Endometriosis is a condition that can occur in women of reproductive age (from puberty to perimenopause). Usually a type of tissue (or cells) that line your uterus (endometrium), tend to move from their usual place and grow in other areas surrounding the reproductive organs. This does not always cause symptoms and it usually is not dangerous. But it can cause pain and other problems. Those with endometriosis may also experience delays in or failure to conceive naturally.
The main symptoms are severely painful periods. The pain may start just before the onset of periods, last through the period, and ease after the period is complete. Some can experience painful sexual intercourse, and there may be associated heavy periods as well. In some cases, people may experience issues with their urinary system and stool movement. Simple pain killers may not provide enough pain relief. Severe endometriosis symptoms often lead to significant suffering.
If endometriosis is suspected, patients need a systematic assessment to confirm the diagnosis and offer appropriate treatment strategies. A thorough gynaecological clinical assessment is required to be able to recommend further tests. Initial tests include ultrasound imaging of the area of the reproductive organs. Further imaging may be required with CT scan or MRI (Magnetic Resonance Imaging). The diagnosis is usually confirmed by a procedure called laparoscopy, which uses a telescope to directly visualise the organs. It is the main way to diagnose endometriosis, and rule out other conditions that may have similar symptoms.
Treatment options include pain killers, hormone treatments, and surgery. Recommendations on appropriate treatment options will depend on your age, severity of endometriosis and reproductive wishes. Less intensive treatments will generally be recommended for young women in order to ensure reproduction is still possible.
Those diagnosed with endometriosis and desiring conception should seek help within six months of trying to conceive naturally. It’s best to consult a fertility specialist, but your general gynaecologist will do, in the absence of easy access to a fertility centre. A review of your endometriosis symptoms, and other reproductive factors will be done. Specific fertility tests will be done, including hormone tests, pelvic imaging and a check of your fallopian tubes. You may end up requiring a laparoscopy to improve your chances with fertility treatment. Your partner too will require a fertility evaluation, including a sperm test.
Specific fertility treatment will be advised following the completed assessment. Young women below the age of 35 with normal tubes, and mild endometriosis, may be suitable for simple treatments like intrauterine insemination (IUI). Such simpler treatments however have disappointing success rates. In Vitro fertilization (IVF) is more suitable for endometriosis-associated infertility. However, the overall success rate will be dependent on the severity of endometriosis and other related infertility factors.
