Endometriosis

Endometriosis is a common and often painful condition affecting 1 in 8 women worldwide which occurs when the tissue that normally lines the uterus called the endometrium is found outside of the uterus.

It can affect the surface of the ovaries, fallopian tubes and the tissue lining the pelvis. Endometriosis deposits are also rarely found in other areas of the abdomen and uterus. These cells can alter the environment of the pelvis and reproductive tract causing a range of issues including pain, bowel and bladder changes, heavy periods and fertility issues.

Unfortunately, despite its prevalence, the cause is not yet clear.

While there are many theories regarding the cause of endometriosis, the leading theory is that the condition is caused by “retrograde menstruation”. This theory suggests that the backward flow of menstrual bleeding through the fallopian tubes and into the pelvis might be the cause of endometrial cells to implant on abdominal organs.

A certain amount of discomfort with periods may be normal; however, pain that stops you from living your everyday life or impacting your athletic performance is not normal.

The symptoms of endometriosis can vary from mild to severe, depending on where the stray endometrial tissue is located. The most common symptom is chronic pelvic pain, especially before and during your menstrual period. Other commonly reported symptoms include:

• Severe period pain – immediately before and during a period
• Pain during or after sexual intercourse
• Abdominal, back and/or pelvic pain outside of menstruation
• Abdominal pain at the time of ovulation
• Painful bowel movements or urination
• Excessive menstrual bleeding, with or without clots
• Irregular bleeding, with or without a regular cycle
• Premenstrual spotting
• Difficulty when trying to conceive

Please note, although pain is one of the most common symptoms, it is not a good indicator of the extent of the condition and should be investigated further. Some women may have no symptoms.

Although the condition can be suspected on ultrasound or MRI, the only way to definitively diagnose endometriosis is through a laparoscopy. A laparoscopy is a surgical procedure that involves inserting a long, thin telescope (laparoscope) into the abdomen through an incision near the navel. This allows the surgeon to look for signs of endometriosis and may take tissue samples for testing, as well as remove any endometriosis deposits if required.

If you experience any of the above symptoms, we encourage you to visit your general practitioner (GP) and seek a referral to a specialist gynaecologist for an accurate diagnosis.

The symptoms associated with endometriosis such as fatigue, abdominal pain, and heavy bleeding can seriously impact athletes of all levels, physically, mentally, socially, and economically. This can have substantial influences on your ability to train and compete.

If you believe you may be experiencing various symptoms that may indicate endometriosis, we encourage you to reach out to your medical team or specialised doctor at Ignite Athlete for further investigation.

Endometriosis can be treated in several ways, depending upon the severity of the condition and your individual circumstances and goals. The treatment options include:

Medical Management

Hormone therapies may be utilised as a treatment in mild endometriosis or used as an added or combined therapy before or after surgery, especially in severe cases. The aim of hormonal therapies is to suppress the growth of endometrial cells which can lead to a reduction in pain symptoms.

This treatment is not suitable for those trying to conceive. Hormone therapies include progestogens, the oral contraceptive pill, GnRH (gonadotrophin-releasing hormone) agonists, and androgenic steroids (e.g., Danazol).

Surgical management

Procedures such as a laparoscopy can surgically remove endometrial implants or adhesions (scarring) caused by the condition. Unlike medical management, this treatment may improve your fertility.

Treatment of infertility

For women with mild endometriosis, the use of fertility medication that stimulates ovulation combined with Intra-Uterine Insemination (IUI), enhances fertility. In Vitro Fertilisation (IVF) procedures may also be effective at improving your chances of conceiving. The decision when to apply IVF in endometriosis-associated infertility considers the age of the patient, severity of the endometriosis, the presence of other infertility factors, and the results and duration of past treatments.

If this is a treatment option you are interested in, we recommend making an appointment with a fertility specialist as they will assess your individual needs and circumstances to form a treatment plan tailored to your needs.

If you think you may have endometriosis or have concerns about endometriosis influencing your life and athletic performance, we recommend you get into contact with a specialised women’s General Practitioner or gynaecologist through our Ignite Athlete portal anytime.

They will be able to discuss your medical history, as well as assess your individual circumstances and symptoms to determine whether further investigation or management is required. If you track your menstrual cycle, this log will be beneficial to bring to your appointment.

City Fertility – Endometriosis: What you need to know

Endometriosis Q&A by Dr Lisa Harris, Brisbane fertility specialist

City Fertility – Is there a link between endometriosis and fertility? by Professor Bill Ledger, Sydney fertility specialist