Endometriosis is a complex and unpleasant condition that affects the health, quality of life and fertility of 5-15% of women of child-bearing age. It’s found in girls before puberty, women after menopause, and even in some men. In endometriosis, the cells that normally form the functional layer of the uterus (which is shed in “periods”) grow away from the womb lining and behave slightly differently. They form abnormal structures (lesions) which disrupt normal bodily functions, reduce fertility and cause pain.
The endometriosis lesions cause chronic inflammation as they grow, and they change how they function across the cycle, and women often experience:
- Painful periods with strong uterine contractions or cramps
- Heavy menstrual bleeding
- Pain during intercourse
- Chronic pelvic pain
- Lower fertility
- Pain at ovulation
Symptoms can be relatively minor to debilitating, and they often have little connection to the severity of the disease. Symptoms depend on the type of endometriosis, how severe it is, and where the lesions are, which are usually:
- Ovaries (chocolate cysts)
- Pelvic cavity
- Fallopian tubes
- Behind the womb or bladder
Because the womb lining has different cell types cells that create a soft, sticky and spongy surface which encourages implantation, endometriosis varies depending on the three main cell types involved:
- Blood cells
- Mucous cells
- Connective tissue
Changes in sex hormones alter the function and behaviour of these cells across the month, which means that endometriosis tissue typically:
- Grows in the follicular phase
- Releases mucus or form adhesions in the luteal phase
- Bleeds during the menstrual bleed
Endometriosis also forms three types of lesion, which are classified according to how severe it is and where they’ve spread.
The exact causes of the disease are not 100% clear, but the significant drivers of the condition are:
- Abnormal sex hormone levels and responses
- Chronic inflammation
- Autoimmune imbalances
- Chemicals that alter hormones or create inflammation
Reducing any one of these factors helps to lessen the growth of the disease and improve immune function.
Endometriosis and Fertility
The impact of endometriosis on a woman’s fertility and health can be profound:
- Women who have endometriosis are less likely to get pregnant, but it rarely makes them infertile
- Average monthly conception rates fall from 15-20% to about 2-10% ii
- 35-50% of infertile women have endometriosis iii
- About 70% of young women with chronic pelvic pain that’s unresponsive to non-steroidal anti-inflammatory drugs (NSAIDs) or hormone treatment have endometriosis iv
Understanding the factors that promote the growth of endometriosis is crucial when managing the condition. Because this condition (and polycystic ovary syndrome – PCOS) are so crucial to health and the chances of conceiving, we’ve extensively researched the latest information on them and divided it into (hopefully) digestible portions.
Endometriosis and polycystic ovary syndrome (PCOS) share many features, and for women under 40, they reduce female fertility more than all the other conditions combined. There’s strong evidence that for many people, a combination of lifestyle, diet and complementary medicine can manage these conditions. Identifying health issues is a core aspect of the morefertile® personal fertility profiles (PFPs), and they significantly optimise health, especially when used alongside the self-help guides each condition has. The comprehensive information on endometriosis is set out in:
We hope the information here helps all women with endometriosis, whether they’re trying to conceive or not.
ii 8 Hughes EG, Fedorkow DM, Collins JA. A quantitative overview of controlled trials in endometriosis-associated infertility. Fertil. Steril. 59, 963–970 (1993).
iii Giudice L, Kao L. Endometriosis. The Lancet. 2004;364(9447):1789–1799
iv Bulun SE: Endometriosis. N Engl J Med 2009; 360: 268–79.
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