How Endometriosis Affects Fertility And Women’s Reproductive Health, Gynaecologist Explains

Endometriosis, often called a “hidden epidemic,” is a chronic reproductive health condition where tissue similar to the lining of the uterus grows outside the uterine cavity. These misplaced tissues can develop on the ovaries, fallopian tubes, pelvic cavity, bowel, or other areas, leading to pain, inflammation, and complications. In India, many women suffer silently because symptoms are mistaken for regular menstrual discomfort or are dismissed altogether. To understand how this condition affects fertility and reproductive health, we spoke to Dr Supriya Puranik, Director – OBGY and IVF at Momstory, Sahyadri Hospitals, Pune.

What Is Endometriosis?

Endometriosis involves endometrium‑like tissue growing outside the uterus, responding to hormonal changes of the menstrual cycle just like normal uterine lining. This misplaced tissue bleeds and sheds with each cycle, causing inflammation, scarring (adhesions), and sometimes painful cysts called endometriomas. These changes can affect surrounding organs and disrupt normal reproductive anatomy. “Endometriosis, a condition that has been termed a ‘hidden epidemic,’ refers to the development of uterine tissue outside the uterus,” says Dr Supriya Puranik.

Common Symptoms of Endometriosis

Symptoms vary widely but often include painful menstruation (dysmenorrhea), chronic pelvic pain, pain during intercourse (dyspareunia), and bowel symptoms like painful movements or bloating. Because these symptoms overlap with other conditions, diagnosis is frequently delayed. “In other cases, women may experience bowel symptoms, especially if the bowel has been affected. These symptoms include painful bowel movements, bloating, bowel habit changes, and the presence of nodules in the bowel,” explains Dr Supriya Puranik.

How Endometriosis Affects Fertility?

Endometriosis can influence fertility in several ways: it can create scar tissue and adhesions that distort pelvic anatomy, block fallopian tubes, egg quality, implantation problems, and hinder the egg’s journey to meet sperm. Inflammation may lead to a hostile pelvic environment, affecting sperm function, egg quality, and implantation.

Dr Supriya Puranik explains “Inflammation, scarring, and cysts can interfere with the natural process of conception — not every woman with endometriosis will have infertility, but the risk increases with disease severity.” In India and worldwide, an estimated 30‑50% of women with endometriosis experience difficulty conceiving.

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Endometriosis Diagnosis: Why Early Detection Matters

Early diagnosis improves outcomes. Typical diagnostic tools include pelvic ultrasound and, in many cases, laparoscopy - a minimally invasive surgical procedure. Because symptoms are often dismissed or attributed to other causes, women may go years before getting a correct diagnosis. “It is imperative to diagnose endometriosis at an early stage to ensure the health and quality of life. Symptoms such as severe pain during menses, pain during intercourse, or pain during bowel movements should never be ignored,” says Dr Supriya Puranik.

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Endometriosis Treatment And Fertility Options

There’s no cure for endometriosis, but treatment focuses on symptom control and fertility preservation. Approaches include hormonal therapies to reduce disease activity, minimally invasive surgery to remove lesions, and fertility treatments like in vitro fertilisation (IVF) when natural conception is difficult. “The management of endometriosis is highly individualized and may involve medical management, especially for pain, hormonal treatments to stop the progression of the disease, minimally invasive surgery to remove endometrial lesions, and IVF, if need be,” notes Dr Supriya Puranik.

Lifestyle support, pain management, and emotional care are also key components of holistic management.

If you experience significant menstrual pain, pelvic discomfort, or fertility challenges, don’t ignore these signs, consult a specialist soon.

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Image credit: Freepik