Endometriosis: Fertility and Pregnancy
Roughly 1 in 10 women have endometriosis, and while the condition is not life threatening, it can have implications for women in later life around their reproduction, fertility and ability to get pregnant.
What is Endometriosis?
Endometriosis is a chronic condition that affects the reproductive organs in women. It’s caused when the cells that line the womb – called the endometrium – move and grow in other parts of the body, outside of the womb.
When you experience your menstrual cycle, your body releases hormones that send signals to the womb and cause the lining of the uterus to thicken ready for a fertilised egg. When no egg is fertilised, the lining of the uterus then breaks down which is what causes women to experience their period. No matter where endometrial cells are in your body, they will still respond to the hormones sent out by your body and breakdown. Outside of the womb, when these cells breakdown, the bleeding that is a result has nowhere to go and can cause further problems around the reproductive organs, such as ovarian cysts, called endometriomas, or lesions around the womb and pelvic area that can ‘leak’ in response to the bodies hormones.
What causes endometriosis?
There is no defined cause for endometriosis – it affects many different women, from all different backgrounds, cultures and lifestyles. It is not an infectious condition and cannot be passed on through sexual activity. It is a chronic condition that can be managed when properly diagnosed.
Some suggested causes for the condition include:
· Your Family History – you are more likely to be diagnosed with endometriosis if you have close female relatives, such as your mother or grandmother, who have experienced or been diagnosed with endometriosis.
· Your Menstrual Cycle – some women experience a form of menstruation called retrograde menstruation – this is where the blood can flow back into your uterus during your cycle, towards the fallopian tubes and pelvis.
· Immune Dysfunction – there is currently research into whether changes in immune cells are a cause for endometriosis.
· Lifestyle Choices – there is also research currently looking into whether different lifestyle factors are a cause for endometriosis including body weight, diet and alcohol consumption.
How does it affect fertility?
Because endometriosis affects the reproductive organs it is estimated that about 30% of women who have endometriosis will have difficulty falling pregnant. There a number of different reasons for this including:
· Scarring caused by endometriosis on the fallopian tubes and ovaries
· Damage caused by endometriosis to the lining of the womb, resulting in a fertilised egg having difficulty in implanting into the wall of the uterus in order to develop
· Blocked fallopian tubes caused by damage and lesions from endometriosis
· Damage to the unfertilised eggs in the ovaries caused by endometriosis
Although these are some of the reasons thought to affect the fertility of women with endometriosis, they are not conclusive and it is important to remember that even if you have been diagnosed with endometriosis, you will not definitely experience all of these symptoms and have issues with fertility.
Endometriosis does mean that you are infertile, and many women have successful pregnancies with no complications, during conception or birth.
How do I know if I have endometriosis?
Endometriosis can be difficult to detect but it can cause a wide range of symptoms, so it’s worth knowing what to look out for and keeping a note of prolonged and reoccurring symptoms that you can report to your doctor if you think you might have endometriosis.
Some of the symptoms to look out for include:
1. Uterus and Ovulation Pain – you may experience strong period pains – both during your period and pre-menstrual pain, and pain during sex.
2. Abnormal bleeding – you may experience bleeding and spotting in between your menstrual cycle or after sex, as well as heavier periods than normal that might contain thickened clots of blood. You may also experience blood in your urine or bowel movements.
3. Pelvic pain – you may experience pain around your pelvic area, which might get worse in the lead up to your period.
4. Irritable Bowel Syndrome symptoms – these include constipation, diarrhoea, bloating and tiredness.
5. Emotional Symptoms – you might experience emotional symptoms such as depression, anxiety, irritability and mood swings as a result of the imbalance of hormones in your body.
6. Difficulty falling pregnant – you may find that it is taking you longer to fall pregnant than expected.
The severity of the symptoms of endometriosis may not match the severity of the condition so many women do not realise they have the it, and it can take up until they start trying to fall pregnant for them to be diagnosed by a doctor. Diagnosing endometriosis can be difficult, but it is worth speaking with your doctor especially if you are having trouble falling pregnant so they can carry out tests and provide supportive medical advice on managing and dealing with the condition.
What if I am diagnosed with endometriosis and want a baby?
Your doctor will be able to diagnose you with endometriosis by carrying out an operation called a laparoscopy. This is where a small incision is made near your belly button, and a small telescope is inserted into your pelvis so your doctor can see what is happening around your pelvic area and reproductive organs. From this your doctor will be able to diagnose for sure if you have the condition, and provide support and treatment.
While there is no cure for endometriosis there are a few ways of managing the condition, both through surgical and non-surgical means that can help you to improve your chances of falling pregnant. These include:
1. Laparoscopic Surgery – as well as using this surgery for diagnosis, it can also be used to help reduce the symptoms of endometriosis. This is done through removing any of the lesions, cysts, patches or nodules that have occurred as a result of the endometriosis.
2. Freezing your eggs – as endometriosis can cause damage to your ovaries, and so also cause damage to your eggs, your doctor may recommend this as an option if you are thinking of having a baby in the future.
3. Hormonal Treatments – your doctor might recommend different fertility treatments that are hormone based, such as clomiphene, which aid the production of your eggs.
4. In Vitro Fertilization (IVF) – if your endometriosis is particularly severe, and you have struggled to get pregnant for a while, your doctor may recommend IVF as an alternative. This is where an unfertilized egg is extracted from your ovary, fertilized outside the body with your partner’s sperm, and then re-implanted into the uterus at the optimal time. IVF usually comes along with a number of hormonal treatments as well and is not an option to be undertaken lightly,
Your doctor will make a diagnosis on the severity of your condition and then discuss with you the best option based on this and other factors, such as your age, lifestyle and individual circumstances (including how soon you want to have children). Your doctor will usually work with a range of other health professionals, including counsellors to ensure you are provided with the right treatment. You may try a few different treatments before finding the one that works the best.
How does endometriosis affect my body during pregnancy?
Many women have perfectly normal pregnancies and births, even if they have been diagnosed with endometriosis. That said it is important that you do not stop receiving medical care when you fall pregnant for the condition and to make sure you make your doctor and midwife aware of your diagnosis when you fall pregnant. Recent studies have shown that there may be a link between endometriosis and:
· Premature birth – there is a risk your baby could be born before 40 weeks, full term.
· Abnormal bleeding – you may experience bleeding after week 24 of your pregnancy
· High blood pressure
· Caesarean Delivery – you may be more at risk and require a delivery by caesarean.
What else can I do to help my fertility if I have endometriosis?
If you are diagnosed with endometriosis, whether you are trying to get pregnant or not, it is important to maintain a healthy lifestyle to help your body manage and deal with the symptoms of the condition. Other ways to stay healthy, manage your condition and improve fertility include:
· Physiotherapy – pelvic floor physiotherapy can help deal with pelvic pain, bloating and other abdominal symptoms caused by endometriosis
· Regular Exercise – regular light exercise will always help you keep healthy and improve your fertility. But try to avoid exercise such as Pilates which focuses on your abdominals and your core as it can cause tightness in your muscles which could make the pain caused by endometriosis worse.
· Nutrition – eating the right foods and getting plenty of fresh water is very important for your entire wellbeing. Eating healthy can also help you pinpoint any foods that irritate your bowl, and so help you eliminate foods that could aggravate any of these symptoms caused by endometriosis.
· Alternative Therapies – relaxing, health focused therapies such as meditation, yoga, acupuncture and natural herbal medicines can also help with some of your symptoms – especially around the emotional symptoms. This can help alleviate the stress associated with your condition, and so also help improve your fertility.
It’s especially important to know that if you are diagnosed with endometriosis, you are not alone. Thousands of women are diagnosed each year and there are many websites, support groups and communities for women to support each other and provide advice and tips on managing the condition.
A diagnosis does not mean you will not be able to conceive, and if you are at all concerned, speak with your doctor who can put in place the right advice, support and treatment for now and your future.