For years, my husband and I struggled to conceive our first child. We tried everything on the spectrum of infertility treatment: from fertility boosting drugs, naturopathy and acupuncture, to IUI and three rounds of (unsuccessful) IVF.
Nothing worked and I was diagnosed with "unexplained infertility."
On the verge of giving up, we had one last visit to our doctor. She suggested that I do a laparoscopy to check for endometriosis. During the surgery it was discovered I did indeed have this condition (on my ovaries, therefore affecting my fertility) and the growths were removed. The very next month, I was pregnant.
In my case, the condition was asymptomatic, making diagnosis that much more difficult without the laparoscopic procedure. But often, endometriosis is accompanied by certain symptoms, which can result in a positive diagnosis and therefore, positive treatment options.
The purpose of this article is to give you an understanding of symptoms of endometriosis, but first:
What is endometriosis and what causes it?
Endometriosis is defined as "a progressive, chronic condition where cells similar to those that line the uterus (the endometrium) are found in other parts of the body," by Jean Hailes for Women's Health.
Often, these cells attach themselves to the fallopian tubes, bladder or bowel. During the menstrual cycle, these cells swell up and become inflamed.
Dr Tamer Seckin, founder and medical director of the Endometriosis Foundation of America (EFA), describes endometriosis as a "war zone," explaining, “If it’s not treated, it’s a wound that never heals throughout the reproductive life of a woman.”
It is thought that this condition affects one in 10 women of childbearing age around the world, affecting millions of women worldwide.
While definite causes for endometriosis have not been identified, there are some possible reasons:
- Family history: Women who have a close relative with endometriosis have a higher chance of getting it themselves.
- Retrograde (backward) menstruation: Usually during a period, the blood not only flows out of the vagina, but also back into the pelvis along the fallopian tubes. In most women, this back-flowing blood (which contains endometrial cells) is re-absorbed or broken down. But in some, these cells start to grow again, causing endometriosis.
- Metaplasia: This is when normal pelvic tissue turns into endometriosis.
Other than these, getting your first period before the age of 11, having regular but short period cycles (less than 27-28 days), having a retroverted uterus, or periods lasting for more than five days may also contribute to this condition.
Here are the most common symptoms of endometriosis:
1. Painful periods
Symptoms of endometriosis: Intensely painful periods are one obvious sign of endometriosis.
Many, if not all women experience some kind of discomfort before and/or during their period. But the kind of pain that accompanies endometriosis is often debilitating and won't go away even with painkillers.
The pain can spread to your back and of course stomach (in the form of severe cramps), and often starts a few days before the period, lasting into the first few days of the flow.
2. Painful poops and pees
Because endometriosis sometimes affects the bladder and/or bowels, the inflammation that occurs around the time of your period can cause pain when you go to the toilet. You might also experience changes in your regular toilet patterns, such as wanting to urinate more often, constipation or diarrhea.
Some women with this condition might even pass some blood with their stools.
3. Painful sex
Symptoms of endometriosis: Does sex hurt a lot? You may have endometriosis, if so.
Many women with endometriosis experience pain during intercourse, ranging from mild to intense. This pain might be felt with any form of penetration, or only with deep penetration.
Julie Davis writing for Everyday Health explains that the amount of pain you feel is determined by the location of the endometriosis, rather than the size of the growth or lesions.
So, if the endometriosis is present "behind the vagina and the lower part of the uterus and is affecting uterine nerves or ligaments, it’s likely to cause more pain as sexual thrusting pushes and pulls the growths," she says.
For some women, the pain can linger on even after sex, sometimes for up to two days.
4. Bleeding
The condition often causes heavier than normal bleeding during menstruation. The bleeding will often include clots. And these can get heavy enough to warrant the changing of a pad or tampon every hour or two.
Sometimes, women with endometriosis experience spotting or bleeding even when they are not on their period.
Dr Robert Albee, Founder of the Center for Endometriosis Care explains that while the endometriosis itself doesn't make the uterus bleed abnormally, it causes this in indirect ways. For example, Ovarian endometriomas (chocolate cysts) can grow to a size where they put pressure on the rest of the ovary. And this leads to abnormal hormone production and bleeding.
5. Nausea and fatigue
That's right – endometriosis can cause extreme fatigue and nausea to the point that some women actually throw up. This usually occurs just before the onset of the period.
6. Subfertility
There is a link between endometriosis and subfertility, according to research. Experts point out that with mild or severe endometriosis, the ovaries and their function can be affected, having an impact on a woman's fertility.
In fact, many women don't even know they have endometriosis until they start trying for a baby and find it hard to conceive.
Diagnosis of this condition is often done via laparoscopic surgery and treatment, according to Mayo Clinic, may include hormonal contraceptives, Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists, and progestin therapy.
If you have none of the above symptoms of endometriosis but are finding it difficult to get pregnant, do speak to your doctor about the possibility that you might have endometriosis.
Often it can be asymptomatic, giving rise to that very frustrating diagnosis of 'unexplained infertility.'
We hope you found this article useful. Do share your thoughts and opinions on the topic by leaving a comment below.
