Endometriosis | Adenomyosis


The female uterus is made up of three layers:

  • Inside the organ lies the uterus lining (endometrium) which, in women of reproductive age, is eliminated from the body during menstruation.
  • The middle layer of the organ consists of muscle tissue (myometrium). This stretches during pregnancy, expanding as the unborn child grows then contracting after birth.
  • A layer of peritoneum (serosa) covers the uterus on the outside, towards the other organs of the body.

Endometriosis

Endometriosis is the spreading of the uterus lining outside the uterine cavity (for example, the abdominal cavity, the ovaries, on the fallopian tubes, on the bladder or the intestines). These foci of uterus lining undergo the same hormonal changes as the membrane of the uterine cavity itself.

The foci build up during the during the first half of the cycle and begin to bleed during menstruation. Unfortunately, there is no way out for blood in the abdomen. This leads to a chronic inflammatory reaction with subsequent scarring of the tissue. If endometriosis persists for many years, there can be scarring to internal organs, which in turn can lead to reduced fertility.

Endometriosis is often the cause of infertility and treatment is therefore supported by the Austrian IVF Fund.

The following symptoms can be an indication of endometriosis:

  • Severe menstrual pain
  • Pain in the abdomen a week before the onset of menstrual bleeding
  • Pain when urinating or with bowel movements
  • Pain during gynaecological exams
  • Bloating
  • Constipation or diarrhoea

If endometriosis is suspected, a gynaecological examination (ultrasound and palpation) is carried out, but definitive diagnosis can only be made via laparoscopy. The procedure can improve the likelihood of a natural pregnancy and drastically reduce symptoms such as period pain (dysmenorrhea). The surgeon’s experience is of great importance here, so that the treatment does not reduce egg reserves and the chance of pregnancy.

Facts about endometriosis:

  • It is estimated that 7 to 15 per cent of all women of childbearing age suffer from endometriosis, and for many the disease is the reason for infertility.
  • Although endometriosis is the second most common gynaecological disease, it is often not recognised.
  • On average, it takes six years from the time symptoms first appear to eventual diagnosis.
  • Women have a sevenfold increased risk of having endometriosis if a first-degree relative has the disease. If a family member has endometriosis, this information should be passed to your doctor.
  • Endometriosis is a chronic illness and can affect organs but is not cancerous.

Adenomyosis 

Adenomyosis is a benign change in the uterus in which cells from the uterine lining grow into the muscle wall. This can lead to heavy menstrual bleeding, pain, and in some cases, reduced fertility. The altered structure of the uterus can make it difficult for a fertilized egg to implant. The diagnosis is usually made by ultrasound or magnetic resonance imaging. Treatment options range from drug therapy to surgical procedures, depending on the symptoms and the desire to have children. An individual assessment is crucial to ensure the best chances of pregnancy. In general, adenomyosis poses a major challenge in fertility treatment.