How Endometriosis Affects a Woman's Ability to Conceive

Struggling with conception and not sure why? Endometriosis could be the reason. According to WHO, Endometriosis affects roughly 10% (190 million) of reproductive-age women and girls globally.

Let's understand how endometriosis can impact fertility and what you can do about it.

Endometriosis occurs when the tissue that normally lines the uterus starts growing outside it, in areas like the ovaries, fallopian tubes, or even beyond the pelvic region.

Think of it as your body getting a little mixed up—this misplaced tissue behaves like a normal uterine lining but has nowhere to go during your period. Over time, this can cause inflammation, pain, scar tissue formation, and fertility issues.

Stages of Endometriosis

Endometriosis is classified into four stages based on the extent of tissue growth and scarring:

• Stage I (Minimal): A few small endometrial implants with little to no scar tissue.
• Stage II (Mild): More implants but no significant scarring.
• Stage III (Moderate): Deeper implants with visible scar tissue and possible small ovarian cysts.
• Stage IV (Severe): Extensive endometriotic growth, large ovarian cysts, and widespread scar tissue affecting the uterus, ovaries, fallopian tubes, and even the intestines or rectum.

If left untreated, endometriosis can worsen over time, making early diagnosis and management crucial.

Endometriosis can look different for everyone. Some people have symptoms, while others don’t even realise they have it until they try to conceive. Common signs include:

• Retrograde Menstruation: This is when some of your menstrual blood, carrying endometrial cells, flows backwards into your pelvis instead of leaving your body. It can then implant and grow in the wrong places.
• Cellular Metaplasia: Cellular metaplasia is when cells change from one form to another. Cells outside the uterus change into endometrial-like cells and start to grow.
• Stem Cells: Some experts believe that stem cells might play a role in spreading endometriosis throughout your body, through the bloodstream or lymphatic system.

No matter the cause, it’s important to know that endometriosis is not something you did or could have prevented—it’s simply how your body reacts.

Symptoms

Endometriosis can look different for everyone. Some people have symptoms, while others don’t even realise they have it until they try to conceive. Common signs include:

• Pelvic Pain: Pain during your menstrual cycle is often the most obvious sign. This isn’t just regular period cramps—it can be more intense and may occur outside of your period, too.
• Pain During Intercourse: If sex is painful, especially during or after intercourse, it could be due to endometriosis.
• Pain During Urination or Bowel Movements: You might notice these everyday activities become more uncomfortable, especially around your period.
• Infertility: If you’ve been trying to conceive and are having trouble, endometriosis could be one of the causes.

You might also feel nauseous, have digestive issues, or experience unusual fatigue during your menstrual cycle. Even if you don’t have all these symptoms, it’s worth checking with your doctor if something doesn’t feel right.

Diagnosing Endometriosis

If the above signs sound familiar, don’t worry—there are ways to figure out what’s happening. Here are a few methods your doctor might use to diagnose endometriosis:

• Pelvic Examination: Your doctor may be able to feel cysts or scar tissue during a routine pelvic exam.
• Ultrasound: Imaging tests like ultrasounds, CT scans, or MRIs can help your doctor see what’s happening inside your body.
• Laparoscopy: This is a surgical procedure in which a small camera is inserted into the abdomen to examine the pelvic organs more closely. It’s one of the most accurate ways to diagnose endometriosis.
• Biopsy: If needed, your doctor may take a small tissue sample during the laparoscopy to confirm the diagnosis..

If you're trying to conceive, endometriosis might be a hurdle. The condition can lead to scarring and adhesions in your pelvis, especially around your fallopian tubes, which are crucial for carrying eggs from your ovaries to your uterus. This scarring can make it harder for eggs to move freely or be released during ovulation, which affects your chances of conception.

It’s important to know that having endometriosis doesn’t automatically mean you won’t be able to get pregnant. But it may make things a little more complicated. About 30% to 50% of women with endometriosis experience infertility, but that still leaves room for hope. Many women with endometriosis go on to have healthy pregnancies, often with a little extra help from fertility treatments.

What Factors Can Affect Fertility If I Have Endometriosis?

Several factors can influence how endometriosis affects your fertility:

• Family History: If your mother, sister or aunt has had endometriosis, your chances of developing it are higher.
• Menstrual Cycle: You may be at greater risk if you have a short cycle (less than 27 days) or very heavy, long-lasting periods (eight days or more).
• Hormones: Estrogen plays a big role in how endometriosis progresses, so if your hormone levels are off balance, the condition may worsen.
• Severity: The stage of your endometriosis also matters. Women with more advanced stages may experience greater challenges with fertility, but even those with mild endometriosis can face difficulties.
• Age: Endometriosis is most common during your reproductive years, but it can also become more noticeable as you approach menopause.

When you’re living with endometriosis, it’s easy to feel overwhelmed by the symptoms. But there’s good news—there are plenty of treatment options that can help you feel better, manage your pain, and even improve your chances of getting pregnant. Alongside medical treatments, making small but impactful lifestyle changes can also support your well-being.

Medical Treatments for Endometriosis

There’s no one-size-fits-all treatment for endometriosis, but understanding your options can help you feel more in control of your health. Here are some common medical treatments you might explore with your doctor:

• Pain Medication: If pelvic pain is something you deal with regularly, pain relief might be your first go-to. Medications like Nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain relievers can make a big difference in how you feel day-to-day.
• Hormonal Therapy: Hormonal treatments, like gonadotropin-releasing hormone (GnRH) therapies, help manage heavy bleeding and reduce the growth of endometrial tissue, offering you some much-needed relief.
• Surgical Options: Surgery may be an option if your symptoms are severe, . Your doctor might suggest a laparoscopic procedure to remove excess tissue or cysts, which could help ease your symptoms and improve your chances of getting pregnant.
• Infertility Treatments: If endometriosis is impacting your fertility, treatments like in vitro fertilisation (IVF) or intrauterine insemination (IUI) could offer a path to pregnancy. It’s important to remember that you have options, and there’s support every step of the way.

Lifestyle and Alternative Treatments for Endometriosis

While medical treatments are essential, lifestyle changes can complement your care and give you extra relief. Here are a few ways you can support your body through everyday choices:

• Exercise and Relaxation: Physical activities like yoga, swimming, or light stretching can help reduce muscle soreness and ease anxiety. Consider setting aside a few minutes each day for mindfulness exercises like deep breathing or meditation, which can work wonders for your body and mind.
• Cognitive Behavioral Therapy (CBT): Dealing with endometriosis can be emotionally draining, but therapies like CBT can help you manage the mental load. You can ask your OB/GYN or reproductive specialist to refer you to a reliable therapist. Working with a therapist can teach you strategies for managing stress, while good sleep hygiene can help you feel more balanced and well-rested.

If you’re hoping to grow your family, dealing with endometriosis can sometimes feel like an added hurdle. But don’t lose hope—there are several approaches to boost your chances of conception:

• Fertility Treatments and Assisted Reproductive Technologies: Doctors often start with ovulation-inducing medications like clomiphene or letrozole, which can be combined with intrauterine insemination (IUI) in milder cases. For some, a laparoscopic procedure to remove tissue may improve fertility, and if that doesn’t work, in vitro fertilisation (IVF) is another option to explore.
• Preserving Fertility: If you’re not ready for a family just yet or need surgery, freezing your eggs or embryos is something to discuss with your doctor. This option helps keep your future family plans on the table while you manage your health.

Coping with endometriosis can feel isolating at times, especially when you’re also navigating the emotional strain of fertility challenges. Remember, you don’t have to face this alone. Connecting with your loved ones or a trusted doctor can provide support. Here are a few ways to take care of yourself:

• Seek Medical Support: Talk to a fertility specialist or gynaecologist who understands your situation. They can guide you through your options and help tailor a treatment plan that works for you.
• Embrace Stress Reduction: While endometriosis can make things challenging, incorporating stress-reducing activities like meditation, yoga, or a simple walk outside can ease physical and emotional tension. Pair this with a healthy, balanced diet to support your body and boost your energy.
• Communicate Openly: Dealing with infertility can strain your relationships, but talking openly with your partner and family can help. Whether through words or simple gestures, ensuring you’re both on the same page will strengthen your bond and lighten the load.