriomas to form. The surrounding tissue may then become irritated, eventually developing scar tissue and adhesions (bands of fibrous tissue that can cause pelvic tissues and organs to become stuck together).
We should also note that a diagnosis of endometriosis is nothing to be ashamed of. With some assistance, the condition is manageable and even though there is no definite cure, there are many treatment options that may help you in the long term.
Is Endometriosis Genetic?
According to an assessment of multiple studies reported in Clinical Obstetrics and Gynaecology, endometriosis does cluster in families, meaning you may be more likely to develop the condition if other relatives have it as well.
A study conducted in 2020 also found that there may be a genetic mutation associated with several forms of endometriosis. This has been linked to more severe forms and researchers are now looking into the possibility of different genetic treatments which may be able to target this specific issue.
What Puts You at Risk of Endometriosis?
Alongside the genetic potential, there are some other factors that may place a person at greater risk of developing endometriosis. Factors that increase the risk of development include:
- Starting your period at an early age
- Going through menopause at an older age
- Having short menstrual cycles (less than 27 days in length)
- Having heavy periods that last for longer than seven days
- Having higher levels of oestrogen in your body or greater lifetime exposure to the oestrogen your body produces
- Having any medical condition that prevents blood from passing out of your body during a menstrual period
- Having a disorder of the reproductive tract
- Having a low body mass index
- Never going through pregnancy or giving birth
Endometriosis will normally develop several years after a patient has started menstruation. The signs and symptoms of it may also improve temporarily with pregnancy, or disappear entirely with the onset of menopause. The latter of these points may also not be true if the patient is taking oestrogen.
The Endometriosis Types and Stages
There are several different ways to measure and group endometriosis. The most common form of measurement is the scale used by the American Society of Reproductive Medicine. This method involves specialists assigning points according to the development and spread of the endometrial tissue, its depth, and the areas of the patient’s body that have been affected.
Based on the results, the condition can then be ranked into one of four different stages:
- Stage 1, or minimal, in which there are a few small implants, or wounds or lesions. These may be found on a patient’s organs or the tissue lining their pelvis or abdomen. There will be little to no scar tissue.
- Stage 2, or mild, in which there will be more implants than in Stage 1. They will also be deeper in the tissue, and there may be scar tissue.
- Stage 3, or moderate, in which there will be many deep implants. The patient may also have small cysts on one or both of their ovaries, as well as adhesions.
- Stage 4, or severe, is the most widespread. The patient will have many deep implants and thick adhesions. There will also be large cysts on one or both ovaries.
It isn’t known why some patients may have more severe cases than others, and endometriosis will not always go through the different stages. Even if it is left untreated, in some cases it may stay the same in a patient, or it may get worse or better.
As well as being measured in stages, endometriosis may also be grouped by the area of the abdomen or pelvis it is affecting. This means there are four main types that a patient is likely to have:
- Superficial peritoneal endometriosis, which is the least severe form. In this type, the endometrial lining attaches to the peritoneum, a thin membrane that lines a person’s abdomen and pelvis. It will also cover most of the organs in these cavities.
- Endometriomas, which are dark, fluid-filled cysts. Because of their colour they may also be referred to as “chocolate cysts”. They can vary in size and are most commonly found in the ovaries, but can appear in different parts of a patient’s pelvis or abdomen.
- Abdominal wall endometriosis, in which the endometrial tissue will grow on the abdominal wall. The cells may attach to incisions from a previous surgical treatment, including hysterectomies and caesarean sections.
- Deeply infiltrating endometriosis (DIE), in which the endometrial tissue will have invaded the organs either within or outside of the pelvic cavity. This can include a person’s ovaries, rectum, bladder, or bowels. If there is a lot of scar tissue, there is also the potential for it to bond organs so they become stuck. This is called frozen pelvis, but is rare and will only affect between 1% and 5% of people who have endometriosis.
What are the Causes of Endometriosis?
The exact cause of endometriosis is currently unknown, though there are a number of theories and possible explanations:
- Retrograde menstruation, in which blood containing endometrial cells flows back up through the fallopian tubes and into the pelvic cavity instead of leaving the body as part of a period. From there, it is possible that the cells will stick to the pelvic walls and surfaces of organs, where they will grow and continue to thicken and bleed over the course of a menstrual cycle.
- The transformation of peritoneal cells, in which it is theorised that hormones or immune factors will promote the transformation of the cells that line the inner side of a person’s abdomen during puberty. It is claimed that this then causes them to become endometrial-like cell implants.
- Embryonic cell transformation, in which cells that are in the very earliest stages of development may be transformed into endometrial-like cell implants by hormones during puberty.
- Endometrial cell transport, in which the blood vessels or the lymphatic system of a person’s body may be transporting endometrial cells to other parts of the body.
- A problem or disorder of the immune system, which may make the body unable to recognise and destroy endometrial-like tissue growing outside of the womb.
- Surgical scar implantation, in which it is proposed that the endometrial cells attach themselves to a surgical incision.
How Common is Endometriosis?
Even though it may not often be reported on or spoken about, endometriosis is actually the second most common gynaecological condition in the UK. 1 in 10 women, or people who are nonbinary or transgender and have female reproductive organs, will have it. Worldwide, it is suggested that 10% of people with a uterus (176 million people in total) have one of the stages and types of endometriosis.
What are the Signs of Endometriosis?
The signs and symptoms of endometriosis can vary greatly, depending on the patient. The most common and prevalent of these will be pelvic pain, which may also often be associated with the start of a menstrual period. This pain may also be worse if you are on your period, and may stop you from carrying out your normal day-to-day activities.
Other endometriosis symptoms and signs may include:
- Fatigue, diarrhoea, constipation, bloating, or nausea, especially during menstrual periods
- Excessive bleeding on your period
- Bleeding in between periods (intermenstrual bleeding)
- Pain during or after intercourse
- Pain with bowel movements or urination
- Difficulties getting pregnant or issues with your fertility
It should also be noted that even though pelvic pain is the most common symptom of endometriosis, the severity of the pain may not be a reliable indicator of the severity of the condition. Mild endometriosis may cause severe pain in a patient, for instance, or someone with severe endometriosis may undergo barely any pain at all.
When to See a GP or Specialist About Endometriosis
If you are having endometriosis symptoms, you will need to speak with your doctor. This is especially important if they are having an impact on your life and your ability to go through your day-to-day schedule.
To help keep a list of what you are experiencing, it may be beneficial for you to keep a diary. Endometriosis UK offers a pain and symptom diary that you can download and print off online.
Because endometriosis has a number of different signs and symptoms, including several that are shared with other conditions, it can be difficult to diagnose. Your doctor should begin by asking you about the symptoms you’ve noticed, and may perform an examination of your abdomen and your vagina.
There are a number of different treatments that your doctor may recommend if they make a diagnosis of endometriosis. If these treatments are found to be ineffective, they may refer you to a gynaecologist for further tests. These tests include ultrasound scans and laparoscopies. We must also note, however, that ultrasound does have its limitations and can only diagnose endometriosis on the ovaries. Laparoscopy, on the other hand, is considered the gold standard in terms of diagnosis of endometriosis.
A laparoscopy is a procedure in which a surgeon will pass a thin tube through a small incision in the abdomen. With the aid of a camera, this allows them to spot any potential patches of endometriosis tissue. This is also the only way to be certain that a patient has endometriosis.
Endometriosis Treatment in the UK
There may not currently be a full cure for endometriosis, but there are many options for treatment which may ease its symptoms. Treatment options that your doctor or a specialist may suggest are listed below:
- Painkillers such as ibuprofen or paracetamol
- Hormonal treatment, including medicines and contraceptives such as the combined pill or the contraceptive patch
- Surgery to remove patches of the endometriosis tissue
- An operation to remove part or all of the organs affected by endometriosis, including hysterectomies
Living with Endometriosis
The most beneficial thing you can do for the management of your endometriosis is ensure you are being supported by a professional. Even though it can often be challenging both physically and mentally (especially in cases related to fertility), also having a strong network of friends, family, and others who have been through the same around you can help keep you feeling reassured. The latter may also be able to provide advice and information that you have not been made aware of before.
Getting Pregnant with Endometriosis
One of the main complications associated with endometriosis is its impact on a patient’s fertility. Getting pregnant with a diagnosis of the condition is not necessarily impossible, but it can present difficulties. This is because the endometrial lining may block fallopian tubes and prevent ovulation, or may damage the egg or sperm. It isn’t known exactly why this may be the case, but it has been theorised that endometriosis causes greater levels of inflammation in the body.
A fertility specialist may be able to help you by conducting blood tests, including an anti-müllerian hormone (AMH) test, in order to check your ovarian reserve. Some surgical treatments for endometriosis can reduce your ovarian reserve, so we would recommend speaking to a specialist before deciding on the best treatment for you.
There are a range of options for fertility treatment that are related to a diagnosis of endometriosis, and that may help you to carry a successful pregnancy at a later date:
- Egg freezing
- Fertility medications such as clomiphene
- IVF treatment cycles
- Intrauterine insemination (IUI)
For More Information on Fertility Treatment After Diagnosis
If you have recently been diagnosed with endometriosis and it has always been your dream to become a parent, GENNET City Fertility can help. When you contact us for the first time and set up a free consultation with a discreet, understanding specialist, you will be taken through a range of treatment options to suit your individual needs. From these, we can help you take the first step on the road to forming your family.
Get in touch with us and find the treatment that is right for you today.