Endometriosis is a common chronic benign disease. It develops when tissue similar to the endometrium (the inner lining of the uterus) grows outside the uterus, commonly on the ovaries. It can also develop in the bladder, in the abdominal cavity or in the lung or gums.
According to gynaecological experts, it affects approximately 15% of women of childbearing age.
Endometriosis generally manifests in the following way:
Although the most common symptom is menstrual pain, this is not always the case. Symptoms can sometimes be unclear or may not appear at all, as is the case in asymptomatic women.
The severity of endometriosis will depend on the existence and extent of the lesions, which will ultimately define the different degrees of the disease: I, II, III and IV.
One of the main problems with endometriosis is that the causes are unknown. Both the lesions and the symptoms experienced by patients with endometriosis can be treated and may even disappear. Even so, as the origin of the disease cannot be determined, lesions may recur, sometimes repeatedly.
This theory is particularly relevant to explaining certain conditions associated with uterine malformations. According to this theory, fragments of endometrium from menstrual flow travel back through the fallopian tubes and reach the peritoneum and ovaries. These fragments would become implanted in these tissues, generating endometriosis.
Tissues from the peritoneal area transform into endometrial tissue in locations where it would not normally be found.
Immune system dysfunction may allow small foci of endometrial tissue in different tissues to be tolerated, leading to clinical or subclinical endometriosis.
Between 30–50% of cases of endometriosis cause infertility, meaning that achieving pregnancy naturally can be more difficult. The disease can affect fertility in various ways:
Endometriosis can cause scarring of the fallopian tubes or ovaries.
This inflammatory disease can cause toxicity to sperm and eggs.
It can also cause endometrial alterations that affect embryo implantation.
It can also cause endocrine disorders that affect ovulation.
Many women who suffer from this disease wonder whether they will be able to get pregnant with endometriosis. The answer is yes: many women with endometriosis can become pregnant and have children, even naturally.
However, the disease can affect fertility in some cases, especially when there is pelvic inflammation, ovarian involvement, or alterations in the fallopian tubes. The possibility of having children with endometriosis depends on several factors, including:
Not all patients with endometriosis experience infertility. In fact, many women achieve a natural pregnancy without the need for assisted reproduction treatments. In moderate or severe cases, it may be more difficult to achieve pregnancy.
Pregnancy improves the symptoms of endometriosis because there is no menstrual cycle during pregnancy. The secretion of hormones that regulate ovulation is stops. In this sense, the ovaries do not produce oestrogens and the hormones that promote the growth and development of endometrial lesions remain inactive.
Finally, when considering the impact of endometriosis on fertility, we must consider that, as it is an inflammatory, progressive and chronic condition, the best decision for a patient of childbearing age is to preserve her fertility. Endometriosis can affect ovarian reserve, oocyte quality or endometrial receptivity, among other things. This means that freezing eggs before fertility is significantly affected can help preserve the possibility of having children in the future.
Egg vitrification makes it possible to preserve oocytes for use when trying to achieve pregnancy at a later stage, even if endometriosis progresses and affects ovarian reserve. Following a diagnosis of mild or moderate endometriosis, egg preservation may be considered before the condition has a greater impact on fertility.
Testimony of a patient with endometriosis and pregnancy in IVF-Life
Laura, an IVF-Life patient, tells us how she managed to become a mother with endometriosis thanks to assisted reproduction.
We can differentiate between different degrees of endometriosis: minimal, mild, moderate and severe. In assisted reproduction they are known respectively as stages I, II, III and IV.
In stage I (minimal endometriosis), there are isolated and superficial implants, while in more advanced stages there may be adhesions, deeper lesions or what specialists call ‘chocolate cysts’ or endometriomas.
The detection of endometriosis is not simple. For this reason, at IVF-Life we emphasise the importance of assessing female fertility before trying to conceive.
In general, the definitive diagnosis is confirmed with a vaginal ultrasound and in cases of severe endometriosis by laparoscopy. This is a minimally invasive test that can detect cysts (also called endometriomas or chocolate cysts) or the presence of pelvic adhesions.
There is also a blood test for CA 125 protein levels. This is a tumour marker that can be elevated in certain cancers, and in other diseases such as endometriosis I and II. However, it is not considered relevant for detecting endometriosis, as the values can be altered by the presence of fibroids, ovarian cancer or menstruation.
There is currently no cure for endometriosis, but there are treatments that can alleviate its consequences. Painkillers can relieve pain, as can hormone treatments, which in certain cases can also slow the progression of the disease. Surgery is an option for women who are in severe pain, always bearing in mind that removing a cyst does not mean that another one will not appear.
Professionals initially opt for less invasive medical treatments than surgery. Depending on the severity of the woman's endometriosis and whether she wishes to become pregnant, the following can be carried out:
These treatments can improve symptoms in many patients. It is important to monitor the progression of the disease and make decisions based on the patient's response to treatment. Surgery is generally considered for women who do not respond to initial treatment or women with other organ involvement.
The fertility specialist may recommend a laparoscopy before starting treatment to improve the chances of pregnancy in women with endometriosis.
Depending on the degree of the disease, assisted reproduction techniques may be the solution to achieve pregnancy.
One of the most successful fertility treatments for patients with endometriosis is in vitro fertilisation (IVF), either conventional IVF or ICSI. It is also a good option when artificial insemination has not been successful.
However, it is important to bear in mind that surgery can damage healthy tissue and further affect fertility. In these cases, egg donation may be an option. However, in these cases, treatment with egg donation can be used.
This treatment is performed with oocytes extracted and fertilized in the laboratory (in vitro) with the semen of the couple or an anonymous donor.
Fertility treatment that consists of performing In Vitro Fertilization with the oocytes of an anonymous donor.
IVF with ICSI is a technique that combines conventional in vitro fertilization with the direct injection of a sperm into the egg.
This treatment is performed with oocytes extracted and fertilized in the laboratory (in vitro) with the semen of the couple or an anonymous donor.
Fertility treatment that consists of performing In Vitro Fertilization with the oocytes of an anonymous donor.
IVF with ICSI is a technique that combines conventional in vitro fertilization with the direct injection of a sperm into the egg.
Find answers to your questions
Endometriosis does not directly cause weight gain. However, some people may notice changes in their weight due to associated factors such as chronic inflammation, fluid retention, pain that limits physical activity, or certain hormonal treatments. Each body responds differently, so not everyone with endometriosis experiences these changes.
There is no single diet, but many specialists recommend reducing foods that promote inflammation, such as:
In general, it is advisable to prioritise an anti-inflammatory diet rich in fruits, vegetables, fish, legumes, and healthy fats, always tailored to each individual and, if possible, with professional guidance.
Endometriosis is not cancer. In the vast majority of cases, it is a benign condition, and most people with endometriosis never develop cancer.
Endometriosis is not usually a life-threatening disease, but it can be serious and significantly affect quality of life. It may cause chronic pain, digestive disturbances, fatigue, and even difficulties in achieving pregnancy. Therefore, early diagnosis and appropriate medical follow-up are important to control symptoms and prevent complications.
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