Endometriosis

What Is Endometriosis?

Endometriosis is a common condition affecting an estimated 10% of women of childbearing age.¹ This condition occurs when tissue similar to endometrial tissue grows outside the uterus. Endometrial tissue can grow either on other tissue or organs in the pelvic area, including the outside of the uterus, the ovaries, bowels, or fallopian tubes.

The tissue acts as endometrial tissue does, thickening and shedding during the menstrual cycle. However, endometriosis tissue that lies outside the uterus is unable to shed through menstruation and instead grows within the body, causing irritation. Cysts, which are not cancerous, can also form in these areas, leading to scarring and other reproductive issues, including infertility.

Endometriosis & Fertility

Many women with endometriosis may also experience issues with infertility. When endometriosis tissue grows in the fallopian tubes, the resulting scarring and adhesions can block the egg and sperm from meeting for fertilization, which takes place in the fallopian tubes.

Endometriosis can also prevent a successfully fertilized embryo from traveling into the uterus where it would implant for a pregnancy. Additionally, hormonal imbalances from the condition can harm the quality and quantity of a woman’s eggs, impeding her fertility.

Once pregnant, patients with endometriosis also have a greater risk of miscarriage, as it can distort reproductive organs.

The Four Stages of Endometriosis

Endometriosis calls for medical care when a woman experiences infertility or the painful symptoms impacting her quality of life. It is generally classified into four stages that reflect the extent and location of the overgrowth of endometrial tissue:

• Minimal
• Mild
• Moderate
• Severe

Infertility occurs more often in severe stages. Depending on the severity of the disease, treatments can enable a woman to carry a child.

Endometriosis Symptoms & Causes

Up to 25% of women with endometriosis do not experience any symptoms and may only realize they have it after experiencing challenges becoming pregnant.²

Symptoms of endometriosis may include:

• Pelvic Pain: Women are likely to experience pain along the pelvis, abdomen, or lower back, especially during their period.
• Pain During Intercourse: Patients may experience similar pains as those above during or after sexual intercourse.
• Excessive Bleeding: Periods may be heavier than normal, and bleeding may even occur between regular menstrual cycles.
• Changes in Bowel Movements: Women may suffer from painful bowel movements during menstruation, constipation, diarrhea, or nausea.
• Heightened Fatigue: Patients with endometriosis experience uncommon levels of fatigue.
• Infertility: This condition is a leading cause of infertility, with 40% of women who have it experiencing some level of infertility.³

Women experiencing these symptoms should speak with their doctor or one of our fertility experts.

Causes

Fertility experts don’t know the exact cause of endometriosis, although it is suspected that retrograde menstruation may be the reason for some women. This is when, during a woman’s period, the uterine lining and blood shed through the vagina but also flow back through the fallopian tubes and into the pelvis.

Risk Factors

Some women are more at risk for endometriosis than others. These risk factors include having a family history of endometriosis, having other pelvic or reproductive system conditions, having periods that are too short or too long, and having periods beginning at an early age.

How Is Endometriosis Diagnosed?

We will seek to identify endometriosis if the patient is having any related symptoms, including difficulty conceiving. In making an endometriosis diagnosis, we will use one or a combination of the following tests:

• Pelvic exam to look for abnormal positioning of the uterus, and sometimes endometriosis lesions can be seen in the vagina or cervix.
• Transvaginal ultrasound to see inside the pelvic cavity to look for abnormal tissue growth.
• MRI to identify any endometriosis inside the muscle walls of the uterus, which would not be visible during laparoscopy.

Laparoscopy is the only examination that can definitively diagnose the disease. This minimally invasive surgery with small incisions and viewing equipment can allow the fertility surgeon to see endometriosis adhesions and scarring. A biopsy can be taken and evaluated for the disease.

Laparoscopy

How Is Endometriosis Treated?

While endometriosis has no current cure, our specialists do have treatments available to help with the symptoms, including infertility. Our providers thoroughly discuss all treatment options with the individual or couple and together agree on a course of action. Treatment for endometriosis is determined by taking into consideration the following:

• The severity of the condition
• The woman’s overall symptoms and their impact on her quality of life
• Other various risks to her health, including comorbid conditions like polycystic ovary syndrome (PCOS)

The next important step is assessing the woman’s pregnancy plans. This will dictate the treatment approach, both short- and long-term.

Medication

If you aren’t ready to get pregnant now but want to in the future, we may prescribe hormonal birth control. These medications can help offset any hormonal imbalances and slow the growth of endometriotic tissue. Hormonal birth control is a noninvasive way to reduce growth, pain, and other symptoms while considering more permanent options.

Fertility Surgery

If you’d like to be pregnant as soon as possible, our specialists may suggest a minimally invasive laparoscopic procedure as a first treatment. During the procedure, we will remove portions of the endometriotic tissue from around the uterus and ovaries. It can also restore pelvic anatomy and remove large cysts.

Fertility Surgery

IVF for Endometriosis

We may also suggest in vitro fertilization (IVF) to address infertility caused by endometriosis. IVF can raise a woman’s chances of a successful pregnancy by completing the fertilization process in the lab, and not in the woman’s potentially blocked or damaged reproductive tract due to endometriosis.

Through the process of hormonal injections, lab fertilization, and transferring the embryo directly to the uterus, IVF significantly increases odds of a woman with endometriosis getting pregnant.

For patients with endometriosis, IVF is one of the most effective treatments to have a baby. To learn more about fertility treatments at The Fertility Institute, we encourage you to schedule an appointment. Our specialists are here to help you achieve your family-growing goals.

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