Understanding Endometriosis

HOW DOES ENDOMETRIOSIS AFFECT FERTILITY?

Endometriosis can make it harder to conceive, but the link between infertility and endometriosis is not entirely clear. Some suggested ways that endometriosis can impact fertility include:

✓ Ovulation disorders and/or unbalanced hormones often seen with the disease

✓ Inflammation and scar tissue in the pelvis blocking the ovary from releasing the egg to the fallopian tubes

✓ Endometrial implants and scar tissue around the fallopian tubes blocking the egg from traveling to the uterus for fertilization

✓ Ovarian cysts filling with endometrial tissue (endometriomas, also known as chocolate cysts) and disrupting the hormonal cascade that leads to ovulation

✓ Impaired implantation

✓ Decreased egg or embryo quality

People with endometriosis are also 40% more likely to miscarry than those without the disease, and people with milder endometriosis are more likely to miscarry than those with advanced disease, possibly due to more pregnancies occurring in people with less severe endometriosis. 

WHAT CAUSES ENDOMETRIOSIS?

Medical experts do not know the exact cause of endometriosis, but there are several theories:

✓ Reverse menstruation, where endometrial tissue goes up into the reproductive organs and abdomen instead of exiting the body during menstruation

✓ Endometrial cells attach to abdominal walls after a surgery

✓ Endometrial tissue migrates to other parts of the body via the blood or lymphatic system

✓ Hormonal or ovulation disorders

✓ Genetics and familial factors

Because the cause is unknown, endometriosis is hard to prevent. People can find relief from endometriosis symptoms through treatment, and it is important to have follow-up visits in case of recurrence.

The chance of getting pregnant with endometriosis largely depends on which reproductive organs are affected, and pregnancy is typically still achievable. One large study found that more than 80% of people with endometriosis get pregnant, either naturally or through fertility treatment. 

WHAT ARE THE SYMPTOMS OF ENDOMETRIOSIS?

Endometriosis symptoms vary from person to person, and the stage of disease does not determine the severity of the symptoms. A person with mild endometriosis may have considerable pain while a person with advanced endometriosis may not have any symptoms. Common symptoms include:

✓ Painful menstrual cramps and periods
✓ Heavy periods and/or shorter menstrual cycles
✓ Pain during or after sex
✓ Painful bowel movements or urination
✓ Chronic pelvic pain
✓ Lower back pain
✓ Infertility
✓ Miscarriage(s)

About 25% of people with endometriosis have no symptoms. If a person has no symptoms but then struggles to get pregnant, they sometimes receive a diagnosis of “unexplained infertility” but can potentially have undiagnosed endometriosis.

HOW IS ENDOMETRIOSIS DIAGNOSED?

An endometriosis diagnosis requires multiple tests. Based on a person’s symptoms and medical history, a doctor may recommend one or more of the following diagnostic procedures:

✓ Pelvic exam: A doctor will feel for any tenderness and possible build-up of endometrial tissue

✓ Pelvic ultrasound: An ultrasound technician will look for any endometrial tissue or endometriomas of the ovary and take pictures for the doctor to analyze

✓ Laparoscopy: A doctor performs this outpatient surgical procedure wherein they can visualize and remove any endometrial tissue on the ovaries or fallopian tubes through small abdominal incisions. This is the gold standard for diagnosis of endometriosis and the only way endometriosis can truly be confirmed. 

Endometriosis has four disease stages ranging from minimal to severe. The amount of scar tissue and endometrial implants found during laparoscopy will determine the stage of the disease:

✓ Stage I (Minimal): Several small endometrial implants with no visible scar tissue

✓ Stage II (Mild): More endometrial implants than Stage I, but are not deep in the abdomen and there is no visible scar tissue

✓ Stage III (Moderate): Significant amount of endometriosis extending into the abdomen with possible cysts on the ovaries (endometriomas). Scar tissue may also be surrounding ovaries and fallopian tubes

✓ Stage IV (Severe): A very significant amount of endometriosis with large cysts likely to be on the ovaries. Scar tissue may be around the ovaries or fallopian tubes and also extending into other areas in the pelvis and abdominal cavity

Although endometriosis is a chronic disease without a current cure, it can still be managed at any stage. 

ARE THERE OTHER TREATMENTS FOR ENDOMETRIOSIS?

There are several ways to address the symptoms of endometriosis beyond restoring a person’s fertility, including:

✓ Laparoscopy: A doctor will perform this minor surgical procedure to remove any endometrial tissue on the ovaries and/or fallopian tubes. The procedure can sometimes help with the pain related to the disease and also is the only true diagnostic method for endometriosis.

✓ Oral medications: Health care providers will often prescribe hormonal therapies, typically birth control pills, to reduce estrogen production and prevent endometriosis from progressing. However, this line of treatment will prevent pregnancy.

✓ Pain medications: Over-the-counter, anti-inflammatory medications such as ibuprofen can help relieve pain. A doctor may also recommend prescription pain medications in some cases.