Understanding Endometriosis and Its Effects on Fertility
“Endometriosis is one of the more common causes of infertility. Period pain is a significant symptom of this disease. But because many women experience painful menstruation, there is a widespread belief that menstrual pain is ‘normal’. This poses a barrier for the prompt diagnosis of this disease.”
Dr Navdeep Singh Pannu
In recent years, the infertility rate has been rising globally due to the prevalence of various health issues in women. According to WHO, Endometriosis affects roughly 10 percent (190 million) of women in the reproductive age category.
What is Endometriosis?
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Endometriosis occurs when the uterine tissue (endometrium) grows outside of the uterus, usually around the pelvic area. During menstruation, this tissue reacts to hormones; it grows and bleeds the same way the uterine tissue does. However, since the tissue is outside the uterus, it can’t shed and exit through the vagina. Instead, the tissue settles in other places and starts new growths and inflammation, which leads to the accumulation of scar tissue causing severe pain.
Endometriosis and Fertility
About 30 – 50 percent of women with Endometriosis may face difficulties in conceiving. Some patients find out about their condition when they have trouble getting pregnant.
Endometriosis affects fertility due to:
- Tissue overgrowth around ovaries that prevents eggs from entering the fallopian tubes;
- Endometriosis forming outside the fallopian tubes causing adhesions;
- Endometriotic cysts (or chocolate cysts) producing chemicals and other substances that are strongly linked to a lower density of ovarian follicles from which mature eggs are released.
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Painful periods, chronic pelvic pain, painful intercourse, and ovarian cysts – these are just some of the symptoms that women with Endometriosis live with. Endometriosis is a progressive disease and not 100 percent treatable. There is no magic pill that can be given to a patient to make Endometriosis disappear.
However, Endometriosis can be managed. Although it is a long-term condition that can have a significant impact on a person’s life, there are treatments that can help.
In general, treatment for endometriosis includes:
1. Pain medication
- NSAIDs (Nonsteroidal anti-inflammatory drugs), such as ibuprofen or other over-the-counter analgesics to provide symptomatic relief.
2. Hormone therapy
- Oral contraceptives, with combined estrogen and progestin hormones, prevent ovulation and reduce menstrual flow.
- Gonadotropin-releasing hormone agonist, which stops ovarian hormone production, creating a sort of temporary ‘medical menopause’.
- Progestin – Visanne (dienogest), a hormonal contraceptive that is used to reduce pain and the size of endometrial lesions, which helps reduce pelvic pain and painful monthly bleedings.
- Androgen Receptor Agonist, Danazol, a synthetic derivative of testosterone (a male hormone) that helps stop the body from releasing hormones that bring about period.
3. Surgical techniques
- Laparoscopy – Also used to diagnose Endometriosis, laparoscopy is a minor surgical procedure in which a laparoscope is inserted into an incision in the abdominal wall. Using the laparoscope to view the pelvic area, the doctor is able to remove the endometriotic tissue.
- Laparotomy – A more extensive surgery to remove as much of the displaced endometriotic tissue as possible without damaging healthy tissue.
- Hysterectomy – In more severe cases, some or all of the reproductive organs are removed if they are damaged or have endometriosis tissue on them.
Whether or not one should have surgery depends on the age and severity of the case. However, taking into consideration that a surgery to treat endometriosis could damage ovarian tissue which may then reduce a person’s ovarian reserve, doctors put forth this option only if necessary. For patients hoping to eventually conceive, doctors may suggest that they freeze their eggs before an Endometriosis surgery is carried out. This allows for the eggs to be preserved for future use.
Knowledge is Key, Be Empowered
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Living with Endometriosis is tough, especially for a woman in her reproductive age. If you have been diagnosed with Endometriosis, my advice is to get as much information as you can before deciding on your next course of action. Knowledge is key and having the right information about the disease will empower you to take a step in the right direction.
You are sure to have many questions. In addressing infertility, the sooner you have them answered, the better. Do list them down and call +6-03-80699333 (TMC Fertility & Women’s Specialist Centre, Puchong) or email email@example.com to make an appointment to consult with Dr Navdeep.
Let’s take the self-assessment quiz for the risk of endometriosis.