March is 'Endometriosis Awareness Month' and ISUOG's Ask the Expert - Patient Perspectives series goes to the heart of the issues surrounding endometriosis. With our specially selected clinical expert panelists, Prof. George Condous and Dr Mathew Leonardi, we answer the questions that matter most to our community's patients.
Endometriosis is a disease where tissue similar to the lining of the uterus grows outside the uterus, causing pain and/or infertility. The disease, to which there is no known cure and where the focus looks to control symptoms, affects roughly 190 million people worldwide.
Questions for our Panellists
This is a brilliant question and question without an easy, simple answer. Unfortunately, despite everybody's hope that it's a simple answer, the reason endometriosis happens is multifactorial. That means that there are lots of things that go into the initiation and the development of the disease. To be relatively simple about it, there are some mainstay reasons, and these are genetics, immunity, inflammation and irregularities and menstruation. This is the main box of reasons why pelvic endometriosis exists. And of course, there are unique, extra pelvic types of endometriosis that may not be explained by the same reasons in that box. But those are the main reasons in the pelvic endometriosis box.
Dr Mathew Leonardi
There's no doubt that a person's genetics is probably one of the reasons that a person who has assigned female at birth may have a tendency to develop endometriosis. And there are other environmental factors that can also contribute to this. I don't think it's necessarily a hereditary disease or condition. However, there has been work looking at twins, particularly identical twins, and in those twins where one of the twins has had endometriosis, there is a much higher chance that the other twin has endometriosis than non identical twins. So, our advice is that if you have a first degree relative, such as your mother, or if your sister has had endometriosis, and you have symptoms that you think may be maybe considered or associated with an underlying diagnosis of endometriosis, then it's really important that you see your general practitioner or gynecologist so that you can get input to help you to confirm or exclude the disease.
Prof. George Condous
The reassuring aspect of endometriosis is that the vast majority of women have mild disease. If you look at those with endometriosis, potentially one in three may have problems with fertility. So that means that the vast majority of women are likely to be able to have a baby and the group that find it difficult can then seek expert input from fertility specialists. Endometriosis can affect different aspects of your pelvis. It can affect the womb, so it can have an impact on the receptivity of the potential embryo that wants to implant into the uterus itself. The fallopian tubes which carry the embryo back to the uterus can be affected, so you can get mechanical obstruction of the plug in to make it more difficult to get pregnant in the first place, or may affect the ability to transport the embryo back to neutral self.
When you look at the ovaries and ovarian function, ovarian function can sometimes also be affected by the presence of endometriosis, or the presence of endometriosis. So, endometriosis can have a global effect on a person's fertility and ability to conceive. However, remember the vast majority of those with endometriosis can still have a baby.
Prof George Condous
Pain is a very challenging experience in pregnancy because there are lots of pregnancy changes people have that are sometimes quite normal pregnancy changes which are uncomfortable or painful. So interpreting endometriosis, pain in pregnancy is quite challenging. However, pregnancy has historically been known as a time when pain due to endometriosis seems to be settled. Lots of patients in their pregnancy do feel better and that's due to the high levels of progesterone. Generally, there are still people with endometriosis who can have pain in their pregnancy. In those people, we try to advise on typical pain management using things like acetaminophen or paracetamol, things that are known to be safe in pregnancy, but certainly we would suggest speaking with your obstetrician, gynecologist, midwife and anesthesiologist looking after pain in your labor process.
Dr Mathew Leonardi
Endometriosis: Read, Watch and Learn
ISUOG has compiled a collection of resources from our community's expert clinicians, including detection of ovarian and deep endometriosis, endometriosis and infertility and the natural history of endometriosis in pregnant and non-pregnant women. Read, watch and learn here:
Expert Voice: Endometriosis