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Endometriosis and fertility: causes, symptoms and treatments

La doctora Jana Bechthold, experta en endometriosis de Tambre, con una paciente

Until very recently, endometriosis was still an underestimated disease. Menstrual pain was normalised and women either resigned themselves to it or expected to get over it with time or pregnancy. Endometriosis was simply not treated or properly diagnosed. Even today, dysmenorrhoea, or menstrual pain, persists as a social stigma that many women hide. This silence prolongs the time it takes to get a diagnosis, on average 7 and 10 years. Endometriosis not only impacts on quality of life, it also reduces the chances of achieving pregnancy. In this article we will tell your causes, symptoms and treatments.

At Tambre we are aware that endometriosis is much more than a period pain. It can compromise fertility and also the health of organs adjacent to the reproductive system. This is why we offer personalised treatment plans which are designed to tackle endometriosis and enhance your chances of pregnancy.


What is endometriosis and why does it occur?

The endometrium is the tissue that lines the inside of the uterus. During the menstrual cycle, the endometrium thickens in order to facilitate the implantation of the fertilised egg and promote pregnancy. But if pregnancy does not occur, the endometrium is shed in the form of menstruation.

Endometriosis occurs when this endometrial tissue grows outside the uterus, in areas where it should not be present like the ovaries, fallopian tubes, uterine ligaments, intestine or in other areas of the pelvis.  

Unlike normal endometrium, the tissue affected by endometriosis cannot leave the body during menstruation, leading to inflammation, the formation of adhesions and, in some cases, the development of ovarian cysts, called endometriomas.

As the endometrial tissue is hormonally dependent on the menstrual cycle, with each menstrual period, miscarriage or any situation in which the uterus suffers, endometriosis and its symptoms also worsen. If pregnancy occurs however and menstruation is suspended during those 9 months, the condition improves.

Endometriosis is therefore a chronic disease which can compromise fertility.



Symptoms of endometriosis

If you suspect you may be experiencing endometriosis, here are some of the most common symptoms associated with the condition:

  • Pelvic pain

Pelvic and/or abdominal pain is one of the most characteristic symptoms of endometriosis. It can range from mild discomfort to severe, sharp pain, especially during menstruation.

  • Severe menstrual pain.

Endometriosis often causes menstrual pain which is more severe than normal (dysmenorrhoea). This pain may start days before menstruation and continue throughout the cycle.

  • Pain during and after sexual intercourse.

Women with endometriosis may experience pain during sexual intercourse (dyspareunia) and after sexual activity.

  • Menstrual irregularities

Irregular menstrual cycles, heavy bleeding or interruptions in menstrual flow may be signs of endometriosis.

  • Painful urination or bowel movements

Endometriosis can cause discomfort when urinating or defecating, especially during menstruation.

  • Fatigue

Chronic fatigue is a symptom that some women with endometriosis experience, possibly related to the constant pain and inflammation.

  • Fertility problems

Women with endometriosis may have difficulty conceiving, as the condition can affect the function of the ovaries, fallopian tubes, the uterus itself and other aspects of the reproductive system.


The impact of endometriosis on fertility

Endometriosis is one of the most common causes of female infertility and miscarriage. But why is pregnancy so difficult if endometriosis is present? This is because endometriosis can affect fertility in several ways:

  • Irregular menstrual cycle

Women with endometriosis often experience irregular and abnormal menstrual cycles, which can make it difficult to predict ovulation. Irregular ovulation can be a challenge for women trying to achieve pregnancy naturally.

  • Decreases the number and quality of eggs.

The inflammation associated with endometriosis can cause ovarian dysfunction and negatively affect egg quality and release during ovulation, as well as ovarian reserve, which can be diminished when fibrosis of the ovaries is present.

  • Adherence and scarring

Endometriosis can cause adhesions or scar tissue to form in the reproductive organs, such as the fallopian tubes. These adhesions can block the tubes, making it difficult for eggs to pass into the uterus and for sperm to reach the egg, thus preventing fertilisation.

  • Alterations in anatomy

The presence of endometriosis can alter the normal anatomy of the reproductive organs and pelvis, which can make fertilisation and implantation of the embryo in the uterus difficult

  • Pain and stress

Chronic pain associated with endometriosis can affect emotional health, contributing to stress that can also negatively influence fertility.


Treating endometriosis

Treatment for endometriosis can often simply consist of painkillers and hormonal drugs to reduce the growth of endometrial tissue. It is also common to use laparoscopic surgery, which is used to diagnose and treat endometriosis. During this minimally invasive procedure, we can remove endometrial tissue, adhesions and cysts associated with endometriosis.

In more severe and extreme cases, extensive surgery, such as a laparotomy, may be necessary to address deep endometriosis that affects nearby organs, such as the bowel or bladder. In cases of severe endometriosis and when childbearing is no longer desired, a hysterectomy (removal of the uterus) may be performed.


How to get pregnant with endometriosis

It is estimated that between 30% and 50% of women with endometriosis have difficulty becoming mothers naturally. Many of the patients who come to Tambre in search of pregnancy are unaware that they suffer from this disease.  

However, depending on the degree of endometriosis and your age, we can offer a range of reproductive techniques that may effectively address endometriosis.

If the diagnosis is made at an early age before you are ready to have children, we can vitrify the eggs so that you try for a pregnancy at a later date. In these cases, the treatment will focus on alleviating the discomfort and improving the quality of life.

In more complex cases where a diagnosis is made later and the disease has progressed, it is possible that we might need to remove the adhesions by laparoscopic surgery in order to improve the anatomy and functionality that will allow us to increase the chances of embryo implantation.

We can also arrange a treatment that allows us to stimulate the antral follicles to try to increase the quantity of eggs and improve their quality. This is essential for IVF treatment with your own eggs. As a last resort, if we have not been able to recover quality eggs, we can offer an egg donation treatment to achieve pregnancy.


Adapted to the specific needs

At Tambre we offer a range of options for achieving pregnancy with endometriosis that are based on an exhaustive diagnosis and personalised treatment protocols that are adapted to the specific needs of each of our patients.

If you have been diagnosed with endometriosis or suspect that this condition is the cause of your infertility, contact us and make your first appointment now on +44 (0) 20 38 688 650.