If you have endometriosis, you are not alone - it affects 1 in 10 women and those assigned female at birth; however, this figure may be higher as the condition remains underdiagnosed. Care Fertility teams routinely provide fertility treatment to women affected by endometriosis and its sister condition, adenomyosis.
Endometriosis is a benign condition where cells similar to the cells of the womb's lining (endometrium) become implanted outside the lining of the womb. This can be in the ovary (forming chocolate cysts or endometrioma), around the womb, within the muscle layer of the womb, fallopian tubes, in the lining of the pelvis and abdomen (peritoneum), vagina, bowel or bladder.
While the awareness about endometriosis has increased in the last few years, little is known about its sister condition - adenomyosis. Adenomyosis is a condition where cells similar to the cells of the lining of the womb implant within the wall of the womb (myometrium).
With every menstrual cycle, the lining of the womb and the endometriosis tissues change in response to the hormones. Whilst the cells of the lining of the womb are shed out in the form of menstrual blood, there is no outlet for the endometriosis tissue. As a result, the endometriosis lesions cause inflammation, pain and scarring. In adenomyosis, the muscle layer of the womb reacts to these uninvited guest cells of the lining of the womb and enlarges in size along with cyst formation.
Although the exact cause is unknown, any female of reproductive age (from first menstruation through to menopause) can develop Endometriosis.
Symptoms of Endometriosis and adenomyosis may vary and coincide with symptoms of other gynaecological conditions. Some women have no symptoms, whereas others might have severe symptoms affecting their quality of life. Some of the common symptoms are:
A pelvic ultrasound scan is a reliable first-line investigation to screen for endometriosis and adenomyosis. Usually, this is an internal vaginal scan performed to check the ovaries, the muscle layer of the womb, the junction between the lining of the womb and muscle layer of the womb, the area behind the womb. However, a scan may not always detect endometriosis lesions at every site involved.
MRI is a second-line tool in cases where advanced endometriosis affecting the bowel and bladder is suspected and where it is difficult to differentiate between adenomyosis and fibroids.
Keyhole surgery (laparoscopy) is the gold standard investigation to diagnose endometriosis and also has the advantage of treating endometriosis. This is carried out under general anaesthesia. A small telescope is inserted through small cuts in your abdomen and allows you to have a detailed look at the structures affected by endometriosis. You may have a biopsy of the endometriosis tissue removed to confirm the diagnosis.
In cases of severe endometriosis, a second operation at an endometriosis specialist centre may be required to remove lesions.
Treatment options are designed depending on individual needs, whether for symptom relief or fertility issues. Some of the treatment options are:
Measures like dietary changes (cutting out dairy or wheat products from the diet) and regular physical activity may be helpful as well.
Not all women with the diagnosis of endometriosis have difficulty conceiving. It is estimated that 30-50% of women who have difficulty conceiving after one year of regular sexual intercourse have endometriosis.
At Care Fertility, we tailor your treatment plan around you. If you’ve been diagnosed with endometriosis, we’ll talk through your options clearly and honestly, so you feel confident about the next step.
For some people with mild to moderate endometriosis, surgery may improve the chance of conceiving naturally. We sometimes use the Endometriosis Fertility Index (EFI) to help estimate the likelihood of spontaneous pregnancy after surgery. The EFI takes into account your age, how long you’ve been trying to conceive, any previous pregnancies, and what was found during surgery.
If fertility treatment is recommended, this will usually fall into one of two pathways: IUI or IVF.
Surgery before IVF does not increase pregnancy rates in most cases. We would usually only recommend surgery beforehand if:
We know how heavy an endometriosis diagnosis can feel, especially when you’re already trying to conceive. But many patients with endometriosis go on to have successful pregnancies through fertility treatment. You’re not alone in this, and with the right plan in place, there are real, evidence-based options to help you move forward.
If you think you may be suffering from endometriosis, or if you are worried about your fertility, please don’t hesitate to contact your nearest Care Fertility clinic to discuss your fertility options. Or you can call our new patient enquiry team on 0800 564 2270. Our expert team will be happy to help you.