March 2021 is Endometriosis Awareness Month – a chance to increase the conversation around this common but often debilitating condition. Affecting an estimated 10% of women, it's the result of the tissue that lines your uterus growing elsewhere – typically in your pelvic region – think places such as your ovaries or fallopian tubes.
'If we are to really support the 25% of women suffering from menstrual health conditions in the UK, we must all accept our responsibility this Endometriosis Awareness Month in talking about endometriosis and menstrual health to break down these barriers and encourage people to seek help if something isn’t right,' says Faye Farthing, Campaigns and Communications Manager for Endometriosis UK.
'Endometriosis is a condition affecting 1.5million women and those assigned female at birth in the UK – yet 64% of women aged 16-24 have never heard of it. It is a condition that can have a huge impact on all aspects of a person’s life, including their education, career, relationships, and their physical and mental health.
'Covid has also had a huge impact on endometriosis care – with people seeing cancellations to appointments and surgeries. We’re calling on the Government to not leave behind the 1.5million with endometriosis in the UK post Covid, and to make sure patients know when they can expect care to resume and do not have to continue face living in limbo.'
One possible effect of the condition can be an impact on fertility. Here, WH speaks to a reproductive expert about getting pregnant with endometriosis, plus, endometriosis and fertility, generally.
What getting pregnant with endometriosis might look like is, naturally, going to be one of your big queries if you're in the estimated 10% of women who deal with the condition.
If you do want to have a baby someday, you might be wondering if conceiving naturally is possible, if getting pregnant with endometriosis fast is something that can actually happen and, if not, how fertility treatment might happen – particularly during a global pandemic, when fertility services have suffered closures, cancellations and staff shortages.
Quick re-cap for the uninitiated: endometriosis is the name given to any tissue that is meant to line your uterus starts to grow in other places, such as ovaries or the fallopian tubes. This can cause cobweb-like adhesions that can, for example, block an egg from travelling down your tubes – hence fertility issues – as well as intense, debilitating pain.
There is not total scientific consensus about what causes it, but the dominant theory is that of 'retrograde menstruation.' This means the 'backward passage of menstrual blood through the fallopian tubes and into the pelvis,' explains Adam Balen, Professor of Reproductive Medicine and Surgery at Leeds Fertility and a leading expert on all things baby-making.
Getting pregnant naturally with endometriosis
When it comes to endo and conceiving naturally, your chances come down to a) how severe your case is and b) factors that aren't anything to do with the condition.
By the latter, we mean that, as with any woman trying to get pregnant, you'll find it easier if you're under 35. Why? Your fertility declines at this age, before a steeper second slide at 38.
Similarly, your significant other may have issues with his sperm (if that applies to your situation) and you want to be sure that you're maintaining a generally healthy lifestyle – minimal booze, not smoking, eating nutritious foods and clocking up regular sweat seshes.
How to get pregnant with endometriosis, fast
If you have endo and are trying to have a baby, it's advisable to seek pro help after six months of trying, as opposed to the year that is usually recommended, according to Professor Balen. If you're over 35, then even sooner than that is a good shout.
What are the chances of getting pregnant with endometriosis?
In terms of percentages, charity Endometriosis UK has crunched the data. It shows that:
If 100 women with minimal-mild endometriosis all start trying for a baby, at the end of one year, 75 will be pregnant.
If 100 women with moderate endometriosis all start trying for a baby, at the end of one year, 50 will be pregnant.
If 100 women with severe endometriosis all start trying for a baby, at the end of one year, 25 will be pregnant.
For context, if 100 women without endometriosis all start trying for a baby, at the end of one year, 84 will be pregnant.
What is the treatment for getting pregnant with endometriosis?
If you have moderate endo, it may be decided that some of the growth should be removed via a procedure known as a laparoscopy (keyhole surgery, in which a small telescope is used to peer at your internal tissue in your abdomen so that a surgeon can take any growth out).
Getting pregnant with endometriosis after laparoscopy
This is so that any growth that is preventing an egg from moving down your fallopian tubes is vanquished. 'This procedure can also be used to diagnose your endometriosis for certain. It's a pretty straightforward day case operation,' explains Professor Balen.
If your endo is more severe – and you have endometriotic cysts that have developed on your ovaries or blocked fallopian tubes thanks to the growth of the tissue that typically lines your uterus – then it may be decided that you should have surgery to have these removed.
This is in the hopes that so that it can get back to ovulating as normal and to increase your chances of conception.
Having IVF with endometriosis
And if it doesn't happen after this? Then it's time to bring out the big guns. 'If conception does not occur within six to 12 months after surgery, then you should be offered IVF,' says Professor Balen.
He also says that starting GnRH agonist therapy, in which you're given a course of hormones that help to control your menstrual cycle, is the best course of action at this point, before starting IVF six to eight weeks later.
Though, something important to bear in mind if your next step is seeking fertility treatment: clinics have been hit – hard – by the COVID-19 pandemic. Tests and treatments due to take place between March and May of 2020 were postponed as we entered a UK-wide lockdown (research suggests that 81.6% of patients had theirs delayed) and, whilst many clinics are now open and operating with a reduced number of patients, some have been forced to put all treatments on pause as staff are redeployed, furloughed or unwell.
Contact your clinic or GP for case-specific advice if you're concerned that the pandemic might affect your treatment.
Getting pregnant with endometriosis: what's on the NHS?
All of the above treatment is covered by the NHS, including IVF. The broad rule around the latter, as prescribed by The National Institute for Health and Care Excellence (NICE), is that women under 40 should be covered for three cycles of the treatment, with women age 40-42 offered one.
To note: this can vary according to where you live (that 'postcode lottery' you've read about over your Sunday poached eggs) and so it's worth working out what your specific location's rules are.
Are there any risks to pregnancy with endometriosis?
First off: it is totally possible to have a healthy pregnancy with endometriosis. However, you are at higher risk of dealing with extra complications.
Sadly, carrying a baby when you have endometriosis does put you at higher risk of miscarriage. A 2015 study on nearly 15,000 people in Scotland, found the disorder increased the risk by 76%.
Your chances of having an ectopic pregnancy, in which a baby starts to develop outside of your uterus and can't be carried to full term, rise to 1.6% from 0.6%, while you're 26% more likely to have a premature birth. You may well end up having a Cesarean, as the chance of needing one rises by 40%.
As such, you'll need extra careful monitoring throughout your pregnancy, so do expect more doctors appointments than most women have.
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