“Tell me about your periods.” I ask patients this question every day.
The answer varies and more often than not I hear “they are so painful I need to stay home” or “I can’t function without pain medication”. Painful periods can be a sign of endometriosis but some women have endometriosis without this classic symptom.
So how do you know if you have endometriosis and why does it matter?
Endometriosis impacts all aspects of health including fertility. Studies show up to 15% of reproductive aged women have endometriosis and up to half of women with infertility have endometriosis. While not all women with endometriosis have infertility, endometriosis can significantly lower one’s chances of becoming pregnant. In practical terms this means it may take longer for a woman with endometriosis to become pregnant, limiting her chances of having more than one child or perhaps leaving her with no children at all. Learning early on that you have endometriosis and seeing a fertility specialist is the best way to improve your odds of building the family you deserve.
In plain terms, endometriosis is a condition where the cells of the uterine lining (the endometrium) are not where they are supposed to be
One theory of how endometriosis develops is a direct spread of endometrial cells through the fallopian tubes into the pelvis. As a result, endometriosis can be seen on the fallopian tubes, ovaries, bladder, or nearly anywhere in the body. Depending on where endometriosis is located, fertility may be effected in different ways. If present in the fallopian tubes, the tubes may become blocked. In the ovary, endometriosis cysts called “endometriomas” can damage the eggs. There is even a type of endometriosis called “adenomyosis” where these cells grow into the muscle wall of the uterus and this can lower pregnancy rates even with fertility treatments like in vitro fertilisation (IVF).
With so many women throughout the world having endometriosis and with 1 in 6 women having infertility globally, it is more important than ever to seek the help of a fertility specialist if you know or believe you may have endometriosis.
Early detection can open up more options for you
While pain management is typically prioritized for younger women, these treatments can delay pregnancy and often do little to preserve your fertility. Surgery can be used to identify endometriosis and treat the causes of pain but many studies have shown surgery doesn’t dramatically improve fertility and in fact may lead to scar tissue down the road. A more proactive approach to preserving one’s fertility with endometriosis is egg freezing. Egg freezing the a method where your eggs are stimulated to grow, collected, and stored for future use with IVF. Having your eggs frozen when you are younger and before surgery for endometriosis can significantly increase your chances of having a family in the future.
Beyond the impact on fertility, endometriosis is a major cause social and economic problems for women globally. Girls and women who have severe painful periods often feel shame and anxiety especially when they don’t have access to doctors that understand and manage endometriosis. They frequently miss school and work which only makes them feel more stress and can lead to depression. Many women do not have the support at work for taking medical leave each menstrual cycle and feel unable to discuss their needs with their managers, resulting in being fired from their jobs. Socially, women with endometriosis may feel isolated and can have difficulties maintaining relationships with intimate partners. As endometriosis can lead to scar tissue forming in the pelvis, this can lead to painful positions during sex, leaving some women unable to experience satisfying sexual relationships.
As a community, we can help raise awareness about endometriosis and how it can impact the lives of women everywhere
By understanding and recognizing the signs and symptoms of endometriosis, women can seek early care to treat both the pain and fertility effects of endometriosis before they progress to a more severe level. Early diagnosis and fertility preservation can allow someone to achieve their dream of becoming a mother even if they ultimately need invasive treatments to manage their pain that may compromise their fertility. As family members, partners, friends, and coworkers, learning about endometriosis can help us become a strong support network for those around us dealing with endometriosis. By lending this support, we can enhance the lives of the nearly 200 million women worldwide living with endometriosis.
