Endometriosis is a condition that is often difficult to diagnose. Those who have endometriosis may need medical advice or specialist support on the best strategies to conceive. In this article, we cover the basics of endometriosis and how to access care.
What is endometriosis?
Endometriosis is a common condition, affecting up to 1 in 10 women, where tissue similar to the inside of the uterus is found in other places, like the outside of the uterus, ovaries and fallopian tubes. Unfortunately, it is a condition that has been underdiagnosed to date and some women report having to visit their doctor multiple times – and on average, it can take 8 years to receive a diagnosis. The cause of endometriosis is still unknown.
What are the symptoms of endometriosis?
There are many different possible symptoms of endometriosis, which may be why it has previously been difficult to diagnose. Some of the more common symptoms include:
- Painful periods
The pain typically begins a few days before the period and usually lasts the whole of the period.
- Pain during sex
The pain is typically felt deep inside and may last a few hours after sex.
- Pain in the lower abdomen and pelvic area
Sometimes the pain is constant, but it is usually worse on the days just before and during a period.
- Bleeding in between periods
- Other symptoms
These may include fatigue, pain on passing poo, pain in the lower abdomen when you pass urine, low back pain and, rarely, blood in the urine or poo.
- Difficulty becoming pregnant
This may be due to endometriosis blocking the passage of the egg from an ovary to the fallopian tube. Sometimes, the reason for reduced fertility is not clear.
How do you test for endometriosis?
Because endometriosis manifests itself in a variety of ways and shares symptoms with other conditions, diagnosis can be difficult. It can help to have a record of your symptoms (the Endometriosis UK symptoms diary is very useful). Investigations might include a pelvic examination, an ultrasound scan, an MRI or a laparoscopy. A laparoscopy is a surgical procedure where a surgeon passes a thin tube (with a light and camera) through a small cut in your tummy so they can see any patches of endometriosis tissue. A laparoscopy is currently the only way to confirm if you have endometriosis.
How is endometriosis treated?
Unfortunately, there is no cure for endometriosis yet. The management options fall into the following categories:
- Pain relief
Pain relief is often the first port of call. Paracetamol and anti-inflammatory medications (such as ibuprofen) may be tried initially. If these are unsuccessful, stronger pain relief may be recommended such as tranexamic and/or mefenamic acid.
- Hormonal treatments
The combined oral contraceptive pill or progestogen may be recommended by your doctor. These should not be used if you are trying to conceive.
Surgery may be performed to diagnose endometriosis or to treat lesions.
- A combination of the above
Endometriosis and trying to conceive
Endometriosis can be associated with fertility problems, although the cause is not fully established. However, it is estimated that 60–70% of those with endometriosis can get pregnant spontaneously. Endometriosis can affect various parts of the female reproductive system (uterus, fallopian tubes and/or ovaries) and can be present in stages from mild to severe. The Béa Treatment could be a good treatment option for mild endometriosis. The Béa Applicator places our custom cervical cap against the cervix, holding semen in place for up to one hour. It increases the exposure to the cervical mucus, minimises the contact of semen in the vagina (where the pH can reduce sperm quality) and reduces semen backflow.
Visiting your doctor about endometriosis and fertility
If you have endometriosis or you suspect you might have endometriosis, then don’t wait to visit your GP if trying for a baby. NICE (National Institute for Health and Care Excellence) guidelines state that if there is a known predisposing factor for infertility, then doctors should make an earlier referral for specialist consultation. A specialist can talk you through options to optimise your fertility. In moderate to severe cases of endometriosis, the tissue may need to be surgically removed before a pregnancy is attempted. An alternative treatment option might be in vitro fertilisation (IVF).
If you’re not sure what to discuss with your GP – read our article How to speak with your doctor about fertility for support.