Updated: Aug 8
Endometriosis can have a significant impact on fertility. While not all women with endometriosis experience infertility, the condition has been linked to a higher risk, with 30-50% of those with endometriosis experiencing difficulty conceiving.
It’s important to note that the severity of endometriosis does not always correlate directly with the degree of infertility. Some women with mild endometriosis may experience significant fertility challenges, while others with more severe forms may conceive without difficulty. The impact on fertility varies from person to person and depends on various factors, including the location and extent of endometrial implants, the presence of adhesions, and individual differences in reproductive health.
However, with appropriate support, many women with endometriosis can successfully conceive and have healthy pregnancies. It's crucial for individuals with endometriosis who are planning to conceive to consult with healthcare professionals specialising in reproductive health to explore their options and receive personalised guidance.
This article will help you to understand what endometriosis is, how it can impact fertility and what you can do to optimise your fertility with your medical care team and your naturopath.
First, let's dive in and get an understanding of what what is happening inside the body with endometriosis and how this can impact fertility. Endometriosis is a chronic and often painful condition where tissue similar to the endometrium (lining of the uterus) grows outside the uterus. This typically happens in the pelvic area, but it can also occur in other parts of the body. This misplaced tissue behaves similarly to the endometrium, thickening, breaking down, and bleeding with each menstrual cycle. However, unlike the endometrium, the blood from this tissue has no way to exit the body, leading to inflammation, scarring, and the formation of adhesions.
The most common symptom of endometriosis is pelvic pain, which may vary in intensity and can be experienced at any time during your menstrual cycle but is particularly common and more severe during your period. However, it’s important to note that not all people with endometriosis experience pelvic pain and may only experience other symptoms from the list below.
Other symptoms include:
Painful periods (dysmenorrhea): Severe menstrual cramps that may worsen over time.
Chronic pelvic pain: Persistent pain in the pelvic region, even outside of menstruation.
Pain during or after sexual intercourse (dyspareunia).
Painful bowel movements or urination, especially during menstruation.
Excessive bleeding during periods or irregular bleeding.
Infertility or difficulty conceiving.
Fatigue, bloating, and gastrointestinal disturbances.
Adhesions and scar tissue, which can lead to organ dysfunction or fusion of organs in severe cases.
It is important to note that the severity of symptoms does not always correlate with the extent or stage of the disease. Some women may have minimal symptoms despite having severe endometriosis, while others may experience debilitating pain with minimal disease.
Diagnosis of endometriosis typically involves a combination of medical history evaluation, physical examination, imaging tests (such as a specialised ultrasound or MRI), and, ultimately, laparoscopy, a surgical procedure to visualise and confirm the presence of endometriosis.
What causes endometriosis?
The exact cause of endometriosis is not fully understood, but several theories exist, including retrograde menstruation (where menstrual blood flows backward into the pelvic cavity), genetic factors, hormonal imbalances, gut microbiome imbalances, environmental toxin exposure and immune system dysregulation.
How endometriosis impacts fertility
Endometriosis impacts fertility via the following mechanisms.
Pelvic adhesions and scar tissue: Endometriosis can cause the formation of adhesions, which are bands of fibrous tissue that stick organs together. Adhesions can distort the pelvic anatomy, leading to blocked fallopian tubes or impaired movement of the ovaries, eggs, or sperm. This can hinder the ability of sperm to reach the egg or prevent the fertilised egg from traveling to the uterus for implantation.
Endometrial implants and ovarian cysts: Endometriosis involves the growth of endometrial tissue outside the uterus, such as on the ovaries, fallopian tubes, or other pelvic organs. These endometrial implants can lead to the formation of ovarian cysts known as endometriomas. These cysts can affect ovarian function and damage ovaries, diminishing egg reserve earlier than normal and impacting egg quality.
Hormonal imbalances: Endometriosis is associated with hormonal dysregulation, particularly elevated levels of oestrogen. Excessive oestrogen can decrease the chance of implanation of the embryo and worsen endometriosis growths as it essentially feeds the growth of the endometrial-like tissue.
Inflammation and immune system dysfunction: Endometriosis is characterised by chronic inflammation in the pelvic region. Inflammatory factors released by endometrial tissue implants can impair fertility by affecting the quality of eggs, sperm, and embryos, and by creating an unfavorable environment for implantation.
Medical interventions and surgical options
Laparoscopic surgery may be recommended either before fertility treatments or after, depending on the location and severity of endometriosis growth and adhesions. While surgery improves fertility, removal of ovarian endometriomas may damage the ovaries and egg reserve.
Recurrence of endometriosis after surgical removal is very common so it is recommended that you try to conceive right away after having it removed. If you aren’t ready to try to conceive, egg freezing may be recommended.
In vitro fertilization and endometriosis
In vitro fertilization (IVF) is needed if tubes are blocked, preventing sperm from reaching the egg but may be also be recommended for endometriosis-associated infertility without blocked tubes, depending on the situation.
Managing Endometriosis-Related Infertility with Your Naturopath as Part of Your Team
Accessing a number of professionals for your support team is ideal, where possible. This may include: a gyaecologist and/or fertility specialist, GP, fertility naturopath, acupuncturist, counsellor/psycholgist and pelvic physiotherapist.
Your naturopath needs to be adequately qualified and experienced and willing to work together and communicate with your other support team members. They will be able to confidently and safely work in and around any medical treaments you are receiving.
Endometriosis naturopathic treatment
Naturopathic treatments for endometriosis include dietary recommendations, herbal and nutritional supplements. These are prescribed in an individualised way after assessment by your fertility naturopath. Aims of treatment include:
Supporting the immune system
Identifying oestrogen excess and improving oestrogen clearance from the body
Reducing and protect against endocrine disrupting chemical exposure
Improving gut, vaginal and endometrial microbiome health
Providing nutrients and antioxidants to improve egg quality
Helping the endometrial enviroment become more favourable for implanation of an embryo
What you can start doing now to help with endometriosis
Dietary changes and supplements for endometriosis
Diet for endometriosis
Following the guidelines below will help to decrease inflammation and increase many helpful nutrients for endometriosis.
Aim for 5 serves of veggies per day where one serve is half a cup for most veggies and a full up for green leafy veggies.
Eat 2 pieces of fruit per day. Kiwi fruit and blueberries are top choices for their fibre and antioxidant content.
Increase fish intake, especially salmon, herring, sardines, anchovies, snapper, blue grenadier, whiting, leather jacket, halibut, cod, mullet, mackerel, ocean trout and pilchards.
Eat a handful of raw nuts and seeds daily
Alcohol consumption. Aim for no more than 4 standard drinks per week with no more than 2 standard drinks in one sitting.
Refined sugar and carbohydrates. This means going for wholegrains, legumes and colourful root veggies as your carbohydrates over white flour products, white rice and white potato.
Red meat. Some red meat can be helpful to support iron levels, but aim for 1-3 x 100g serves per week. Slow cooked meat dishes help boost iron levels more than fast cooked.
Fats from meat (some is ok, just not very fatty cuts), margarine, refined vegetable oils (except good quality extra virgin olive oil), processed foods and deep fried foods.
Whilst some people notice signficant benefits to symptoms from the above dietary changes, others may not. If needed, speak to your naturopath about what else can be done, particularly if you notice your gut reacts to certain foods.
You may have heard that you should eliminate gluten if you have endometriosis. Whilst it's true that this does benefit some people, make sure you have a coeliac test before stopping gluten so you know whether you need to avoid it strictly or not.
Lifestyle changes for endometriosis
Reduce endocrine disrupting chemicals
Many chemicals we come into contact with in our daily life act like oestrogen, adding to the body's overall oestrogen load. See our detailed article here for everything you need to know about reducing endocrine disrupting chemicals to benefit your endometeriosis.
Improve your oestrogen detoxification
One of the most important ways we eliminate oestrogen is through bowel motions and urine. Making sure you are drinking 1.5-2L of water per day supports urinary elimination of oestrogen. When it comes to endometriosis and bowel motions, we want to try to ensure a regular, daily motion that feels complete. If you are constipated try increasing your fibre intake along with your water and if that doesn't help, talk to your naturopath about other options for supporting your digestion and gut health.
In summary naturopathic treatment, including dietary adjustments, herbal and nutritional supplements, stress management, and lifestyle changes, can be valuable in managing endometriosis and supporting fertility. Addressing inflammation, hormonal imbalances, and endocrine-disrupting chemicals can create a more favorable environment for conception.
Remember that every individual's journey with endometriosis and fertility is unique, and personalised care is crucial. By working closely with qualified healthcare practitioners, individuals can explore a holistic approach to managing endometriosis, optimising fertility, and ultimately achieving their dreams.
Reach out to us if you need help by booking a free 10-minute discovery call.
The RH:RH Team are highly experienced, Reproductive Health and Fertility Naturopaths in Melbourne practicing online. We are available for consults Australia-wide.