Endometriosis
Endometriosis is a chronic disease that affects women during reproductive age. More than five million women in the United States are diagnosed with this disease each year. Endometriosis causes tissue that is similar to the endometrial lining (the inside of your uterus) to build up outside of your uterus in places such as, your ovaries, fallopian tubes, uterine wall, and can burrow into numerous “nooks and crannies” in the pelvis. Just like your endometrium, this tissue can shed during menstruation. However, the blood has no way of exiting the body. As a result, this discarded blood and tissue remains in the body, causing pain, scar tissue, and organ adhesion. Although the symptoms of endometriosis can be extreme, many doctors overlook these signs as just a regular part of a woman’s menstrual cycle. In fact, studies have found that it can take as long as nine years before a woman is officially diagnosed with endometriosis. Many women are told that they have irritable bowel disease (IBS) because their bowel function is altered. Knowing just what to say to your doctor about your endometriosis can help speed up the diagnostic process.
Endometriosis and Infertility
Between 30 and 40 percent of infertile women have been diagnosed with endometriosis. Women complaining of pelvic pain, painful periods, and infertility may have a greater than 80 percent chance of having endometriosis, which can result in severe scarring of the reproductive and pelvic organs impeding their ability to function properly. Endometrial tissue can also cause pelvic adhesions, in which organs vital to reproduction stick together. The swelling and inflammation around these areas of disease also contributes to infertility since the fluids released are hostile to eggs and sperm. As a result of this, many women suffering from endometriosis often cannot become pregnant.
What Causes Endometriosis?
Unfortunately, the cause of endometriosis is not completely understood, though a number of possible reasons for the disease have been addressed. Possible causes of endometriosis include:
Genetics. Endometriosis appears to run in families, which suggests a genetic component to the disease.
Menstrual Fluid Backup Endometriosis may be the result of a backup of menstrual fluids. If menstrual fluids back up through the fallopian tubes, it is possible that the tissue can take root outside of the uterus. This backup (retrograde menstruation or Sampson’s Hypothesis) is undoubtedly a cause of some endometriosis. Birth control pills have been known to work in treating this type of endometriosis.
Problems with Lymph and Blood Systems Endometriosis may be caused by a problem with your lymph or blood systems. These systems are responsible for distributing endometrial tissues around the body. This may explain why doctors are occasionally surprised to see rare cases of endometriosis in the lungs!
Spontaneous conversion of pelvic lining cells This theory (called coelomic metaplasia) is gaining more traction in recent years. Stem cells within the tissues which coat the pelvic organs may develop a mind of their own and begin to behave like and convert to endometrial cell types. These cells may be particularly aggressive since they can make their own estrogen (that is, they can fuel themselves), and they may resist treatment with progesterone-like hormones. Surgery is typically used to treat this type of aggressive endometriosis.
Symptoms of Endometriosis
Severe pelvic pain is the most obvious symptom of endometriosis. In fact, if you have to miss one or two days of work or school per month (generally curled up in bed during your period), your risk of the disease may be greater than 70 percent. However, not all women with endometriosis suffer from these terrible cramps. Common symptoms of endometriosis include painful periods, pain during ovulation, deep, stabbing pain during intercourse, painful bowel movements, chronic constipation alternating with loose, frequent stools with your menstrual flow, painful urination, or heavy bleeding and/or bleeding between periods.
In order to avoid further damage to your reproductive organs, it is necessary to get treatment for your endometriosis as soon as possible. There is no cure for the condition, however, a number of excellent treatments are available to reduce your discomfort and preserve your fertility.
Medical Treatments
There are a variety of medications designed to help reduce the symptoms of endometriosis. Commonly-prescribed medications include pain killers, hormonal contraceptives, Gn-RH Agonists (synthetic forms of gonadatropin-releasing hormone that helps control estrogen production in the body), progestins and danazol (a testosterone-like steriod).
Surgical Treatments
Sometimes surgery is required to help reduce or eliminate symptoms of endometriosis. Usually, an operative laparoscopy is done to diagnose and treat the endometriosis. However, surgery may compromise future fertility if there are any complications. It is imperative that the surgeon who does your surgery be experienced with advanced endoscopic techniques!
Most gynecologists are happy to do laparoscopies, but ask if your surgeon has vast experience with aggressive “cyto-reducing” endometriosis lesions. In layman's terms: can they remove the vast majority of the disease the first time? Do they have the skill to remove the disease wherever it may be found while preserving fertility? If not, find another surgeon.
Unfortunately, some women have multiple procedures with little to show for it but pain, scar tissue, and grief. It is not uncommon for young women to show up in the Reproductive Endocrinologist’s (RE) office after half dozen or more surgeries! Rather than suffer this, ask your surgeon numerous questions before surgery. If possible, start with an RE or other experienced endometriosis surgeon first.
Learn More
Treating the Infertility
If you are suffering from endometriosis-related infertility, you will likely be placed on some type of suppressive medical therapy. This will help slow pelvic bleeding and preserve fertility. Once you are ready to start a family, intra-uterine insemination (IUI) or In-Vitro Fertilization (IVF) is often recommended in order to maximize the chance of pregnancy. IUI allows for a large number of sperm to reach their mark easily, while IVF may be suggested if a large amount of scar tissue is known to be present. Super ovulation (making extra eggs per month) is often recommended to increase the chance of an egg getting through the hostile endometriosis environment.
Between 30 and 40 percent of infertile women have been diagnosed with endometriosis. Women complaining of pelvic pain, painful periods, and infertility may have a greater than 80 percent chance of having endometriosis, which can result in severe scarring of the reproductive and pelvic organs impeding their ability to function properly. Endometrial tissue can also cause pelvic adhesions, in which organs vital to reproduction stick together. The swelling and inflammation around these areas of disease also contributes to infertility since the fluids released are hostile to eggs and sperm. As a result of this, many women suffering from endometriosis often cannot become pregnant.
What Causes Endometriosis?
Unfortunately, the cause of endometriosis is not completely understood, though a number of possible reasons for the disease have been addressed. Possible causes of endometriosis include:
Genetics. Endometriosis appears to run in families, which suggests a genetic component to the disease.
Menstrual Fluid Backup Endometriosis may be the result of a backup of menstrual fluids. If menstrual fluids back up through the fallopian tubes, it is possible that the tissue can take root outside of the uterus. This backup (retrograde menstruation or Sampson’s Hypothesis) is undoubtedly a cause of some endometriosis. Birth control pills have been known to work in treating this type of endometriosis.
Problems with Lymph and Blood Systems Endometriosis may be caused by a problem with your lymph or blood systems. These systems are responsible for distributing endometrial tissues around the body. This may explain why doctors are occasionally surprised to see rare cases of endometriosis in the lungs!
Spontaneous conversion of pelvic lining cells This theory (called coelomic metaplasia) is gaining more traction in recent years. Stem cells within the tissues which coat the pelvic organs may develop a mind of their own and begin to behave like and convert to endometrial cell types. These cells may be particularly aggressive since they can make their own estrogen (that is, they can fuel themselves), and they may resist treatment with progesterone-like hormones. Surgery is typically used to treat this type of aggressive endometriosis.
Symptoms of Endometriosis
Severe pelvic pain is the most obvious symptom of endometriosis. In fact, if you have to miss one or two days of work or school per month (generally curled up in bed during your period), your risk of the disease may be greater than 70 percent. However, not all women with endometriosis suffer from these terrible cramps. Common symptoms of endometriosis include painful periods, pain during ovulation, deep, stabbing pain during intercourse, painful bowel movements, chronic constipation alternating with loose, frequent stools with your menstrual flow, painful urination, or heavy bleeding and/or bleeding between periods.
In order to avoid further damage to your reproductive organs, it is necessary to get treatment for your endometriosis as soon as possible. There is no cure for the condition, however, a number of excellent treatments are available to reduce your discomfort and preserve your fertility.
Medical Treatments
There are a variety of medications designed to help reduce the symptoms of endometriosis. Commonly-prescribed medications include pain killers, hormonal contraceptives, Gn-RH Agonists (synthetic forms of gonadatropin-releasing hormone that helps control estrogen production in the body), progestins and danazol (a testosterone-like steriod).
Surgical Treatments
Sometimes surgery is required to help reduce or eliminate symptoms of endometriosis. Usually, an operative laparoscopy is done to diagnose and treat the endometriosis. However, surgery may compromise future fertility if there are any complications. It is imperative that the surgeon who does your surgery be experienced with advanced endoscopic techniques!
Most gynecologists are happy to do laparoscopies, but ask if your surgeon has vast experience with aggressive “cyto-reducing” endometriosis lesions. In layman's terms: can they remove the vast majority of the disease the first time? Do they have the skill to remove the disease wherever it may be found while preserving fertility? If not, find another surgeon.
Unfortunately, some women have multiple procedures with little to show for it but pain, scar tissue, and grief. It is not uncommon for young women to show up in the Reproductive Endocrinologist’s (RE) office after half dozen or more surgeries! Rather than suffer this, ask your surgeon numerous questions before surgery. If possible, start with an RE or other experienced endometriosis surgeon first.
Learn More
Treating the Infertility
If you are suffering from endometriosis-related infertility, you will likely be placed on some type of suppressive medical therapy. This will help slow pelvic bleeding and preserve fertility. Once you are ready to start a family, intra-uterine insemination (IUI) or In-Vitro Fertilization (IVF) is often recommended in order to maximize the chance of pregnancy. IUI allows for a large number of sperm to reach their mark easily, while IVF may be suggested if a large amount of scar tissue is known to be present. Super ovulation (making extra eggs per month) is often recommended to increase the chance of an egg getting through the hostile endometriosis environment.
