Some women experience all or none of these signs of endometriosis:
- Pelvic pain
- Painful intercourse (dyspareunia)
- Constipation, bloating, bowel discomfort, diarrhoea
- Heavy and/or irregular periods
- Lack of energy
- Back pain
- Rectal pain and/or rectal bleeding
- Pain on passing urine, blood in the urine
Endometriosis can be suspected by the presence of a particular type of ovarian cyst seen on ultrasound called an endometrioma. Ultrasound can sometimes also detect endometriosis growths or scar tissue, but often the only way to accurately diagnose the condition is by an operation called a laparoscopy. This requires a general anaesthetic and keyhole surgery through two to four small incisions in the abdomen. The endometriosis can often be removed surgically at the same time as the diagnosis is made. The surgeon is very careful to remove the endometriosis and not damage the normal ovarian or other tissue, particularly where future eggs will mature.
Doctors are not 100% sure what causes the condition but one theory is that the endometrial cells move from the womb down the fallopian tubes and out into the abdomen where they adhere and grow outside of the uterus.
There are many theories as to the effects of endometriosis on fertility. Those diagnosed with endometriosis are still likely to conceive but it is a common cause of infertility. For some, the condition can distort the ovaries and fallopian tubes and can cause the body to resist or reject foreign material – such as sperm. Endometriosis growth also produces a whole series of chemical substances (called cytokines or interleukins) that are thought to contribute to infertility. Under the influence of these chemicals, ovulation and egg quality may be impaired, sperm may not function so well in the environment and embryos can find it harder to implant.
If you know or suspect that you have endometriosis, consulting a doctor for review before trying to conceive is highly recommended.
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In addition to surgically removing the endometriosis during a laparoscopy, hormonal treatments can be used to suppress endometriosis but they stop ovulation and therefore a woman cannot become pregnant whilst taking such hormone treatments.
Pregnancy is unfortunately not a cure for endometriosis and about 50% of women have recurring symptoms of the condition after giving birth.
For those struggling to conceive, there are a range of fertility treatments that can support conception.
When to seek help getting pregnant