Endometriosis and Fertility: What You Need to Know-image

Endometriosis and Fertility: What You Need to Know

A common symptom of endometriosis is fertility issues. Up to 50% of people with endometriosis will struggle to conceive, with the causes still relatively unknown. Here take a deep dive into what you need to know about your fertility if you have diagnosed or suspected endometriosis. Quick facts: What is endometriosis? Endometriosis is a reproductive health condition where tissue similar to the lining of the womb grows in other places. This is called endometrial tissue. This tissue can grow in the ovaries and fallopian tubes and can cause painful symptoms.  It’s one of the most common reproductive health conditions. 1 in 10 women and those assigned female-at-birth (AFAB) will develop endometriosis, yet its definitive cause is still unknown.  As a long-term condition, endometriosis can significantly impact some people’s lives. One of the most common concerns is how does endometriosis affect fertility? Will endometriosis affect my fertility? In short, it might. Fertility problems are common in those with endometriosis, with 30-50% experiencing fertility problems (1). But having endometriosis does not automatically mean you will have fertility problems—every case is different. It will depend on the severity of your symptoms and any structural or hormonal issues you may have.  Is it possible to get pregnant with endometriosis? Yes, it’s possible to get pregnant with endometriosis. However, you may experience difficulty getting pregnant. Those with endometriosis have a lower chance of getting pregnant with each monthly cycle (2). This can result in it taking longer for people with endometriosis to conceive (3).  Infertility is also common in those with endometriosis, and in subfertile (failure to conceive after one year of trying) women the prevalence seems to be considerably higher, ranging from 20% to 50%, but it varies with time and age (1). How does endometriosis affect fertility? Again, not necessarily. But those with endometriosis are at an increased risk of miscarriage, ectopic pregnancy and other obstetric complications compared to those without (4). How does endometriosis affect fertility? Exactly why and how endometriosis affects fertility is still unknown. But here are the latest theories of possible links and causes.  Structural issues One of the ways endometriosis is likely to affect fertility is by distorting the position of reproductive organs. Growth of endometrial tissue and adhesions around the uterus and Fallopian tubes can cause this distortion. In turn, this may block mature eggs from reaching the uterus to be fertilised. The risk of blocked Fallopian tubes, in particular, increases in the more advanced stages of endometriosis.  Endometriomas The presence of cysts on your ovaries, called endometriomas, could also affect fertility and ovulation. Endometriomas can damage ovarian tissue and the precious ovarian follicles which house immature eggs.  Immune reaction Another theory is an immune reaction to endometrial tissue growing outside the uterus. This is because this tissue is recognised as ‘foreign’ to these parts of the body. The immune system responds by attacking it, causing inflammation. Inflammation leads to harmful toxins which may affect Fallopian tube function, sperm function and egg quality (5). Womb reciprocity There is also debate about whether endometriosis affects the receptivity of the womb to a fertilised egg. However, there is currently no conclusive evidence to prove this theory.  Painful sex Painful sex is one of the symptoms associated with endometriosis. Pain during or after intercourse can negatively impact your sex life and make the trying-to-conceive process difficult. Can treating endometriosis improve fertility? Various treatments for endometriosis that aim to improve fertility. The right ones for you will depend on the location and severity of your endometriosis and what your symptoms are.  One treatment that aims to improve fertility is laparoscopic surgery. This is surgery to remove the endometrial tissue deposits and adhesions. It aims to free the pelvic organs of any structural issues or blockages and reduce inflammation.  For people with endometrioma, laparoscopic ovarian cystectomy can remove the endometriosis-related cysts on the ovaries (6). This has been shown to lower the recurrence rate of both cysts and pain symptoms.  However, there are risks associated with any surgery. For example, ovarian cystectomy can also negatively affect ovarian reserve by the removal of healthy tissue.  It’s important to discuss the potential for surgery with a specialist. And to explore the individual risks. How can I improve my chances of conceiving with endometriosis? If you’re trying to conceive with endometriosis, there are options to improve your chances. These include expectant management and assisted reproductive techniques (ARTs).  Expectant management  This is for heterosexual people who are trying to conceive naturally and:  To improve your chances of conceiving with every menstrual cycle, it is recommended to have sex every 2-3 days so there is a good chance of catching your fertile window.   Assisted reproductive techniques (ARTs) ART options include ovarian stimulation (COS), intrauterine insemination (IUI), and in-vitro fertilisation (IVF).  Depending on your age, ART is recommended if: IUI is usually offered to couples with minimal or mild endometriosis if their partner has normal semen quality and is typically not offered to those with moderate/severe endometriosis, because of a probable effect on the Fallopian tubes. IVF can be offered to those with moderate or severe endometriosis. It can also help those with a very low egg reserve. IVF has been found to be less successful in people with endometriosis compared to those without endometriosis. However, lots of factors influence IVF success, like age, whether you’ve been pregnant before, if you’ve had treatment before body mass index, underlying health conditions, lifestyle and your partner’s sperm quality.  Resources:  

 What are the Main Symptoms of Endometriosis?-image

 What are the Main Symptoms of Endometriosis?

Endometriosis is a common reproductive health condition that affects 1 in 10 in the UK. It’s characterised by painful, heavy periods as well as other, often debilitating symptoms. Here we go through each of the main symptoms in detail, so you know what to look out for and when to get checked.  Quick facts: Endometriosis in the UK In the UK, endometriosis affects around 1.5 million women and people assigned female-at-birth (AFAB). That’s 1 in 10 who are currently living with the condition, regardless of race or ethnicity (1). People with endometriosis often experience very painful periods as well as a host of other symptoms. Many people live with endometriosis for a long time before getting diagnosed. Sometimes up to 7 years or more.  This is often the result of a general lack of awareness about the condition, dismissal of women’s pain and symptoms having a lot of crossover with other conditions. So what are the main symptoms of endometriosis? Here’s what to look out for if you suspect you, or someone close to you, may have the condition. What is endometriosis? Endometriosis is a chronic reproductive health condition where cells similar to those lining the uterus grow in other parts of the body. Endometrial tissues and lesions are found in the ovaries and Fallopian tubes.  They can sometimes also grow in the vagina, cervix, vulva, bowel, bladder and rectum. Rarely, do they appear in other parts of the body, like the lungs, brain, and skin (2). Just like the lining of the uterus, these cells build up and eventually shed. But unlike your period which drains through the vagina, this blood and tissue has nowhere to go. This can cause inflammation, crippling pain and a long list of other symptoms. Endometriosis can affect women of any age, including teenagers. What are the main symptoms of endometriosis? Here are the most common symptoms of endometriosis (3):  Severe period pain  Severe period and pelvic pain are often reported to be the most debilitating symptoms of endometriosis. This pain is often described as ‘a razor blade pain’.  During your menstrual cycle, the lining of your uterus (endometrium) is built up to support a potential pregnancy. If its baby-making dreams are not fulfilled, your body releases chemicals called prostaglandins.  Prostaglandins cause the uterus to contract and your endometrium sheds. Cue, your period. These contractions are what cause period pain. With endometriosis, the endometrial-like cells that have grown outside of the uterus also build up and shed. This internal bleeding leads to inflammation, intense pain and a buildup of scar tissue and adhesions (a type of tissue that can bind your organs together).  Usually, the first or second day of your period is the most painful. But in cases of endometriosis, the crippling pain usually kicks in a few days before your period’s arrival. It can also make an unwelcome return during ovulation or even throughout the month.  People can also experience chronic pain, increased lower back and pain around their legs which increases around their periods. “Endo belly” is a common term used to refer to the uncomfortable abdominal symptoms associated with endometriosis. Heavy periods Another common endometriosis symptom is heavy periods. Heavy periods are defined as: If your periods are painful or heavy it’s important to seek medical advice. Monthly heavy bleeding can increase the risk of anaemia (iron deficiency) which can result in symptoms of fatigue, feeling cold often and hair thinning. Pain during or after sex Another common symptom of endometriosis is pain during or after vaginal penetration. This can be caused by endometrial lesions growing in the pelvic region and becoming inflamed during or after sex. This pain is called dyspareunia. It has been reported to feel like a stabbing shooting pain, usually felt deep inside the pelvis. Any unwanted pain during sex is not normal. If you experience any pain during or after sex or any bleeding, get it checked out. There is also mental health support available if you feel your intimacy is being affected by pain during sex. Bowel and urination pain Endometrial lesions can sometimes find their way to the surface of the bowel or even penetrate its wall. This can cause uncomfortable symptoms such as pain when urinating or passing bowel movements or noticing blood in your urine or poo. Pain during urination can sometimes be misdiagnosed as a UTI. If you’re in pain when passing urine or poo or if you notice any blood in either, get it checked out to understand what might be the cause. Bloating and gastrointestinal issues People with endometriosis can also experience bloating and gastrointestinal issues. These symptoms are similar to those of irritable bowel syndrome (IBS). Including diarrhoea, constipation and bloating. These symptoms are often affected by your cycle and can worsen in the days before your period. Fertility problems Unfortunately, endometriosis can affect your fertility. Infertility affects about 30-50% of those with endometriosis, but there are no definitive answers (yet) as to why—only theories.   However, this does not mean that if you have endometriosis you can’t conceive. Even in cases of severe endometriosis, natural conception is possible.  Mental health impacts Living with a chronic condition can be tough and often isolating. Endometriosis can affect various aspects of life from personal to professional relationships, which can impact your mental health.  If you feel like endometriosis is impacting your mental health, there are online support communities like Endometriosis UK. You can also talk to our Fertility Counsellors for any mental health concerns relating to your fertility.  Getting to the bottom of symptoms Just like any reproductive health condition, endometriosis varies from person to person. Not everyone with endometriosis will experience all of these symptoms to the same severity. Some people may not experience any of these symptoms at all.  Having severe pain or very heavy periods is not necessarily a sign of more severe endometriosis. It’s also important to remember that each of these symptoms can also be caused by other conditions.  If you’re experiencing any of the […]

Managing Endometriosis: Treatment Options Post-Diagnosis-image

Managing Endometriosis: Treatment Options Post-Diagnosis

Have you been diagnosed with endometriosis? Discover our top tips for managing endometriosis pain and the treatment options available to you. From painkillers to surgery.  Quick facts: Living with endometriosis If you live with endometriosis, you probably know that one of the biggest symptoms of endometriosis is pain… a lot of it. Experiencing chronic pain amongst other, often equally debilitating symptoms, can have big physical and emotional consequences.  Sadly, there is currently no cure for endometriosis. And with limited research and understanding of the condition, it can be difficult for both doctors and endo warriors to get a handle on managing endometriosis symptoms.   But you don’t have to put up with pain. There are several treatments available to manage symptoms and help improve your quality of life. Lots of people report huge improvements with these treatments—it’s just about finding what works for you. Medication for managing symptoms The first step in managing pain is usually exploring the use of painkillers. Your doctor may recommend taking nonsteroidal anti-inflammatory drugs (NSAIDs) (aspirin, ibuprofen) or paracetamol as a first line of treatment to manage any pain.  However, there are lots of different types of painkillers and your doctor can help you to find ones that work for you and your pain level.  Depending on the severity of your endometriosis pain, you may try a course of painkillers for a few months until you assess whether or not they are working for you.  But if you’re finding that these aren’t making the cut and you’re unable to go to work, uni, school, work or other plans, don’t suffer in silence! This is just the first option for managing endometriosis, so push your doctor for alternatives. Tips for endometriosis pain management Endometriosis UK suggests some extra tips for pain management: Heat and comfort Hot water bottles, heated wheat bags or special heat pads can really help to soothe pain, cramping and inflammation.  Remember to never put them directly onto the skin and always have a layer in between. Partnered with your comfies, hopefully, this can help you to feel more comfortable. Physiotherapy Physiotherapists can develop a programme of exercise and relaxation techniques designed to help strengthen pelvic floor muscles, reduce pain, and manage stress and anxiety. TENS machines Transcutaneous Electrical Nerve Stimulator (TENS) machines are small devices with electrodes that send electrical pulses into the body. This can block the pain messages as they travel through your nerves. Pain clinics Your doctor can refer you to your nearest pain clinic to see chronic pain specialists. Push for your doctor to get you the expert advice you deserve to manage your endometriosis pain. Hormone treatment for endometriosis When you’re diagnosed with endometriosis, hormone treatment is another common avenue to explore. You should discuss hormone treatment with your doctor or specialist to decide if it’s right for you. For those with endometriosis, similar cells to those lining the womb exist outside of the womb (usually in the abdomen).  These cells also respond to your sex hormones, particularly oestrogen and progesterone, in the same way as your womb lining. They thicken, break down and bleed during your period. This bleeding causes inflammation and scarring, leading to chronic pain.  Hormone treatment is commonly used to reduce the growth of this endometrial tissue.  How does hormone treatment help endometriosis? Hormone treatment aims to maintain low levels of oestrogen in the body, as oestrogen has been found to encourage the growth of endometrial tissue. Hormone therapy can help reduce heavy flow or even stop periods and therefore improve symptoms.  Whilst most endo warriors find that hormonal treatment reduces their symptoms, it is not a permanent fix to manage endometriosis. Types of hormonal treatment used to manage endometriosis? There are lots of different types of hormone treatment available. Some of the most common are also used as contraceptive methods including: Unfortunately, not everyone gets on with hormonal contraception and side effects can be common. It’s important to consider which hormone treatment is right for you. Surgery for endometriosis A last resort if the above treatments aren’t keeping your symptoms at bay, is endometriosis surgery. This aims to remove or destroy areas of endometrial tissue.  This can include laparoscopic surgery or a hysterectomy. The kind of surgery you have will depend on where the endometriosis is and how much of it there is. Laparoscopic surgery for endometriosis Initial surgery will almost always involve gynaecological laparoscopy for both diagnosis and excision. In laparoscopic surgery, also known as keyhole surgery, your surgeon inserts a small tube with a light source and a camera, through a small incision near your belly button.  They use this to be able to look inside your tummy or pelvis and then use fine tools to remove endometrial tissue (excision) or use intense heat to destroy the tissues (ablation). They can also remove any scar tissue that has built up in the area.  This form of surgery can be difficult, as many of the lesions are below the surface and not visible, so a highly skilled practitioner is required to remove them.  It might be the most long-lasting treatment, and people do notice relief in symptoms, but many who undergo surgery find their endometriosis grows back over time. This is why endo warriors may have to undergo surgeries multiple times. Hormone treatment might be used after surgery to help get better, longer-lasting results. Hysterectomy for endometriosis Sometimes healthcare professionals will also suggest undergoing a hysterectomy, a surgery where the womb is removed. This can be a very big decision as post-surgery, you will no longer be able to become pregnant or carry a pregnancy.  If you want children, you can discuss egg freezing before this procedure with your doctor. This means that you will then have the option of trying to have a baby using fertility treatments such as in vitro fertilisation (IVF) with the help of a surrogate. In some cases, someone might still experience symptoms after getting a hysterectomy done as a form of endometriosis management. If the ovaries […]