What are the signs and symptoms of endometriosis, and how can it affect fertility?

Endometriosis is a common condition that affects about 1 in 10 women. It occurs when tissue similar to the lining of the womb is found elsewhere. Commonly it is found in and around the pelvis and near to the womb, ovaries and fallopian tubes. Women will often report pelvic pain and painful heavy periods. Some patients will get pain with sex and fertility problems. In severe cases patients may have problems related to opening their bowels or their bladder. Some women with endometriosis don’t have any symptoms at all.

Getting pregnant can be a problem for some people with Endometriosis. It is a disease of the  pelvis that has varying levels of severity. It  can affect the fallopian tubes causing them to become scarred and eventually blocked if severe. If the endometriosis affect the ovaries then cysts can sometimes develop on the ovaries, which can affect a woman’s egg reserve. Usually patients with this severity of endometriosis will experience symptoms. The endometriosis can be damaging to a woman’s fertility but it does not


How is it diagnosed?

Endometriosis can be difficult to diagnose as women experience a range of symptoms and some women have no symptoms. A gynaecologist will take a careful history and examine you as this alone may suggest underlying endometriosis, especially if there are tender lumps. Tests such as pelvic ultrasound may be helpful to scan the womb and ovaries in detail. Deposits of endometriosis can sometimes be seen in the muscle wall of the womb and cysts can be seen on the ovaries, suggesting underlying endometriosis. You may be offered a diagnostic laparoscopy as this is the way to get a definitive diagnosis.


How is it treated?

Treatment may take several forms. Initially simple pain relief medication may be offered to treat the symptoms.  The next common step would be to offer hormonal medication to reduce ovulation and suppress the body’s natural drive to stimulate the disease. Many forms of hormones are contraceptive so will stop you getting pregnant, and this method can help to shrink the endometriosis. A GP or gynaecologist may suggest starting a combined contraceptive pill or give you progestogens in the form of a ‘mini’ contraceptive pill, hormone coil or implant. There are some forms of hormones that are not contraceptive. Your healthcare professional may suggest surgery to try and diagnose endometriosis in the pelvis. This primary surgery may also offer an opportunity to treat some forms of endometriosis in the early stage. If more advanced disease is found then further surgery in a specialist centre may be required. The surgery recommended depends really on the severity of the endometriosis. Although there is limited evidence for the use of homeopathic treatments some women will see a great improvement to symptoms and quality of life with complementary therapies.