Published May 2024
Dr Juliette Koch – Repromed Medical Director
What Is Endometriosis?
Endometriosis (endo) is a chronic inflammatory condition characterised by tissue growth similar to the uterine lining outside the uterus, such as on the bowel, bladder, or ovaries. This misplaced tissue can cause internal inflammation, scarring, and adhesions, leading to symptoms that can significantly impact quality of life and fertility health. It is a menstrual health condition that affects at least one in seven women and those assigned female at birth in Australia.
Despite its prevalence, endometriosis is often misunderstood and misdiagnosed, with symptoms that can mimic other conditions and vary significantly in intensity. On average, it takes six and a half years from experiencing your first symptom to receiving an official endometriosis diagnosis. Many people endure their symptoms for even longer without realising they’re part of a larger issue.
Key Symptoms Of Endometriosis
There are a range of both common and uncommon symptoms of endometriosis. People with endometriosis may experience several of them or only a few. The nature and intensity of these symptoms are highly individual, meaning that two people with endometriosis can have vastly different experiences.
Painful Periods: While it’s common to experience some discomfort during menstruation, excessive pain that disrupts daily activities is not. This level of pain is often described as far worse than typical menstrual cramps and may not respond to standard over-the-counter pain medication.
Heavy Bleeding (Menorrhagia): Heavy periods associated with endometriosis often include bleeding that lasts longer than seven days or that involves passing large blood clots, coupled with the need to frequently change sanitary products every hour for several consecutive hours. It can also cause bleeding between periods. While many people may experience heavier flows at times, it’s important to understand that incredibly heavy periods are not a ‘normal’ part of menstruation.
Painful Sex (Dyspareunia): Extending beyond the occasional discomfort some may experience during intercourse, endometriosis-related pain is often deep and persistent and, crucially, isn’t confined to the menstrual phase of your cycle. It arises from endometrial-like tissue growing outside the uterus, which can create painful spots that the movements and pressures of sex can aggravate.
Painful Bowel Movements: Endometriosis lesions near the rectum can trigger inflammation, potentially impacting bowel function and resulting in discomfort during bowel movements. Unlike occasional digestive discomfort, this pain is often sharp and may occur before, during, or after defecation. It is not limited to the menstrual period but can become more pronounced during it. Other bowel-related symptoms may include bloating, diarrhoea, and constipation, which can appear similar to irritable bowel syndrome (IBS).
Urinary Symptoms: Urinary issues associated with endometriosis include painful urination, an increased urgency to urinate, and discomfort that may not be related to a urinary tract infection. These symptoms arise when endometrial-like tissue grows near or on the bladder, leading to irritation and inflammation.
Ongoing Fatigue: Unlike normal tiredness, ongoing fatigue is not just about needing a nap or a good night’s rest. It’s an exhaustive state that rest or sleep does not help alleviate. The cause of this fatigue is multifaceted, involving chronic pain, emotional stress from living with a long-term condition, and possibly the body’s systemic response to inflammation.
Chronic Lower Back Pain: This is persistent lower back pain, often manifesting as a chronic, throbbing ache that can radiate from the pelvic area to the lower back. It may worsen during your period due to hormonal changes affecting the misplaced endometrial-like tissue.
Chocolate Cyst Diagnosis: These cysts are named for their dark, chocolate-coloured contents, which consist of thick, old blood. These cysts often develop from endometrial-like tissue that invades the ovary and begin to bleed internally during menstrual cycles. If you have received a previous diagnosis or been advised of a potential chocolate cyst, this may be a sign of advanced endometriosis. These chocolate cysts or endometriomas are easily diagnosed on most ultrasound examinations. Other lesions, like those on the bowel, are harder to see and usually require special skills to be detected.
Endometriosis And Fertility
Endometriosis can affect fertility, with the condition appearing in up to 50% of people with uteruses who are experiencing infertility. The formation of endometriosis adhesions can distort the pelvic anatomy, with inflammation affecting the quality of eggs and creating potential issues with the implantation of the embryo. The ovaries and fallopian tubes can also be affected, with the ectopic growth of uterine tissue potentially leading to pelvic adhesions, cysts on the ovaries, and disrupted ovulation, all of which can make falling pregnant more difficult.
However, it’s important to note that a diagnosis of endometriosis does not immediately equate to an inability to conceive. You can get pregnant with endometriosis, and many people have successfully conceived, either naturally, following surgery or through fertility treatments such as IVF. For those with advanced disease, a conversation with a fertility clinician about egg freezing may be appropriate.
When To Seek Professional Advice About Endometriosis
Identifying the symptoms of endometriosis can be challenging, particularly because many people believe that severe menstrual pain, one of its most common symptoms, is a normal part of life.
If you experience any of the symptoms listed above, particularly if they’re severe enough to impact your daily life or are accompanied by fertility issues, we recommend you seek professional medical advice. Understanding whether your symptoms indicate endometriosis, or another condition can help you decide whether to visit a general practitioner or to consult a fertility specialist.
Take Our Quiz
Fertility Specialists have designed a Quiz to help people recognise what their symptoms are and identify the best next steps depending on their unique combination of symptoms.
If you believe you may be experiencing endometriosis symptoms and are concerned about the potential impact on your fertility, the quiz will help you gain insight into whether your symptoms may be indicative of endometriosis or another condition that requires medical attention.
Monitoring Your Health Moving Forward
If you feel you may be experiencing symptoms but aren’t ready to seek medical advice, there are a few things you can do at home to help monitor your menstrual health.
- Track your cycle. This will help you monitor whether your periods are consistent and make it easier to identify when something is out of the ordinary.
- Document your symptoms: Keep a detailed record of your symptoms, including their frequency, severity, and any triggers. This information can be invaluable when you’re ready to speak to a medical professional.
- Over-the-counter care: Maintain healthy self-guided care, such as over-the-counter painkillers or menstrual health technologies like electric pain relief devices. If they do not help manage your symptoms, it may be time to speak to a professional.
- Take the Quiz every six months: Bookmark the quiz and retake it every few months to help monitor your menstrual health. Your answers may change as time passes, and your result will indicate if your symptoms have progressed to the point that professional advice is recommended.
- Fast track if you’re concerned about fertility: It’s always better to know earlier than later. If you’re concerned about your ability to conceive due to suspected or confirmed endometriosis, organise a complimentary, no obligation chat with a member of Repromed’s New Patient Coordinator Team.
Organise a complimentary nurse chat