Clinica Tambre‘s Dr Marta Zermiani gives you the lowdown on endometriosis, read here everything you need to know about one of the most common fertility conditions in the modern world
Endometriosis is a disease characterised by the migration of endometrial tissue to the outside of the uterus. The endometrium is the innermost part of the uterus where pregnancy develops and which is renewed monthly with a menstrual period.
Endometrial implants can affect the tubes, ovaries, uterine ligaments, bladder or bowel. There are different degrees of endometriosis in relation to the affected structures:
Grade one: with small implants especially in the ovaries and narrow adhesions
Grade two: with superficial ovarian and pelvic implants
Grade three: with deeper ovarian and pelvic implants and firmer adhesions
Grade four: with implants and firm adhesions at ovarian, pelvic and bladder or bowel level.
The symptoms of endometriosis are highly variable, the most frequent being abdominal and pelvic pain, especially during menstruation. Some women have excessive periods or bleeding outside of their period.
It is also common to have pain during sexual intercourse. Sterility is another problem related to endometriosis, which is often diagnosed in the study prior to assisted reproduction treatment in couples who aren’t achieving pregnancy.
Treatments for endometriosis
Drug treatment of endometriosis involves blocking spontaneous ovulation to reduce symptoms. This may also help slow the growth and activity of endometrial lesions and try to prevent scarring (adhesions). An oestroprogestative contraceptive pill (containing oestrogens and progesterone) is normally used and for women where oestrogens are contraindicated, an oral progesterone contraceptive can be used. Another option is the use of gonadotropin-releasing hormone (GnRH) agonists, which are hormones that inhibit ovulation by simulating menopause.
Sometimes, surgical treatment is indicated when pain is very difficult to control, in the case of seeking pregnancy to check the state of the ovaries, uterus and tubes and also in the case of urinary or intestinal complications. Normally the first step is to perform an exploratory laparoscopy (enter with a camera at abdominal level to assess the stage of the lesions and the involvement of the pelvic organs). The same technique can be continued to remove the lesions and eventually check the permeability of the tubes or, in some cases, it is necessary to proceed with open surgery (laparotomy) especially when there is intestinal or bladder involvement.
Many women with endometriosis have fertility difficulties. The main cause is pelvic adhesions and implants, which can affect the functioning of the tubes and make a natural pregnancy complicated. But we also know that endometriosis affects the quality of the oocytes and can alter the ovarian reserve, causing problems in achieving pregnancy also with assisted reproduction techniques. Fertility preservation treatments allow delaying the search for pregnancy preserving the oocyte quality and extracting them before ovarian lesions develop.
The most common technique to achieve pregnancy for women with endometriosis is IVF. However, in women who have already tried this technique without result or with more advanced age an egg donation is recommended.
We are aware of the large number of strong and brave women fighting endometriosis nowadays. If you are one of them and you don’t get pregnant after six to 12 months of trying, we wait for you in Tambre. We can discuss your situation and the options that exist to carry out the appropriate treatment in time. All our team will do their best to make your dream come true.