Unveiling the impact of endometriosis and adenomyosis on women's fertility

Endometriosis and adenomyosis, two conditions affecting a woman's reproductive health, can significantly influence fertility. In her latest online article, Dr Anu Chawla explores their characteristics, symptoms, and potential treatments.

Understanding endometriosis and adenomyosis:

The inner lining of the uterus, called the endometrium, prepares itself monthly for a potential pregnancy. When pregnancy doesn't occur, this lining is shed through menstruation. Endometriosis and adenomyosis are conditions where the endometrial tissue grows in abnormal locations within the body.

Endometriosis: Endometriosis involves the endometrial tissue growing outside the uterus, sometimes affecting organs like the fallopian tubes, ovaries, or bladder. This misplaced tissue can lead to difficulties in getting pregnant.

Adenomyosis: Adenomyosis occurs when endometrial tissue infiltrates the uterine muscle wall, thickening it and distorting blood vessels. This condition often results in heavy and painful menstruation, pain during intercourse, and is linked to fertility issues. Unlike endometriosis, the endometrial tissue remains within the uterus.

How endometriosis can impact fertility:

While many women with endometriosis can conceive, approximately half of them may encounter fertility challenges. The exact mechanisms behind this phenomenon are not definitively understood but may involve the following factors:

Scarring: Endometriosis can lead to scarring in the pelvic region, obstructing the passage of eggs through the fallopian tubes.

Altered reproductive environment: Endometriosis and its associated scarring can disrupt the normal reproductive environment, making it harder for eggs and sperm to meet.

Immune response: Endometriosis might trigger an irregular immune response to embryos, generating chemicals that make the pelvic environment unfavourable for gametes and embryos.

Progesterone receptors: Faulty progesterone receptors, linked to endometriosis, could affect embryo implantation and early pregnancy.

Inadequate womb lining: Women with endometriosis may have an underdeveloped uterine lining, potentially hindering a successful pregnancy.

Is adenomyosis a variant of endometriosis?

No, endometriosis and adenomyosis are distinct disorders that may coexist in some cases. Though they share certain symptoms, they affect different parts of the body and may require different treatment approaches.

Symptoms of adenomyosis:

Adenomyosis is sometimes referred to as a 'silent' condition, as it can remain undiagnosed for an extended period. However, it may manifest with symptoms such as:

• Prolonged or heavy menstrual bleeding
• Severe menstrual cramps or sharp pelvic pain during menstruation
• Recurring pelvic pain
• Pain during sexual intercourse
• Pressure or sensitivity in the lower abdomen due to an enlarged uterus

The severity of adenomyosis:

While adenomyosis is not life-threatening, it can significantly impact a woman's quality of life due to pain, heavy bleeding, and potential complications.

Consequences of untreated adenomyosis:

Untreated adenomyosis is often progressive, meaning it can worsen over time, resulting in more severe and frequent pain.

Optimal treatments for adenomyosis:

The best approach to treating adenomyosis varies from one individual to another and depends on factors such as age, previous treatments, surgical preferences, and future fertility desires.

Treatment options include:

• Anti-inflammatory medications and painkillers
• Hormone therapies
• Non-hormonal medications to reduce menstrual bleeding
• Hysterectomy (consideration should be given to the impact on future fertility)
• Uterine artery embolisation to reduce blood supply to the adenomyosis

Impact of adenomyosis on fertility:

Evaluating the precise impact of adenomyosis on fertility can be challenging due to various factors:

Ongoing research: The relationship between adenomyosis and fertility is still under investigation.

Age: Many women with adenomyosis tend to be older, which can independently affect fertility.

Comorbid conditions: Women with adenomyosis often have other reproductive conditions, such as endometriosis, uterine fibroids, or polyps, which can also impact fertility.

Recent studies have indicated that adenomyosis negatively affects in-vitro fertilisation (IVF) outcomes, with lower rates of pregnancy, embryo implantation, continuing pregnancy, and higher miscarriage rates in affected individuals. Dr Anu Chawla, emphasises the potential for success in addressing the challenges presented by adenomyosis through careful investigation and precise treatment methods.

Dr Anu Chawla is a senior fertility specialist with over 15 years of experience. You can book an appointment with Dr Chawla on her Top Doctors profile.