Endometriosis is a common condition that affects about one in 10 women during their reproductive years
What is endometriosis?
It is one of the most common gynaecological problems, yet many women who suffer from endometriosis are only diagnosed when they struggle to fall pregnant. As Dr Nicolas Bernard, a gynaecologist and obstetrician at Mediclinic Bloemfontein explained, the uterus is lined with something called endometrium, which is shed during menstruation. “When a woman has endometriosis, this lining is found outside of the uterus – most commonly in the abdomen or pelvic cavity, but these ‘patches’ of endometrium can attach to the ovaries, fallopian tubes, large bowel, and bladder too.”
Symptoms usually include pain in the lower part of your abdomen just before a woman’s period starts; painful intercourse; heavy or irregular periods; bladder problems (if the endometriosis attaches to your bladder) and painful bloating, diarrhoea, and constipation if you have patches on or near your bowel. Some women display no symptoms – and only discover they have endometriosis when they battle to conceive.
As Dr Bernard explains, endometriosis does not necessarily cause infertility, but there is an association with fertility problems, although the cause is not fully established.
According to an article by the Endometriosis Australia’s Advisory Committee titled: A New Look at Endometriosis and Fertility, the current theory is that endometriotic implants produce a range of chemicals that adversely affect the endometrium and reduce the chances of embryo implantation sticking to the uterine lining to allow the pregnancy to continue. In addition, adhesions that affect the ovaries, uterus, and fallopian tubes can inhibit the passage of eggs to the fallopian tubes. It can also stop the ovaries from releasing eggs and can decrease the number and quality of healthy eggs being released. As Dr Natalia Novikova, a gynaecologist and endoscopic surgeon at Mediclinic Cape Town adds, endometriosis is usually diagnosed by laparoscopy.
Although there is no cure for this condition, it can be managed to reduce pain and improve fertility. “Treatment options include medication and different types of surgery, ranging from conservative to aggressive, depending on the type and stage of the disorder,” said Dr Novikova.
Medication options include hormone therapy, pain medication, and hormonal contraceptives. “The approach to treatment will also depend on the patient’s age and immediate and long-term wishes for family planning.”