One in ten women suffer from it, there aren’t always symptoms and it may be the cause of half of all unexplained infertility. Yet how much do you know about endometriosis?
‘It’s a disease that women need to know about, yet so few do,’ says gynaecologist Dr Benjamin Abramov from Boston Place Clinic, part of The Fertility Partnership.
‘Endometriosis is a disease that can cause infertility, yet it’s often asymptomatic (which means it doesn’t have any symptoms) and in a lot of cases it’s discovered incidentally. Doctors are often searching for something else that’s wrong when they discover endometriosis by chance.’
So what is it? ‘During a woman’s monthly cycle the lining of her womb gets thicker in preparation for an egg to implant. When this doesn’t happen – ie, if she doesn’t get pregnant that month – this lining sheds and creates a period. With endometriosis this same process happens but elsewhere in the body. The lining appears in places it shouldn’t like the ovaries, the ligaments that hold the womb in place, the bladder or bowel.*
"When the lining sheds it has no place to go, which causes bleeding around the area. This prompts an inflammatory immune response which can cause a great deal of pain and scarring. And it’s this scarring and inflammation that can cause a delay in conceiving or even infertility.’
Dr Abramov says that while symptoms of endometriosis can include painful periods, pain around bowel movements, pain during sex and bladder problems (‘often a patient will have a history of recurring “bladder infections” that aren’t actually bladder infections at all,’ he says) sometimes there are no symptoms at all.
It can also cause fertility problems and a 2008 study found that almost half (47%) of women with unexplained infertility in the study had endometriosis.
So why the slow diagnosis (on average it takes eight and a half years to be diagnosed)? ‘Because it can present a wide range of symptoms that can be blamed on other conditions, it’s an often undiagnosed and misunderstood condition,’ says Dr Abramov. ‘Not all doctors have a high enough level of suspicion that it’s endometriosis.’
Eventual diagnosis is usually via a scan or through a keyhole procedure. Treatment includes the oral contraceptive (this suspends monthly ovulation), or any scars or lesions can be lasered away.
‘Lastly, there are monthly hormonal jabs to treat it but these can’t be done long term because they lower oestrogen levels which results in menopause-like symptoms,’ says Dr Abramov.
So what if you’re one of the women who have endometriosis but you don’t have symptoms and you have no trouble getting pregnant? ‘Then leave it alone,’ says Dr Abramov. ‘Don’t go looking for it unless it presents a problem.’
For more information and support, visit Endometriosis UK.
5 facts about endometriosis
Women with a close female relative with the disease are five times more likely to have it.
A study from the European Society of Human Reproduction and Embryology found that
women with endometriosis have a 76% higher risk of miscarriage.
Tomatoes may help with the scarring caused by the disease. Scientists from Wayne State University in Detroit found the antioxidant lycopene (it gives tomatoes their red colour) helped lessen the scarring and pain.
Experts believe women who have periods lasting longer than seven days are more likely to endometriosis.
Currently there is no known way to reduce your risk of endometriosis.
Words by Maria Lally.