For some women, endometriosis means severe pain or struggles with infertility. But for others it can be totally symptomless.
Endometriosis is a condition that affects women during their childbearing years. It happens when endometrial tissue, which normally lines the uterus, grows outside of the uterus.
It can implant and grow anywhere in the abdominal cavity – usually in the pelvic area and lower abdomen, but rarely also in other places such as the lungs or navel. This tissue sometimes grows in patches known as implants, in thicker nodules, or it can form cysts in the ovaries known as endometriomas.
The endometriosis irritates surrounding tissue and may cause web-like scar tissue called adhesions. However, what makes this condition challenging is that the symptoms can vary significantly from woman to woman. Symptoms include heavy menstrual pain, pain during or after sex and severe back pain.
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“In general, it takes about eight years to reach a diagnosis, and often the woman will have seen five different healthcare providers, so it is underdiagnosed and it takes quite a long time to reach that diagnosis,” says Dr Chris Venter of the Vitalab Centre for Assisted Conception.
Women who have a mother or sister who suffers from endometriosis have a greater incidence of the disease.
“I am seeing people being diagnosed much more frequently,” comments Dr Venter. He believes that the reasons are twofold. More women are choosing to postpone their families, and as they get older, the chance of endometriotic lesions is higher and makes it more prevalent, he says.
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There are two ways to treat endometriosis, explains Dr Venter. The first is hormonally, using medication which will relieve the symptoms of the disease, but will not enhance fertility.
Pain medication can also be used to treat painful symptoms, usually nonsteroidal anti-inflammatory drugs (NSAIDS) and opioids. Some women do very well on hormonal treatments. However, not all treatments work well for all women with endometriosis.
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The second treatment option is surgery, usually a laparoscopy. “We know that surgical treatment can enhance your natural chances of conceiving,” explains Dr Venter. However, he cautions that the new trend is to be more conservative and regard surgery as something only to be considered when hormonal therapy has failed. “There are major risks involved.
This is very delicate surgery and it is extremely important to make sure you have a qualified surgeon performing the procedure,” he warns. Repeated surgery can be harmful and should be avoided unless vital, he says.
How it affects fertility
While figures vary slightly from study to study, about five to 10 percent of the general female population suffers from endometriosis, while 50 percent of all women with fertility issues have the disease, says Dr Venter.
Likewise, approximately 50 percent of women with endometriosis will struggle to conceive. Although they may conceive spontaneously (without fertility treatment), the timeline for achieving a spontaneous pregnancy is considerably prolonged.
“The most effective way of treating endometriosis related infertility is in vitro fertilisation (IVF),” explains Dr Venter. However, women who have endometriosis do not need to worry that it will in any way affect the pregnancy or the foetus, says Dr Venter.
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“There’s no evidence to show that someone with endometriosis has a poorer obstetrical outcome. Whether they have endometriosis or not, the pregnancy outcome is the same. In fact, the pregnancy has a very positive influence on endometriosis,” explains Dr Venter.
“In some women it will regress the disease, so they could actually go from a stage three to a stage two, and at the very least it will suppress the endometriosis for the nine months of the pregnancy. We tell patients that the best thing that can happen to your endometriosis is to conceive.”