Endometriosis is a condition where tissue similar to the lining of the womb (endometrium) is found elsewhere, usually in the pelvis around the womb, on the ovaries, tubes, ligaments holding the pelvic organs in place as well as occasionally the bowel or bladder.
It can affect up to one in ten women and can vary massively in severity. It is more common in women with a family history in their mother or sister. When this tissue is found within the muscle of the womb it’s called adenomyosis.
The symptoms will depend on the severity of the endometriosis and where the deposits of endometriosis are found. Dysmenorrhea (period pain) is the commonest symptom along with dyspareunia (painful intercourse) and ovulatory pain with deposits in the uterus. Continuous pelvic pain can occur which can significantly impact on quality of life along with long term fatigue. If there are deposits on the bowel, cyclical rectal bleeding can occasionally occur.
However, endometriosis is a notoriously poor witness in that some with severe endometriosis may not always have the worse symptoms and vice versa.
Here are some of the symptoms that can be experienced.
During the menstrual cycle, in response to oestrogen being produced by the ovaries the endometrium in the womb thickens and then after ovulation the ovaries produce progesterone to prepare the thick lining for a potential embryo to implant. If pregnancy doesn’t occur, progesterone levels drop and this is what induces a period. This process is a completely normal one for the uterus but the same process in response to these hormones occurs in the “endometrium” like tissue in women with endometriosis in the pelvis, ovaries etc and causes pain, potential scarring and formation of cysts in the ovary.
The exact cause of endometriosis remains unknown. One theory is that during a period, some blood/tissue travels back up the tubes from the uterus into the pelvis increasing the chance of this tissue being found in the pelvis. This occurs in a large proportion of women but only a few of these develop endometriosis so if this is true we still don’t fully understand why some develop symptoms and some do not. There may be a genetic link we are yet to establish.
Another potential theory is that some cells in the pelvis are “primitive” cells that have the ability to transform into various cell types such as endometrium and this causes the disorder. This process is called “coelomic metaplasia”. Again why this might occur in some women and not others is unknown.
It is very common and the Royal College of Obstetrics and Gynaecology, as well as Endometriosis UK, estimate it to affect one in ten women in the UK.
Not always and may depend on the severity. Minimal to mild endometriosis is common and it is far more likely that you will have no difficulty conceiving naturally. With increasing severity of endometriosis, scar tissue (adhesions) becomes more common and can cause the tubes to be blocked or scarring around the ovary that inhibits the ability of the released egg to reach the tube and the chance of natural conception decreases.
Though even with severe endometriosis, natural conception is still possible. On occasion even those with mild or moderate endometriosis with no such scarring may take longer to conceive. Although the exact cause for this is unknown, it is suggested that the presence of endometriosis in the pelvis creates an inflammatory environment that is more hostile to eggs or sperm.
Not necessarily as most will conceive despite having endometriosis as above. The main benefit of surgery is the relief of symptoms. The majority of this surgery is done via a laparoscopy (keyhole surgery), looking inside the abdomen with a camera and removing the endometriosis deposits using a laser of similar. It is crucial that endometriosis surgery is ideally performed by a gynaecologist with a special interest in endometriosis as this will maximise the chances of benefit and minimise the chance of recurrence.
In terms of fertility small studies have shown that treating mild endometriosis surgically may improve the chances of natural conception over the next year so this is an option for those who want to continue to try naturally and have mild disease.
Not necessarily as most will conceive despite having endometriosis as above. The main benefit of surgery is the relief of symptoms. The majority of this surgery is done via a laparoscopy (keyhole surgery), looking inside the abdomen with a camera and removing the endometriosis deposits using a laser of similar. It is crucial that endometriosis surgery is ideally performed by a gynaecologist with a special interest in endometriosis as this will maximise the chances of benefit and minimise the chance of recurrence.
In terms of fertility small studies have shown that treating mild endometriosis surgically may improve the chances of natural conception over the next year so this is an option for those who want to continue to try naturally and have mild disease.
Are there different types of the severity of endometriosis from mild to very severe?
Endometriosis can present in different severities. In fact, endometriosis has been categorized into four stages by the ASRM: from stage I to stage IV. The stages are based on the number of implants and infiltration depth.
Stage I is a minimal disease with a few superficial implants.
Stage II is a mild disease with more and deeper implants.
Stage III is a moderate disease with many implants, endometrial cyst(s) on one or both ovaries, and the presence of filmy adhesions.
Stage IV is a severe disease with many deep implants, large cysts on one or both ovaries, many dense adhesions.
The only way to diagnose endometriosis and know its stage is through surgery, where the surgeon can visualize the disease and assess it.
Endometriosis can be associated with other inflammatory conditions like IBS, irritable bowel syndrome, and interstitial cystitis.
Of course, endometriosis is associated with infertility, painful periods, pelvic pain, and dyspareunia (painful sex).
When it comes to conceiving and your overall fertility, your doctor can walk you through all your options but be aware that it may take you getting one or two opinions before being accurately diagnosed and treated. You know your body best and if you sincerely feel you have endometriosis, absolutely advocate for yourself because endometriosis lasts much longer than just the duration of March!
High fibre fruit and vegetables including cruciferous vegetables (as these can help to eliminate excess oestrogen from the body which is found in women with endometriosis and help to improve the immune system) – Fibre is important as it helps to expel unwanted substances from the body, particularly excess hormones such as oestrogen. Fibre will help to balance gut flora- but introduce slowly.
Drink plenty of fresh water each day (lovely with a slice of lemon in!) to flush out toxins.
Omega 3- oily fish such as salmon, trout, mackerel along with nuts and seeds to reduce inflammation.
Recent research has indicated that lycopene may be useful in reducing the abnormal activity of cells and as a result, reduce the adhesion effects of endometriosis. Lycopene is a phytochemical and is found in tomatoes (in highest amounts), and other brightly coloured fruit and vegetables such as watermelons, apricots, pink grapefruit- to name a few!
Leeks, onions and garlic are prebiotics that help boost gut flora. These also contain compounds and bioflavonoids that help protect against inflammation. Have you ever considered taking a high quality probiotic?
Consume organic produce whenever possible.
Foods containing selenium such as brazil nuts, walnuts, eggs, tuna, turkey, chicken and cod – selenium helps to boost white blood cell function and thus immunity. It also helps to produce liver detoxification enzymes.
Processed meats and red meats – these can lead to further inflammation. Look for grass fed or organic meat if you do consume a small amount of red meat or choose chicken, fish or turkey (lean protein) if you include meat in your diet.
Full fat dairy – Dairy includes milk, cheese, yogurt, and butter. Of course, not all dairy is created equal. Some people can easily digest yogurt, but not milk, or butter, but not cheese. There is no conclusive evidence that dairy is bad for endometriosis however, dairy products often contain a high percentage of saturated fat and many types of hormones, which may aggravate endometriosis. Why not start by trying a non-dairy milk such as almond or coconut milk for a while to see if it makes a difference to you?
Reduce omega 6 foods to help rebalance the omega 3:6 ratio. Examples of some omega 6 containing foods are: processed snacks, fast foods, cakes, fatty meats, and cured meats – these lead to an increase in inflammation.
Limit Caffeine – can increase oestrogen levels and menstrual pain in some.
Additives and processed foods- affect the liver which is involved in hormone processing.
High fat foods – as saturated fats lead to more inflammation.
Sweets – excess sugar can lead to inflammation.
Foods containing gluten – substitute with sweet potato, quinoa or wild rice for a while to see if symptoms ease.
Alcohol – A healthy liver is important for good hormone balance, as the liver detoxifies chemicals and waste products including excess hormones.
With these 3 simple steps, Babble Health will help you take control of your reproductive health. whether you are at the start your fertility journey, trying to conceive, or are managing the symptoms of menopause.
