Today we’re going to talk about what is endometriosis. Endometriosis is an unusual disorder that affects a lot of women. It affects somewhere between 5 and 15% of women and it’s a disorder where the lining of the womb sits outside of the womb. This can affect women by causing them terrible pain or infertility.
We find that the main symptoms that women express with endometriosis are painful and sometimes heavy periods. This can occur at the start of menstrual life, so right at the very first period, and some girls suffer from this from the very first time they have a menstrual bleed, or it can occur after many months or many years of having periods.
One of the cardinal symptoms of endometriosis is that it tends to be a disorder where symptoms get worse and worse with time, and so when a woman gets into her 20s, or even into her 30s, the periods can be quite debilitating, to the point where women need to spend a day or even a week in bed with their period. They can have symptoms prior to their period coming, so they can have terrible abdominal pain in the week leading up to their period or the few days leading up to their period, be completely bedbound for their cycle, and then have pain afterwards. When it gets very severe, women can even feel pain with ovulation, which can be debilitating, and cause acute pain and even requiring hospitalization just for simply ovulating.
We don’t really know why women with endometriosis get the pain that they have. It’s likely and explained partly by the tissue that is deposited outside of the womb. At the time of the hormone stimulation where a period occurs, women bleed into their peritoneum or into other spaces in their body which are not the uterus, and that bleeding causes discomfort and pain. But we also think the nerve endings around the deposits of endometriosis are upregulated, and that’s what accounts for those symptoms where women get pain prior to their periods and then pain with ovulation.
The other main symptoms that women can get are discomfort with intercourse. Endometriosis, when it’s more severe, can cause adhesions within the abdomen, and with intercourse, this can cause terrible pain, sometimes causing women to stop being sexually active at all, and can really disrupt a woman’s sense of self-esteem and their sex life, essentially.
Other symptoms that endometriosis can cause are infertility. We don’t really know, once again, why endometriosis causes infertility, and we think it’s a multifactorial thing and more of an association than a direct cause, because it doesn’t always necessarily stop the sperm and the egg from meeting, but we think the deposits of the endometriosis cause inflammation in the abdomen, and that might be damaging to the sperm, and it might actually cause inflammation which affects an embryo’s ability to implant. We also know that the ovaries affected by endometriosis, because women who have endometriosis, and in fact endometriomas, which are ovarian cysts with endometriosis within them, have poorer egg quality.
So, in multiple ways, endometriosis can affect a woman’s fertility, and as I said earlier, 5 to 15% of women have endometriosis, but if we do laparoscopies, which is keyhole surgery on couples, where we find no other reason for the infertility, we actually find that endometriosis is present in up to 50% of those women. So it accounts a lot for that unexplained infertility, that we don’t know why couples aren’t falling pregnant. Everything seems to check out medically, right? The sperm count’s normal, the fallopian tubes are open, the woman’s ovulating, but the couple just aren’t getting pregnant, and sometimes it is something like endometriosis which is affecting that couple’s chance of getting pregnant.
So when does one seek medical advice? Unlike other medical conditions that I deal with, endometriosis is not a life-threatening condition, so you can be reassured about that. However, it can really affect your quality of life, so I think that’s the best guide as to when you should seek medical advice, is when it is affecting your quality of life. If you’re having periods that are just debilitating, or really affecting your ability to get on with day-to-day activities, if your sex life is affected because you are unable to have intercourse, because it’s just too painful, or if you can’t get pregnant and everything else seems otherwise to be working, they’re t times to really seek medical advice, because you may have endometriosis.