Heavy period?

For some wo men, endometriosis means severe ors trugg le s with infertility. But for others, it can be totally symptomless.

Endometriosis is a condition that affects women during their childbearing years. It happens when endometrial tissue, which normally lines the uterus, grows outside of the uterus. It can implant and grow anywhere in the abdominal cavity – usually in the pelvic area and lower abdomen, but rarely also in other places such as the lungs or navel. This tissue sometimes grows in patches known as implants, in thicker nodules, or it can form cysts in the ovaries known as endometriomas.

The endometriosis irritates surrounding tissue and may cause web-like scar tissue called adhesions. However, what makes this condition challenging is that the symptoms can vary significantly from woman to woman. Symptoms include heavy menstrual pain, pain during or after sex and severe back pain.

“In general, it takes about eight years to reach a diagnosis, and often you will have seen five different healthcare providers, so it is underdiagnosed, and it takes quite a long time to reach that diagnosis,” says Dr Chris Venter of the Vitalab Centre for Assisted Conception.

”If you have a mother or sister who suffers from endometriosis you have a greater incidence of the disease.

“I am seeing women being diagnosed much more frequently,” comments Dr Venter. He says the reasons are twofold. More women are choosing to postpone their families, and as they get older, the chance of endometriotic lesions is higher and makes it more prevalent, he says.

I’M DIAGNOSED. NOW WHAT?

There are two ways to treat endometriosis, Dr Venter explains. The first is hormonally, using medication that will relieve the symptoms of the disease, but will not enhance fertility. Pain medication can also be used to treat painful symptoms, usually nonsteroidal anti-inflammatory drugs and opioids. You might do very well on hormonal treatments. However, not all treatments work well for everyone with endometriosis. The second treatment option is surgery, usually a laparoscopy. “We know that surgical treatment can enhance your natural chances of conceiving,” explains Dr Venter. However, he cautions that the new trend is to be more conservative and regard surgery as something only to be considered when hormonal therapy has failed. “There are major risks involved. This is very delicate surgery, and it is extremely important to make sure you have a qualified surgeon performing the procedure,” he warns. Repeated surgery can be harmful and should be avoided unless vital, he says.

HOW IT AFFECTS FERTILITY

While figures vary slightly from study to study, about five to 10 percent of women suffer from endometriosis, while 50 percent of women with fertility issues have the illness, Dr Venter says. Likewise, approximately 50 percent of women with endometriosis will struggle to conceive.

Although they may conceive spontaneously (without fertility treatment), the timeline for achieving a spontaneous pregnancy is considerably prolonged. “The most effective way of treating endometriosis-related infertility is in vitro fertilisation,” Dr Venter explains. However, if you have endometriosis, don’t worry that it will in any way affect the pregnancy or the foetus, Dr Venter says. “There’s no evidence to show that you’ll have a poorer obstetrical outcome if you have endometriosis.

Whether you have it or not, the pregnancy outcome is the same. In fact, the pregnancy has a very positive influence on endometriosis,” explains Dr Venter. “It could regress the disease, so you could actually go from a stage three to a stage two, and at the very least it will suppress the endometriosis for the nine months of the pregnancy. The best thing that can happen to your endometriosis is to conceive.”

SYMPTOMS CANVARY SIGNIFICANTLY FROM WOMAN TO WOMAN AND INCLUDE HEAVY MENSTRUAL PAIN, PAIN DURING OR AFTER SEX AND SEVERE BACK PAIN.

WHAT DOES YOUR PERSONALITY HAVE TO DO WITH IT?

It’s a cliché that the Type A personality woman is the one who will battle to conceive, but research has shown that if you fit this profile, you actually do have a significantly higher chance of suffering from endometriosis. “Psychological profiles done on women with endometriosis show that the more Type A personality, the more stressed woman, who smokes a lot, with lower body mass is more prone to have it,” comments Dr Chris Venter of Vitalab. All the women presenting with endometriosis have two things in common, reports Dr Mandy Rodrigues of the Medfem Assisted Fertility Clinic in Johannesburg, who has undertaken nearly 20 years of research. They’re time urgent (rushed, busy people) and they’re perfectionists. “They aren’t necessarily neat and ordered, but they have high expectations of themselves and others. They are black-and-white thinkers, and they push themselves,” she comments. Dr Rodrigues and her colleagues noticed that, as they decreased the stress, so the symptoms of endometriosis decreased and these women fell pregnant. The theory comes from the belief that there is a relationship between the mind and the body. “If you’re time urgent and a perfectionist, you secrete a higher level of noradrenaline and cortisol, higher than the normal population, and those two hormones make the immune system vulnerable. When the immune system’s not functioning, that’s when our body doesn’t fight all those cells and the endometriosis starts growing,” she explains. Fortunately, if you fit the profile, it’s not hopeless. “If we can fix the stress, we can fix the endometriosis and improve the infertility rate,” she comments. Dr Rodrigues and her colleagues developed a programme that is accessible on timeurgency.com. The programme is designed to meet the needs of the time urgent and perfectionists. You can test yourself on the website, and the online programme consists of a series of keys to what causes stress and how the individual reacts, a set of homework and five-minute daily tasks. The programme teaches a set of responses to stress. “It’s very goal oriented, which suits this kind of personality,” Dr Rodrigues explains. ●