Endometriosis & Anti-Müllerian Hormone (AMH) – What you really need to know.

What is Endometriosis? 
Endometriosis (pronounced “en-duh-mee-tree-ow-suhs”), affects 1 in 9 women, most typically in those aged between 30 and 40 years. In the community and on social media it is frequently referred to as “Endo”. Endometriosis is a common women’s health problem and is more likely in women who have:

• never had children
• short menstrual cycles (27 days or fewer)
• menstrual periods that last greater than 7 days
• a family history of endometriosis
• a health issue that blocks the normal flow of menstrual blood

What causes Endometriosis? 
It occurs when tissue similar to that which lines the uterus (womb) grows outside the uterus into other body parts. It is most commonly found on the:

• Ovaries
• Fallopian tubes
• Tissues and ligaments that hold the uterus in place
• Outer surface of the uterus

It can grow in other sites, including the following:

• Vagina
• Cervix
• Vulva
• Bowel
• Bladder
• Rectum

 
What are Endometriosis symptoms and signs?
Pain is the most common symptom of endometriosis, which presents as severe menstrual cramps that get worse over time and long-term, cause pain in the pelvis and back. Endo can present as a deep pain during or after sex or pain when urinating during menstrual periods.

Regular bleeding or spotting between menstrual periods can indicate endometriosis and should be investigated. Stomach or digestive problems including diarrhea, constipation, bloating and nausea during menstrual periods are also symptoms of this disease but are frequently mistaken for other illnesses like irritable bowel syndrome.
 
Does endometriosis affect fertility?
Endometriosis can cause infertility, and research suggests it may affect as many as one in every two women with infertility¹.  The exact reason endometriosis causes infertility is unknown^2, but possible reasons are that the abnormal tissue:

• Blocks or distorts the shape of the pelvis and reproductive organs, making it difficult for sperm to reach the egg
• Causes inflammation of the pelvic structure
• Changes the hormonal environment of the eggs, which can alter egg quality and impair implantation
• Alters the immune system functioning, so it attacks the embryo

If you have endometriosis, it does not mean that you cannot get pregnant. However, you may need some assistance, so speak to your GP, a Genea Fertility GP or Fertility Specialist who can discuss the appropriate treatment that is right for you.
 
What is AMH?
Anti-Mullerian hormone (pronounced “an·ti-mul·le·ri·an hor·mone”), or AMH, is produced by ovarian follicles and used to measure the ovarian reserve (number) of eggs. AMH is produced by the follicles that contain developing eggs and as a result is reflective of the number of available eggs each month - and in turn the number of eggs remaining in the pool of eggs that the woman was born with. If there is a lower than usual number of remaining oocytes for a given age, the AMH result will in turn be lower. 
 
Why is measuring AMH important in women with Endometriosis?
AMH levels in women with endometriosis may be lower and decline quicker than in women without endometriosis, probably because the endometriosis tissue leads to cysts and scarring of the ovaries which in turn affects both egg quantity and quality.  Low levels of AMH and those that decline rapidly can lead to early menopause. If you have endometriosis, the sooner your doctor knows your AMH level, the earlier they can provide options for you to either preserve your eggs now for use later or for you to start a fertility plan with your doctor to increase your chances of falling pregnant³.

You can request an AMH blood test through your GP, Genea Fertility GP or Fertility Specialist to measure your ovarian reserve, which is an indicator of the quantity of your remaining eggs (oocytes) and your reproductive age compared to women of the same age. An AMH test will assist your doctor or Fertility Specialists in understanding the right treatment approach for you.
 
Talk to your GP or a Genea Fertility GP to discuss AMH testing today – call 1300 361 795 or visit Genea.com.au to book an appointment.
 
References:

1. Macer, M.L., Taylor, H.S. (2012). Endometriosis and Infertility: A review of the pathogenesis and treatment of endometriosis-associated infertility. Obstetrics and Gynaecology Clinics of North America; 39(4): 535–549.
2. NICHD. (2013). Endometriosis
3. Romanski, R.A., Brady, P.C, Farland, L.V., Thomas, A.M, Hornstein, M.D (2019). The effect of endometriosis on the anti-mullerian hormone level in the infertile population. Journal of Assisted Reproduction Genetics, 36(6): 1179-1184. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6603105/

Disclaimer: Please note that this is a Genea Group blog and as such information may not be relevant for all clinics. We advise that you consult clinics directly for further information. Please note that this is a Genea Group blog and as such information may not be relevant for all clinics. We advise that you consult clinics directly for further information.