The Problem

1 in 10 women of childbearing age has endometriosis. Despite the fact that it is so common and causes 20-30% of infertility, it can take forever to be diagnosed. On average in the UK it takes 7.5 years to be diagnosed. If you have painful periods with big clots, then it’s worth investigating to find out if it could be endometriosis that’s stopping you from getting pregnant.

What Is Endometriosis?

Each month your endometrium or womb lining builds up to get ready for a possible pregnancy. If there is no pregnancy then the top layer of the womb lining is shed and you get your period.

Endometriosis is where cells from the endometrium travel outside the womb and implant usually in the pelvic cavity. Commonly they are found on the back of the womb, the womb ligaments, the ovaries, the fallopian tubes, the cervix, the bowel or the bladder. Occasionally they are found in other areas of the body, such as the lungs, nose or brain.

The problem with the endometrial cells is that they behave like they would if they were in the womb. They are affected by hormonal changes and they bleed during menstruation. There is nowhere for the blood to go and so it builds up, causes inflammation and scarring. If it is on the fallopian tubes the scarring can block the tube, cause permanent damage and stop the egg and sperm ever meeting.

Checklist Of Endometriosis Signs

• Severe period pain

• Heavy periods

• Large clots during period

• Bleeding between periods

• Irregular periods

• Bloating

• Nausea

• Chronic abdominal pain

• Chronic lower back pain

• Pain during sex

• Pain when passing a stool

• Pain urinating

• Bleeding from bowel

• Constipation

• Constantly tired

• Chronic fatigue

• Depression

• Migraines

• No symptoms

Diagnosis

The only reliable way to diagnose endometriosis is to have a laparoscopy. A laparoscopy is where a surgeon will look inside the pelvic area for endometrial tissue. The severity of endometriosis is gauged on a scale from 1-4.

Types Of Endometriosis

Endometrial tissue can look different and behave differently depending on where it is and how long it’s been there.

Small dark brown spots

During a period blood is lost from the endometrial tissue.
The blood gets trapped, dries and turns dark brown in colour.
This can cause pain.

Chocolate cysts

Endometrial tissue forms as a cyst inside the ovary.
The blood from the tissue is stuck inside the cyst.
The blood inside the cyst becomes dark brown and thick, like chocolate.

Light pink or white

Endometrial tissue that has recently formed outside the womb.
It is not brown yet because it hasn’t developed enough to bleed.
They are still detrimental to fertility because they secrete substances that inhibit conception.

Superficial endometriosis

On the surface of the membrane.
Worse for fertility.

Deep endometriosis

Penetrates a few millimetres into the membrane.
Worse for pain.

Endometriosis is not fully understood. Sometimes a woman can have very severe endometriosis without knowing. She can go through her life with no pain and no problems having children. It is only found when she has a hysterectomy. Other examples show women with very minor endometriosis that causes extreme pain and problems getting pregnant.

How Does Endometriosis Affect Fertility

• Endometriosis on fallopian tubes and ovaries can physically block conception.

• Endometriosis creates an inflammatory response in the body because endometrial cells are in the wrong place. This attracts more macrophages to the area to clear up the endometriosis. Macrophages are like the rubbish or garbage trucks of our body because they get rid of leftover material from cells, bacteria and foreign material. Macrophages also get rid of unwanted sperm that swim out of the tubes and into the pelvic area.

• The problem with endometriosis is that macrophages are more activated and actually go and seek out sperm in the fallopian tubes and get rid of them before they can meet the egg.

• Macrophages produce cytokines, which are chemicals that are toxic to sperm and embryos.

• Superficial endometriosis secret mucus, which can go on the ovary and stop the egg being transferred to the fallopian tube.

• Endometriosis increases prostaglandins (PGE2 and PGF), which damage the fallopian tubes.

• Endometriosis lowers progesterone in the luteal phase.

• Endometriosis can affect ovulation and create Luteinised Unruptured Follicle Syndrome (LUFS).

Surgery or Drugs

If you have a lot of old dark brown spots of endometriosis and no other factors stopping you from getting pregnant, then surgery can be a good option.

If you have lots of light pink or white smaller areas of endometriosis then they are difficult to find and will not all be removed. Surgery might not be very effective because they will continue to secrete mucus that stops conception.

There is a selection of drugs that aim to stop you from ovulating or put your body into temporary menopause to stop your menstrual cycle. Treatment is normally for between 3-9 months with the aim of starving and shrinking the endometriosis tissue. If you’re trying to get pregnant, then taking drugs to stop your menstrual cycle is not an option.

The problem with surgery or drugs is that the root of the endometriosis has not been addressed and it is likely to return. The best time to get pregnant is immediately after surgery or drug treatment before the endometriosis comes back.

Natural Ways To Reduce Endometriosis

Take control of your endometriosis and do everything you can to get to the root of the problem with natural ways of balancing your hormones, reducing inflammation and decreasing endometriosis.

1. Stop eating food that causes inflammation. Eliminate alcohol, sugar, caffeine, processed food, hydrogenated fats, carbohydrates, red meat and dairy.

2. Eat anti-inflammatory food. Eat organic vegetables, fruit and protein, especially leafy green vegetables, broccoli, beetroot, celery, blueberries, salmon, sardines, trout, anchovies, mackerel, bone broth, walnuts, flaxseeds, chia seeds, turmeric and coconut oil.

3. Stop excess oestrogen. Eliminate soy products because they are phytoestrogens, mimic oestrogen in the body and can make endometriosis worse. Eliminate plastics because they are xenoestrogens, mimic oestrogen and are toxic.

4. Reduce stress. Meditation, walking, yoga and tai chi are all excellent ways of reducing stress. Doing something creative, dancing or gardening might also work for you. Whatever it is find ways of relaxing and reducing stress to help balance your hormones.

5. Take supplements and Chinese herbs. See a nutritionist or herbalist to get the right supplements and herbs. Endometriosis manifests differently and so it’s important to get an individual prescription of supplements or herbs that work for you.

6. Acupuncture helps to balance hormones, reduce pain and elevate endometriosis symptoms. Evidence shows that acupuncture can help to reduce pain from endometriosis.

7. Abdominal massage. Research shows that abdominal massage can help to reduce the pain, stress and anxiety of endometriosis.

8. Castor oil packs. Castor oil has anti-inflammatory effects. Use castor oil and a hot water bottle on your belly to reduce pain and inflammation after your period and before ovulation.

9. Use sanitary towels. Stop using tampons because they could block the flow of menstrual blood and create retrograde menstruation where blood moves in the opposite direction and creates more endometriosis.

10. Don’t have sex during your period. Having sex during your period can cause blood to move in the wrong direction and create more endometriosis.