- What is endometriosis? (jump to link) It is the growth of tissue from the endometrium (the lining of the uterus) outside of the uterus, occurring in about 1 in 10 reproductive age women.
- What causes endometriosis? The exact cause is not known, but it causes additional reproductive issues because the tissue reacts in the same way outside of the uterus as inside during the menstrual cycle by bleeding and growing new tissue, which results in swelling, inflammation and scarring in the area where the tissue attaches.
- Endometriosis and infertility are often linked, with about 40% of women with the condition experiencing infertility due to inflammation that disrupts egg and sperm movement necessary to achieve fertilization.
- Symptoms of endometriosis include chronic pelvic pain, particularly during or prior to a woman’s period, with pain also possible in areas where the tissue is growing outside of the uterus like the bowels and bladder.
- Diagnosing endometriosis can involve a pelvic exam that can indicate the disease, but this can only be confirmed with minimally invasive laparoscopic surgery.
- Endometriosis treatments: The condition can’t be cured but we can address symptoms with drugs, surgery or both together, though the extent of the disease and symptoms, as well as the woman’s desire to have children, influence the treatments we recommend.
What is endometriosis?
Endometriosis is a common condition affecting an estimated 10% of all women, according to the American Society for Reproductive Medicine, impacting women during their reproductive years.
This condition occurs when tissue similar to the tissue of the endometrium, which is the lining of the uterus, grows outside the uterus. This happens 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, which thickens and sheds during the menstrual cycle (a woman’s period). But endometriosis tissue outside the uterus can’t shed out of the body as with the tissue shed through menstruation during a normal period. So the endometriosis tissue stays and 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 and infertility (the inability to conceive)
- According to a study in the Journal of Assisted Reproduction and Genetics, infertile women are 6 to 8 times more likely to have this disease than fertile women.
- Scars or lesions from it can damage reproductive organs.
- When endometriosis tissue grows in the fallopian tubes, it can cause infertility because the resulting scarring or adhesions block the egg and sperm from meeting for fertilization, which takes place in the fallopian tubes.
- It can also prevent a successfully fertilized embryo from traveling into the uterus where it would implant for a pregnancy.
- Endometriosis can impair the embryo’s ability to implant.
- Hormonal imbalances from the disease can harm the quality and/or quantity of a woman’s eggs, impeding her fertility.
- Once pregnant, patients with endometriosis also have a greater risk of miscarriage. For example, it can distort reproductive organs or the shape of the pelvis.
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:
Infertility occurs more often in severe stages. Depending on the severity of the disease, treatments can enable a woman to carry a child.
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Fertility experts don’t know the exact cause of endometriosis, but they suspect retrograde menstruation may be the reason. This is when, during the woman’s period, the uterine lining and blood don’t just shed through the vagina but also flow back through the fallopian tubes and into the pelvis. This may cause endometriosis in some women.
Endometriosis risk factors
Some women are more at risk for the disease 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.
Up to 25% of women with endometriosis do not experience any symptoms, according to the Journal of Assisted Reproduction and Genetics. Women may only realize they have it after having challenges conceiving (infertility, which occurs in about 40% of women with endometriosis).
The most common symptom is pelvic pain that worsens near menstruation, but it can lead to other possible complications and symptoms.
Symptoms may include some or all of the following, which can be related to where the endometrial tissue adheres outside the uterus.
- Pain: Women are likely to experience pain along the pelvis, abdomen or lower back, especially during their period.
- Pain with sex: 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 in 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, according to the American College of Obstetricians and Gynecologists.
- Women experiencing these symptoms should speak with their doctor or one of our fertility experts.
We will seek to identify endometriosis if the patient is having any of the above 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.
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We cannot currently cure endometriosis, but we do have treatments 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.
Hormonal birth control to manage symptoms
If the woman isn’t ready to get pregnant now but wants to get pregnant in the future, we may prescribe hormonal birth control. These medications can help offset any hormonal imbalances and slow the growth of endometriotic tissue. They don’t fully correct the disorder, but are a noninvasive way to reduce growth, pain and other symptoms while considering more permanent options.
For women wishing to conceive as soon as possible, our doctor may first suggest less invasive laparoscopic surgery. This is to remove portions of the endometriotic tissue from around the uterus and ovaries. It is also done to restore pelvic anatomy and remove large cysts.
The reason why we may first recommend surgery is because it takes less time for the woman to begin attempting to conceive again than with medications.
We offer both minimally invasive and robotic surgery for endometriosis.
IVF for endometriosis
We may also suggest in vitro fertilization (IVF) to address infertility from the condition. 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 increased odds of a woman with endometriosis getting pregnant.
In fact, a study review in Obstetrics and Gynecology Clinics of North America found that, “IVF appears to be the most successful treatment option for patients with all stages of endometriosis.”