Endometriosis is a chronic condition in which tissue similar to the lining of the uterus (endometrium) grows outside the uterine cavity. It affects approximately 10% of women of reproductive age and is a significant cause of pelvic pain and infertility.
What is Endometriosis?
In endometriosis, endometrial-like tissue is found on the ovaries, fallopian tubes, the outer surface of the uterus, and other organs within the pelvis. This displaced tissue responds to hormonal changes during the menstrual cycle – it thickens, breaks down, and bleeds. However, unlike the normal endometrium, this blood has no way to exit the body, leading to inflammation, scarring, and adhesion formation.
Common Symptoms
- Severe menstrual cramps (dysmenorrhoea) that worsen over time
- Chronic pelvic pain, not limited to menstruation
- Pain during or after intercourse (dyspareunia)
- Heavy or irregular menstrual bleeding
- Pain during bowel movements or urination, especially during periods
- Fatigue, bloating, and nausea
- Difficulty getting pregnant
Causes and Risk Factors
The exact cause of endometriosis remains unclear. Retrograde menstruation – where menstrual blood flows back through the fallopian tubes into the pelvic cavity – is the most widely accepted theory. Other contributing factors include genetic predisposition, immune system dysfunction, and hormonal imbalances. Women with a family history of endometriosis, those who started menstruating early, or those with short menstrual cycles are at higher risk.
How Endometriosis Affects Fertility
Endometriosis can impair fertility in several ways. It can distort the pelvic anatomy, block the fallopian tubes, damage the ovaries through endometriotic cysts (endometriomas), create a hostile environment for egg and sperm interaction, and affect embryo implantation. It is estimated that 30–50% of women with endometriosis experience difficulty conceiving.
Treatment Options
Treatment depends on the severity of symptoms, the extent of the disease, and whether the patient is trying to conceive:
- Pain management: Anti-inflammatory medications and hormonal therapies can help manage symptoms in women not currently trying to conceive.
- Laparoscopic surgery: Minimally invasive surgery to remove or destroy endometriotic tissue can relieve pain and improve fertility. This is often the preferred approach for moderate to severe endometriosis.
- Ovulation induction with IUI: For mild endometriosis, controlled ovarian stimulation combined with intrauterine insemination can improve pregnancy rates.
- IVF (In Vitro Fertilisation): IVF is often the most effective treatment for endometriosis-related infertility, particularly in advanced stages or when other treatments have not been successful.
- Fertility preservation: Women diagnosed with endometriosis who are not ready to conceive may consider egg freezing to preserve their fertility for the future.
When to See a Specialist
If you experience persistent pelvic pain, painful periods, or have been trying to conceive without success, it is important to seek evaluation from a reproductive medicine specialist. Early diagnosis and a tailored treatment plan can significantly improve both quality of life and fertility outcomes.