Silent or Asymptomatic Endometriosis

Endometriosis commonly causes pain and infertility, however 20 to 25% of women have no symptoms at all.¹ Additionally, if endometriosis is diagnosed via laparoscopy, the symptoms do not always correlate to its appearance.¹ This means that someone can have minimal amounts of endometriosis, but can experience severe pain and vice versa.

How can endometriosis be silent?

How can a chronic inflammatory disease that usually presents with severe pain, bloating, constipation, and/or diarrhea and heavy bleeding have no symptoms? There is no definitive answer, but as noted above, nearly a quarter of women with endometriosis have no symptoms.

Often in cases of silent endometriosis, in the women who are affected it goes undetected for years, until she tries to become pregnant for some time and her doctor can’t work out why she isn’t able to.

Endometriosis and infertility

About 25 to 50% of women with infertility have endometriosis. There can be a number of reasons why endometriosis can cause infertility:

• Changes in anatomy of the pelvis
• Inflammation and altered immune system functioning
• Impaired implantation of pregnancy
• Reduced egg quality which can be due to a chocolate cyst (also called an endometrioma) on an ovary
• Low ovarian reserve which means there is a lowered quality and quantity of eggs

Usually, the more extensive the disease the more difficult it can be to become pregnant. This is because severe or stage 4 endometriosis causes extensive scarring, it can damage ovaries, block the fallopian tubes and often needs advanced fertility treatment. You can read more about the stages of endometriosis in this article.

Treatment options

Laparoscopy is the gold standard of treatment for endometriosis. In fact, studies have shown that endometriosis removal has shown to improve fertility. But it is important that excision surgery is performed rather than ablation surgery, because there is a greater risk of the disease growing again.¹

Other diagnosis methods

Often endometriosis is missed being diagnosed, because the only real way to detect it is through laparoscopy.  There are some other ways that can detect the presence of endometriosis:

• Anti-Mullerian Hormone or AMH, is an indication of ovarian reserve and may be low in cases of endometriosis.²
• High levels of Follicle-Stimulating Hormone or FSH may also be another marker indicative of endometriosis.²
• Inflammatory markers such as cytokines may be elevated.³
• An internal ultrasound by a trained specialist can detect endometriosis, but it is not completely accurate.⁴

Summary

If you are struggling to get pregnant and can’t seem to find the cause, it is worth talking to your gynecologist about the possibility of endometriosis. While tests can be indicative, laparoscopy is the only way to confirm the diagnosis and is considered the best form of treatment for endometriosis, especially if you are wanting to get pregnant.