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‘It made my symptoms worse’- how opioids are putting women with endometriosis at risk
Despite being more likely to become chronic users, women with endometriosis are still frequently prescribed opioids
Carla Cressy was 14 when she began experiencing the first symptoms of endometriosis. Despite presenting with all the common signs of the disease, her diagnosis only came 11 years later.
“I was diagnosed with stage four endometriosis through a laparotomy, which by this time had led to frozen pelvis disease and infertility,” she explains.
“I had no other choice than to undergo a total hysterectomy forcing me into surgical menopause. This was following eight operations to try fix the irreversible damage caused by endometriosis.”
During this time and even before getting a formal diagnosis, Carla, like many women battling endometriosis, was prescribed opioids for pain relief.
“I was given bottles of morphine and told to take this amount and get on with it. I was suffering with horrible bowel symptoms and I was being given all these pain medications which only made my symptoms worse.”
Opioids, such as morphine, codeine and tramadol, work by activating an area of nerve cells in the brain and body called opioid receptors that block pain signals between the brain and the body. They are commonly prescribed to treat moderate to severe pain, including endometriosis pain.
In the US, nearly two-thirds of women newly diagnosed with endometriosis fill an opioid prescription within the first year.
But although they may be effective at temporarily reducing pain, there is no clear clinical evidence establishing opioids as an effective treatment option for endometriosis.
“Prescribing an opioid might be an easier option, but in the long term, it’s not helpful to the patient,” says Karolina Afors, a consultant gynaecologist at University College London Hospitals NHS Foundation Trust.
“Women with endometriosis have a four times greater risk of developing a chronic opioid use compared to women without the condition.
“Opioids are not what these young girls and women should be on in the long term, because it’s potentially putting them on a different path which they may not even be aware of.”
Carla, who knew little to nothing about opioids when she was given her first prescription, struggled with suicidal thoughts.
“Because I was on such a high dose and I was given all these tablets to get through my operations, I started feeling quite low,” she says.
“I was having suicidal thoughts and I realised that it was a side effect from the morphine. I was lucky I had my mum who supported me, but not everyone has that level of support.
“I think we need to make people aware of the risks and make sure they come for regular follow-ups. No one should be given these medications willy-nilly.”
Afors agrees. She thinks we should also address the lack of research and funding in endometriosis which, she says, is responsible for the disease being so poorly understood.
“We need need to find better treatment options. Yes, opioids have been around for a long time, and we understand how they can be used for pain management, but why don’t we try and find a cure for endometriosis or research new drugs?”
Venkatesh Subramanian, a consultant in obstetrics, gynaecology and reproductive medicine at King’s College Hospital, suggests a more holistic approach.
“Simply prescribing patients opioids and discharging them is not acceptable practice,” he says.
“I think we should focus on evidence-based treatments and have a more holistic view, adopting a multidisciplinary approach, getting pain management teams involved and liaising with dietitians when needed.
“There’s a huge lack of awareness and education around endometriosis so one of the things we should be doing, as clinicians, is counselling patients with regard to the different therapeutic options available.
“The aim should be to empower women to make informed decisions and become their own health advocates.”
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Housing, work and fertility pressures are stopping many Britons growing the families they want, new research suggests.
A UK fertility report found that 79 per cent of people surveyed who had tried to conceive in the past five years would like more children than they currently have.
Among parents with one child, that figure rises to 88 per cent.
The report surveyed more than 1,000 people across the UK who had tried for a baby in the past five years.
While birth rates continue to fall, the findings suggest it is not because people no longer want children. Instead, many respondents said external pressures are making it harder to grow their families.
The findings, from wellness brand Wild Nutrition’s Fertility Disconnect report, highlight how financial pressures, fertility struggles and gaps in reproductive health knowledge are shaping modern family life in the UK.
Gail Madalena, fertility nutritional therapist at Wild Nutrition, said: “People often assume fertility begins the moment they decide to try [for a baby].
“In reality, egg and sperm health are shaped months and years earlier.
“By the time someone starts thinking about fertility, their body has already been responding to its environment for a long time.”
Among the biggest barriers, 26 per cent said career progression affected their family plans, 25 per cent cited housing affordability and lack of space, and 52 per cent said they required medical intervention during their fertility journey.
The report also found that almost a quarter of respondents had spent more than two years trying to conceive.
Trying for a baby can take a significant toll on mental health and relationships, especially for those navigating fertility treatment.
According to the research, 38 per cent of respondents said trying to conceive had negatively affected their mental health. That figure rose to 99 per cent among people undergoing fertility treatment.
Julianne Boutaleb is a perinatal psychologist.
She said: “Navigating a fertility journey is about so much more than medical appointments and procedures.
“It’s an emotional marathon that can take a huge toll on your mental wellbeing.
“Sadly, the stats show that 15 per cent of couples going through fertility treatment say their relationship has been irrevocably impaired.”
The report also highlighted the realities of secondary infertility, which affects around one in 20 people, challenging the assumption that having one child means conceiving again will be straightforward.
Researchers found many people felt under-informed about fertility, particularly younger adults.
Ten per cent of Gen Z respondents said they “know nothing” about fertility, while only one in five respondents said they know “a lot” about egg health.
The report also found that 60 per cent of women were unaware of fertility testing options, and one in five Gen Z respondents said they felt uncomfortable discussing fertility, even with their partner.
Around 40 per cent of those surveyed supported fertility education being included in schools, covering topics such as egg health, sperm health and hormonal health.
The report also explored how lifestyle and long-term health may influence fertility outcomes.
Many respondents said they only made changes once they started trying to conceive.
Some 44 per cent improved their diet when trying for a baby, while 32 per cent reduced alcohol intake at that stage.
The report also referenced emerging research that suggests ultra-processed foods and microplastics could have an impact on reproductive health.
While fertility conversations often focus on women, the findings showed male fertility issues are also affecting many families.
Seventeen per cent of respondents cited sperm health issues as a barrier to conception, while male factors contribute to around half of all fertility challenges.
Only one in four men said they would share fertility struggles with friends.
“Many causes of male infertility are entirely treatable yet so often the last resort is the first response,” said Ian Stones, co-founder at Test Him Ltd.
The findings come as UK birth rates remain below replacement level.
The report noted that the UK fertility rate is now 1.41, meaning that on average women give birth to 1.41 children over their lifetimes. The replacement rate, or rate that maintains population numbers, is 2.1.
It also said the average age of mothers has risen to 31, while birth rates are falling across most age groups except among over-40s.
“There is no single fertility story, and it is rarely a simple, linear narrative,” said Dr Zeynep Gurtin, lecturer in women’s health at UCL.
Dr Gurtin added that better fertility education, fairer access to treatment and more open conversations around infertility and pregnancy loss are needed.
Femtech World is thrilled to reveal the shortlist for the Fertility Innovation Award.
The award, sponsored by FinDBest IVF, celebrates a pioneering product, service or initiative that is transforming fertility care and support.
FinDBest IVF is a global B2B digital platform created to simplify and accelerate how IVF and ART manufacturers connect with trusted, pre-vetted distributors around the world.
This year’s nominees represent a remarkable breadth of approaches to fertility care: from clinic-floor breakthroughs to at-home hormone intelligence to truly borderless access.
Three companies made the cut, with each tackling a real, persistent barrier in reproductive health.
Congratulations to the shortlist and many thanks to everyone who entered.
Fertility Innovation Award Shortlist
HRC Fertility’s Needle-Free IVF is a pioneering advancement designed to transform one of the most challenging aspects of fertility treatment: daily hormone injections.
Developed by board-certified reproductive endocrinologist Dr Rachel Mandelbaum, this innovative approach reimagines how stimulation medications are delivered during IVF and egg freezing, dramatically improving the patient experience while maintaining the same trusted clinical outcomes.
Inspired by feedback from patients who struggled with the injection process, Dr Mandelbaum adapted an innovative drug-delivery system commonly used in other areas of medicine and applied it to reproductive care
Mira is a hormonal health technology company that provides lab-grade hormone testing and AI-driven insights to help women and couples understand their fertility.
The platform has already supported more than 200,000 couples on their fertility journeys worldwide, helping over 60,000+ users achieve pregnancy.
For some users, pregnancy rates have reached up to 89 per cent within six months, demonstrating how accurate hormone data can significantly improve fertility outcomes.
Founded in 2021 by Marija Skujina, a Certified Fertility Nurse Specialist accredited by the European Society of Human Reproduction and Embryology, with nearly 15 years of clinical experience at one of the world’s top IVF clinics, and having navigated her own fertility journey as a patient, Marija built the clinic she had always wished existed.
Plan Your Baby began with a bold, but simple mission – make best quality fertility and pregnancy available anywhere.
Plan Your Baby has created a new generation fertility and pregnancy clinic with patients accessing expert consultations remotely, while blood tests and ultrasound scans are available at over 450 locations across the UK, eliminating the exhausting travel burden that often forces people to take days off work, relocate appointments, or abandon treatment altogether
What happens now
The shortlist will be judged by a representative from category sponsor FindBestIVF, with the winner announced at a virtual event on June 19.
Winners will receive a trophy and be interviewed by a Femtech World journalist.
A common cholesterol drug could help weaken a fluid shield that helps ovarian cancer tumours survive, early lab findings suggest.
The findings do not show the drug treats ovarian cancer. But they suggest changing the environment the cancer depends on could make it more vulnerable to existing treatment.
A federally funded study at Duke University School of Medicine found that ascites, a build-up of fluid in the abdomen, may do more than cause discomfort.
Doctors can drain ascites to ease pain, improve mobility and make breathing easier, but the fluid may also help cancer cells survive and spread. It occurs in 90 per cent of people with advanced ovarian cancer.
According to the study, ascites acts as a shield, helping cancer cells evade ferroptosis, a form of cell death.
Ferroptosis is a kind of cellular rusting. It happens when iron inside a cell reacts with certain fats, causing the cell membrane to break apart.
Many metastatic cancer cells, meaning cells that float freely through the abdomen looking for new places to grow, are naturally vulnerable to this kind of damage.
“Doctors have mostly viewed ascites as a symptom rather than an active driver of disease,” said Jen-Tsan Chi, professor in the department of molecular genetics and microbiology and co-leader of the Cancer Biology Program at the Duke Cancer Institute.
“We’ve learned it gives cancer a survival advantage, which fills a major gap in understanding how ovarian cancer spreads.”
Scientists bathed cancer cell lines and patient-derived tumour cells in ascites collected from patients and watched how they responded to ferroptosis triggers.
The fluid protected cancer cells by changing how they store fats and control iron levels, effectively blocking cell death.
The protection required only trace amounts, with as little as 2 per cent immersion shielding cancer cells from destruction.
“What surprised us was how selective this effect was,” said Yasaman Setayeshpour, first author and graduate student in molecular genetics and microbiology at Duke School of Medicine.
“Ascites didn’t protect the cancer cells from other well-known types of cell death, like apoptosis or necrosis, it only blocked ferroptosis.
“To figure out why, we broke ascites down into major parts, like lipids, proteins, and small molecules, and tested what happened when each was removed.
“When we took the lipids out, the protective effect disappeared. That told us lipids are the key reason ascites helps these cancer cells survive.”
But researchers found an unexpected helper in bezafibrate, an older cholesterol drug used to lower triglycerides by altering how the body processes fats.
The cholesterol drug restored sensitivity to ferroptosis, but only when ascites was present. On its own, the drug did not trigger cell death or slow tumour growth in mice.
The drug’s impact depended on the cancer’s surroundings, in this case the fat-rich fluid bathing the tumour. Researchers found that targeting this environment, using repurposed drugs like bezafibrate, could leave cancer cells more exposed to existing cancer treatments.
Chi said the finding could have implications beyond ovarian cancer. Other cancers, including colorectal and pancreatic cancers, can also spread within the abdominal cavity.
“This work shows how much the environment around a tumour matters,” Chi said.
“Biological fluids like ascites don’t just give cancer cells a place to move. They actively help drive how cancer spreads.”
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