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Women with worse endometriosis pain have more fertility problems

July 17, 2017  23:31

Period pain isn’t always normal – excruciating pain can be a sign of endometriosis. Now it seems that the severity of pain is a sign of how extensive the condition is, with very bad pain linked with fertility problems.

Although around 10 per cent of women have endometriosis, little is known about the condition. It involves uterus cells turning up elsewhere in the body, where they bleed every month, which appears to cause scar tissue and pain. These out-of-place cells are usually found on the ovaries or fallopian tubes, but they have also been found on the intestines and even on the lungs and the brain.

Over time, endometriosis might lead to fertility problems; around a third of women with the condition may be infertile. And while some people experience only a little pain, for others it can be much worse.

No one knows why the symptoms of endometriosis can vary so much between women, says Mathilde Bourdon at Descartes University, Paris. “Some women have little or no symptoms, while others have major impairments to their quality of life,” she says.

Severe pain

To find out if the severity of endometriosis pain might be linked to how many uterus cells have spread, where they have spread to, and the damage they have caused, Bourdon and her colleagues spoke to women who had been treated for the condition between 2004 and 2017.

The team identified 422 women who had been unable to conceive naturally after a year. When they were asked to score their endometriosis pain on a scale of 1-10, 289 of them rated it as a seven or higher.

By looking at surgical reports, Bourdon’s team found that those who reported worse pain had more extensive disease – the patches of endometriosis were deeper in the body, and more likely to be found on the intestines. Those who rated their pain as six or lower were less likely to have deep lesions and less likely to have endometriosis on their intestines.

Women who reported being in more pain also took significantly longer to get pregnant, and ended up needing more surgery and more fertility treatments before doing so. Bourdon presented her findings at the annual meeting of the European Society of Human Reproduction and Embryology in Geneva, Switzerland, this month.

Delayed diagnoses

Andrew Horne, at the University of Edinburgh, UK, hopes these findings will raise awareness of endometriosis among doctors. It currently takes between seven and 11 years for a woman with endometriosis to receive a diagnosis.

But the issue of pain in endometriosis is far from settled, says Horne. “We still don’t fully understand why women with endometriosis experience pain.”

Bourdan thinks it is vital that doctors pay close attention when a woman says she has pelvic pain. “Women with endometriosis require specific care, preferably in a specialist centre,” she says.

But women’s pelvic pain is often seen by doctors as a normal experience, says Federica Facchin at the Catholic University of Milan in Italy, who is studying the effects of endometriosis on mental health. This can be why it takes so long to get diagnosed with endometriosis, she says.

Horne advises women to seek specialist treatment for endometriosis. “If you’re not getting it, persevere,” he says.

NEWS.am Medicine

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