Why you should care about endometriosis
March was Endometriosis Awareness Month, but its importance does not end there. Endometriosis affects 1 in 7 women, nearly a million Australians.
March was Endometriosis Awareness Month, but its importance does not end there. Endometriosis affects 1 in 7 women, nearly a million Australians. It is a condition in which tissue similar to that lining the uterus (womb) grows in places it should not, such as the lining of the pelvis, on the ovaries, and in rare cases, even the lungs and brain. Everyone will know someone who has this chronic and, at times, debilitating condition, whether it be a coworker, a sister, or a partner. Thankfully, it seems we are getting better at diagnosing it more quickly, with the previous average time from symptoms to diagnosis in 2005 being 12 years and now it is less than 5 years. The economic burden of this disease in Australia in one year was $248 million dollars, accounting for 40,000 hospitalizations from 2021-2022. It is a problem for us all and a huge problem for those wanting to conceive, with endometriosis estimated to affect up to half of women with infertility.
Diagnosis is not simple as it is known to be a disease of symptoms without clinical signs most of the time. And the severity of the disease is not proportional to the symptoms. Some women will have very severe disease and minimal symptoms, some have minimal disease but terrible symptoms. These symptoms include pain, often preceding and then during menstruation with related bowel and bladder symptoms, pain with intercourse, and infertility. One of the reasons diagnosis is often delayed is that women presenting to a doctor with pain are more likely not to be taken seriously; they receive less pain relief and wait longer for a diagnosis (regardless of doctor gender).
There is no blood test to diagnose this condition. Some severe endometriosis can be seen on ultrasound or MRI, but diagnosis cannot reliably be excluded without surgery and biopsy of potentially affected tissues.
The effects on infertility can be due to anatomical distortion, e.g., scar tissue making it difficult for the ovaries and tubes to meet at the time of ovulation or due to the inflammatory burden caused by the deposits in the pelvis. It is also implicated in low ovarian reserve and worse outcomes during fertility treatment. Endometriomas are cysts of endometriosis on the ovaries. They can contribute to damage but with the added complexity of their removal also causing damage to ovarian reserve as the tissue housing the potential eggs being damaged by the nature of the removal.
Many of the treatments for symptoms of endometriosis are hormonal and are not compatible with trying to conceive. Many have other unwanted side effects such as menopausal symptoms.
Even if you haven't been diagnosed with endometriosis, if you suspect you have it and have been trying to conceive for six months, then specialist assessment is warranted. It is important to be seen by someone who understands the balance of treatment options and priorities for symptoms and preservation of fertility. Every year we are doing better with diagnosis and new treatment insights and recommendations. We can and will continue to do better. We should all care about endometriosis.
Written by Dr Sylvia Ross
Dr Sylvia Ross is a dedicated medical professional with over a decade of experience in the field of women's health. She is a specialist in Obstetrics and Gynaecology (FRANZCOG) and currently in the final stage of completing her Certificate of Reproductive Endocrinology and Infertility (CREI), a highly competitive program producing board certified subspecialists in infertility.
Specialising in infertility treatment, Sylvia offers a range of services to support individuals and couples facing fertility issues. Her expertise includes management of polycystic ovarian syndrome, ovulation induction, in vitro fertilisation (IVF), and various surgical interventions tailored to meet the unique needs of her patients.