Endometriosis: The silent enemy of fertility

Endometriosis affects a lot of women of reproductive age. We blame endometriosis for infertility problems and women often have no symptoms. How will we recognize it and deal with it?

What is it?

A woman has endometriosis when the endometrium, (the tissue that normally coats the inner wall of the uterus and detaches each month with the menstrual blood) grows out of it. It usually attaches to organs in the pelvic area, such as the Fallopian tubes, ovaries or behind the uterus, and sometimes extends to the intestines and bladder. In rare cases it can also reach parts of the body, far from the genitals (lungs, brain, auditory canal etc.).

In the parts where the endometrium is trapped, cysts are created (endometrial foci) with blood and measuring, from just a few millimeters to centimeters. They also bleed, but have no way to get out of the body. Thus, they cause inflammation and create scar tissue (adhesions). This tissue connects the vital organs together. In other words, they simply stick to each other and when the woman’s organs do their usual moves (for example the Fallopian tube and ovarian movements during ovulation, the bowel movements, or movements during intercourse) they cause severe pain.

How does it occur?

The most common symptom is severe pain and cramps in the abdomen shortly before and during menstruation (dysmenorrhea). Other signs may include pain in the lower abdomen and back of the pelvis when there is no menstruation. This may happen even on a daily basis. More signs are pain during intercourse, heavy blood loss during the period, which usually lasts for 7 or more days. We also have the short cycle (25 days of menstrual cycle or less), gastrointestinal matters (diarrhea, constipation, flatulence), painful and frequent urination, and even feeling of fatigue. However, doctors do not relate the extent of the condition to the intensity of the pain. For instance, it happens that women with severe pain to have small foci of endometriosis. On the other hand, we have women with absolutely no symptoms to have severe endometriosis.

Who suffers?

Specialists estimate that 10-15% of women of childbearing age suffer from endometriosis. It has been observed that it occurs most often between the ages of 25-40, several years after the first menstruation. Heredity seems to play a decisive role in it. In fact, they have found that women with a family history are ten times more likely to develop it themselves. Women with anatomical abnormalities in the genitals are also more likely to develop it.

What are the possible risks?

One of the most serious problems of endometriosis is infertility. We estimate that 40% of women diagnosed with endometriosis have infertility problems, while it has been observed that one in three women with infertility problems suffers from endometriosis. Usually, after treatment, the woman restores her fertility and she can get pregnant. However, we recommend that endometriosis should be treated immediately, as it worsens over time.


The doctor, after taking a detailed history, proceeds to a gynecological examination to exclude other causes with similar symptoms (simple cysts). Intravaginal ultrasound MRI scan can provide reliable information. However, the only reliable method of diagnosis is surgery (laparoscopy and histological examination). In contrast, the CA 125 index, which we can see with a blood test, is not reliable, as it does not always rise. After the diagnosis, the doctor is able to know the extent of the disease. There are stages 1, 2, 3 and 4, which refer to minimal, light, moderate and severe endometriosis, respectively.


The gynecologist prescribes analgesics to relieve the symptoms. At the same time he recommends the appropriate treatment taking into account the stage of the problem. In cases where the disease is in an early stage, doctors recommend to take contraceptives or progesterone. They do it in order to suppress the function of the ovaries, which favors the expansion of endometriosis. Contraceptives have minimal side effects, while taking progesterone can lead to weight gain or cause flatulence and irregular periods. However, if the diagnosis shows endometriosis at an advanced stage, they recommend special medication(triptorelin, goserelin, leuprolide), which stops ovulation and menstruation (usually for 3 to 8 months depending on the case). We do not give them for long periods of time and they may have several side effects. Some of them are hot flashes, headaches, sleep disorders, melancholy, vaginal dryness, decreased libido and osteoporosis.

In very severe cases or when we observe infringements, we perform laparoscopy in order to remove the visible foci of endometriosis. We do it either by laser cauterization or by their removal. It has been observed, however, that the foci do not change position. For instance, if endometriosis was found in the bowel in the first surgery, then it is more likely that we will find it again in the same place.

When needed, we perform a combination of medication and surgery. In any case, the type of treatment depends on both the stage of the disease and the intensity of the symptoms as well as on other factors. For example the woman’s age and her desire to get pregnant.

Myth: Pregnancy cures endometriosis

After the treatment of endometriosis, we often recommend pregnancy. During this time, when ovulation and menstruation stop and hormonal changes occur, the endometrial foci shrink and become less painful, but never go away. After childbirth and breastfeeding the symptoms return and may be more intense than before.

If you’re trying to get pregnant but do not succeed, there is a possibility that endometriosis is responsible, as it is blamed for infertility problems.

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