According to ESHRE, it is estimated that between 2 and 10% of the women within the general population have endometriosis and that up to 50% of the infertile women have endometriosis.Women with endometriosis often have severe complaints and significantly reduced quality of life, including restraint of normal activities, pain/discomfort and anxiety/depression. We spoke with Dr Elias Tsakos from EmbryoClinic to learn the recent guidelines issued by ESHRE for the treatment of endometriosis.

What is endometriosis

Endometriosis is defined as the presence of endometrial-like tissue outside the uterus (Kennedy et al., 2005). Endometriosis triggers a chronic inflammatory reaction resulting in pain and adhesions. Dr Elias Tsakos FRCOG, is a British trained and certified fertility specialist with 20 years experience at EmbryoClinic explained that for some women, symptoms may be worse at certain times in the cycle, particularly just prior to and during the woman’s menstrual period. Some other women experience severe pain, others have no symptoms at all or believe their symptoms are ‘ordinary menstrual pain’.

What are the symptoms of endometriosis?

- Dysmenorrhea or painful menstruation
- Nonmenstrual pelvic pain or pain occurring when a woman is not menstruating
- Dyspareunia or painful intercourse
- Infertility
- Fatigue
- Periodic bloating, diarrhoea or constipation
- Painful urination or defecation
- Rectal bleeding
- Shoulder pain
- Any other cyclical symptom

Classification of endometriosis

- Stages 1 & 2 (minimal to mild disease): Superficial peritoneal endometriosis. Possible presence of small deep lesions. No endometrioma. Mild filmy adhesions, if present.

- Stages 3 and 4 (moderate to severe disease): The presence of superficial peritoneal endometriosis, deeply invasive endometriosis with moderate to extensive adhesions between the uterus and bowels and/or endometrioma cysts with moderate to extensive adhesions involving the ovaries and tubes.

How is endometriosis diagnosed?

A definite diagnosis of endometriosis is considered when the doctor has seen endometriosis during laparoscopy and this is confirmed by taking biopsies for histology. At EmbryoClinic we can perform laparoscopy to identify endometriosis but also to remove it.

Does endometriosis affect fertility?

It is estimated that 60-70% of women with endometriosis are fertile and can get pregnant spontaneously and have children. Of the women with fertility problems, a proportion will get pregnant, but only after medical assistance, either surgery or medically assisted reproduction (IUI or IVF). There is no evidence that hormonal treatment or alternative treatment enhances the chance of spontaneous pregnancy in women with endometriosis. If you think you may have endometriosis and want to speak with a specialist doctor, get in touch.