What is endometriosis?It's called endometriosis when parts of your uterine lining (the endometrium) grow where they should not. This often happens in the ovaries and / or fallopian tubes, in the pelvis behind your uterus, in the intestines or your bladder. Rarely, the tissue even grows in the lungs.
Experts have not yet figured out why endometriosis occurs, though it's quite common. About 5 to 10 percent of all women in Germany have endometriosis. If you belong to it, you probably know that it is a long-term condition.
You may have endometriosis without knowing it. Therefore, it is worthwhile to learn more, especially if you suffer from painful periods.
The problems with endometriosis arise when your period is due. Because every month, the lining of your uterus thickens and becomes soft and ready to receive a fertilized egg.
If there is no conception, your body will simply relieve that cushion. It leaves your body as menstrual blood when you have your period.
However, if this tissue has formed outside of your uterus, your body will not be able to break it down. He tries to get rid of the pad, but the blood can not go anywhere. This may cause cysts, adhesions and scar tissue.
What causes endometriosis?Physicians have various theories:
- Tiny pieces of upholstery tissue migrate from the uterus through your fallopian tubes or, in extremely rare cases, through the lymphatic system.
- Endometriosis also occurs in families. Ask your mother if she had endometriosis because it can affect every generation.
- Menstrual blood and tissues accumulate in the fallopian tubes.
- Your immune system can not get rid of tissue that's in the wrong place.
- Environmental toxins that disturb your hormonal balance. (NHS Choices 2010, PRODIGY 2009)
What are the symptoms of Endometriosis?Endometriosis is unpredictable. You may not know that you are affected. Or you have painful periods and feel uncomfortable during sex. It all depends on where the endometriosis is in your body and how well developed it is (Vercellini et al 2007). It probably gets heavier the longer you have it.
There is an indication of pain in the following situations:
- just before or during your period
- during sex when your partner invades you
- in the pelvis or scar of your caesarean section - if you have one
- During ovulation
- if you excrete feces, especially during your period
Endometriosis can also trigger a feeling of fatigue (PRODIGY 2009, RCOG 2006).
Can endometriosis make conception more difficult?Yes. If you have difficulty getting pregnant, according to the experts, there is a 25-30% chance that these difficulties are due to endometriosis (NCCWCH 2013: 105). This can block your fallopian tubes and damage the ovaries. The cysts and scarring of endometriosis can also deform your pelvic organs.
If you know you have endometriosis and have trouble getting pregnant, you should seek help sooner rather than later (NCCWCH 2013: 79). Do not try for more than six months before seeing a doctor.
How is endometriosis diagnosed?Your gynecologist will discuss with you the symptoms and history of your illness. He / she will examine you for cysts, sensitive areas and thickening in your pelvis (RCOG 2006, NCCWCH 2013: 107). This is best done during your period because it is easier to get the crucial clues. (RCOG 2006).
The safest way to confirm endometriosis is to perform a laparoscopy (RCOG 2006: 3-4). With this minimally invasive procedure, the doctor can examine your uterus, ovaries and fallopian tubes. This procedure can be done on an outpatient basis. By the way, your doctor will not treat you for infertility by endometriosis unless he / she is sure that you are affected. Therefore, in case of doubt you have to endure a laparoscopy.
If you decide to, and your doctor finds a mild form of endometriosis during laparoscopy, then he / she may be able to treat it directly. However, if endometriosis is more advanced or stronger, this possibility may not exist.
What is the best way to get pregnant despite endometriosis?
Since your gynecologist probably knows that you would like to have a baby, he / she will refer you to a Fertility Specialist. With mild endometriosis, a laparoscopy can increase your chances of a successful pregnancy. The specialist may also suggest flushing your fallopian tubes (RCOG 2006: 9). This procedure is an alternative to surgery and is often successful.It can also help you with a surgical procedure. In some women with a mild form of endometriosis, the chances of getting pregnant after surgery increase (NCCWCH2013: 189). In more severe cases, your chances of getting surgery are still between 36 and 66 percent (NCCWCH 2004: 74).
You may also be advised to have a blood test done to determine the power of your ovaries to deliver healthy oocytes.This will check if your ovaries have been damaged by endometriosis.
You have the best chance of conceiving in the year following the surgical procedure. If you wait longer, it may happen that the endometriosis has reformed. Ask your doctor about the options for getting pregnant after the procedure.
In case of mild endometriosis and your age, your doctor may recommend that you wait up to one year longer to see if you become pregnant. Because even if you've been trying for a year, you could still get pregnant without the need for surgery. (NCCWCH 2013: 216).
Even with severe endometriosis, you can still get pregnant naturally. It depends entirely on where and how much endometriosis affects you. Most likely, in this case, your doctor advises you to have an IVF (NCCWCH 2013: 263).
Can I have an artificial insemination despite endometriosis?
The answer is yes. You and your partner may opt for artificial insemination because:you prefer that to surgical techniques.
- You are still not pregnant despite surgical and other procedures.
- Although your endometriosis is mild, you still are not pregnant after trying for two years.
- If you have mild endometriosis, you may be suggested to have IVF (In Vitro Fertilization) (NCCWCH 2013: 216, RCOG 2006: 10). This can include a three to six month hormone treatment, as this increases your chances of receiving. (Sallam et al 2006).
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