Endometriosis Signs That Affect Fertility and Pregnancy

What is Endometriosis?

Endometriosis is a gynaecological condition in which tissue similar to the lining of the uterus (endometrium) grows outside the uterus. This tissue most commonly appears on the fallopian tubes, ovaries, ligaments supporting the uterus and the lining of the pelvis.

The tissue responds to monthly hormonal changes, which can cause inflammation, pain and the formation of scar tissue (adhesions). In some cases, it can form ovarian cysts called endometriomas. Endometriosis is estimated to affect 1 in 10 women of childbearing age.

Understanding endometriosis signs is helps in recognising the signs and symptoms that may impact fertility and pregnancy.

What Are The Common Signs of Endometriosis?

Endometriosis signs can vary from person to person. Some may experience severe symptoms, others mild and some may have almost none. The most common signs include:

• Painful periods: Period pain that is more intense than usual, often starting before bleeding and lasting several days.
• Chronic pelvic pain: Persistent ache or stabbing pain in the lower abdomen or back, which often worsens during your period or ovulation.
• Pain during or after sex: Deep pain with penetration, sometimes depending on position, which is a classic sign of endometriosis.
• Bowel or bladder symptoms: Pain during urination or bowel movements during your period, as well as bloating, diarrhoea or constipation with your menstrual cycle.
• Heavy or irregular bleeding: Excessive bleeding during periods, with clots or spotting between periods, though these symptoms can also have other causes.
• Fatigue: Pain, heavy bleeding and disrupted sleep can lead to tiredness and low energy.

Some people have few or no obvious symptoms and may only discover endometriosis during fertility investigations, so the absence of severe pain does not rule it out.

How Do Endometriosis Signs Show Up During Sex?

Pain during or after intercourse (dyspareunia) is a common symptom of endometriosis. This pain can occur when the ligaments at the back of the uterus, the ovaries or the pelvic floor are stretched or irritated during sex due to endometrial adhesions.

Can Endometriosis Change Your Periods?

Endometriosis can make periods more painful or irregular. The pain often worsens over time and feels different from typical menstrual discomfort, usually not responding well to standard pain relief.

Heavy or prolonged bleeding, clots and spotting between periods are also common and may contribute to fatigue or iron-deficiency anaemia.

How Can Endometriosis Affect Pregnancy?

Many women with endometriosis have normal pregnancies, though there may be a slightly increased risk of complications, such as preterm labour or placental problems, in more severe cases.

Symptoms can also change during pregnancy, with pelvic pain improving for some women and new discomforts appearing for others. It is important to inform your midwife or obstetrician if you have or suspect, endometriosis.

When Should You See a Doctor About Endometriosis Signs?

You do not need to wait until your symptoms are severe before seeking help. Research indicates a mildly increased risk of certain pregnancy complications in some people with endometriosis.

Consider speaking to your GP or gynaecologist if:

• Your periods are very painful or heavy and regularly disrupt daily life.
• You have chronic pelvic pain, painful sex or bowel/bladder symptoms that follow your cycle.
• You have been trying to conceive for over 12 months (or 6 months if you are over 35) without success and notice any endometriosis signs described here.

Tracking your symptoms; including timing, severity, period heaviness and duration of attempts to conceive, can make your doctor visits more productive and help plan appropriate investigations.

How is Endometriosis Diagnosed?

Diagnosis usually begins with a detailed medical history and a pelvic examination. Your doctor may then recommend an ultrasound scan to check for ovarian cysts or signs of deep endometriosis. In some cases, an MRI scan is used to provide additional detail.

The only way to confirm endometriosis definitively is through laparoscopy, a keyhole surgery that allows the surgeon to view the pelvis and, often, treat visible endometriosis at the same time.

What Treatments Can Support Fertility With Endometriosis?

If you are not planning to become pregnant, treatments such as the combined pill, progestogen-only methods or hormonal IUDs can help reduce pain and bleeding by suppressing your menstrual cycle. These methods are usually stopped when you are ready to try for pregnancy.

When trying to conceive, treatment options may include:

• Laparoscopic surgery: Endometriosis and adhesions can be surgically removed, which may reduce pain and improve chances of natural conception in women with mild to moderate disease.
• Assisted reproduction: Procedures such as IUI or IVF may be recommended if the disease is severe, ovarian reserve is reduced, the fallopian tubes are affected or other fertility issues are present.

A fertility specialist or gynaecologist can help you balance symptom management, preserve egg reserve and determine the most appropriate path to pregnancy based on your individual circumstances.

Takeaway

Endometriosis can affect daily life, fertility and pregnancy, but it does not define your reproductive journey. While symptoms like painful periods, pelvic pain or bowel and bladder discomfort can make conception more challenging, many people with endometriosis still conceive and have healthy pregnancies; naturally or with fertility support.

The most important step is to listen to your body and seek help early. Tracking your symptoms, understanding your fertility options and consulting a GP, gynaecologist or fertility specialist can give you clarity and control. With the right guidance and support, you can make informed decisions, manage symptoms effectively and confidently plan your path to parenthood.