Endometriosis can be a hidden cause of infertility

Endometriosis occurs when endometrial tissue implants and grows outside the uterus (usually on the ovaries or pelvic cavity), where it can then continue to respond to a woman’s cyclic hormonal changes, causing bleeding and pain. This condition is quite common, but its true incidence is unknown because the best way to diagnose it is with surgery. Experts estimate that from 3-10% of all reproductive age women and 25-40% of all women with an infertility problem may have this issue.

Symptoms of endometriosis

• Painful periods (dysmenorrhea). Pain and cramping may begin before and extend several days into menses can can involve the lower back and extend into the legs and other body parts in severe cases.
• Chronic pelvic pain.  Adhesions and inflammation from endometriosis implants can cause generalized pain that lingers throughout the cycle.
• Pain with intercourse (dyspareunia). Pain during or after sex.
• Pain with bowel movements or urination. These symptoms are reported more often during menses.
• Infertility. Endometriosis may be discovered or suspected initially during an infertility workup.
• Other symptoms. Endometriosis symptoms are variable and may include fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

The most common symptom of endometriosis is pelvic pain with a monthly pattern. This pain may arise from cyclic bleeding into the surrounding tissues, which can result in inflammation and formation of scarring and adhesions. Pain however is not used to diagnose the condition because some women with extensive disease may have no pain, and women with ‘mild’ disease may have debilitating pain.  Many women with endometriosis describe menstrual cramping and pain with their periods that is more than average, and that worsens over time.

What causes it?

The exact cause of endometriosis is not known, but the most accepted explanation for why this occurs is retrograde menstruation.  It is thought that endometrial cells can pass through the fallopian tubes during menses and attach to the ovaries and pelvic wall and other abdominal structures.  The areas in which endometrial implants are most commonly found support this theory.  It is also thought that the pelvic tissues can contain cells that become endometrial cells, which could cause endometriosis.

What can be done to treat endometriosis?

Treatments for endometriosis depend on the severity of the disease and if pregnancy is desired or not.  Women seeking pregnancy usually manage their symptoms with medications while pursuing fertility treatment to achieve pregnancy as soon as possible.  For women who do not desire pregnancy, birth control pills and Depot Lupron can be used to decrease circulating estrogen levels, which leads to decreased endometrial growth and can slow or stop the progress of endometriosis.  Surgery or Laparoscopy additionally may done in either case to remove endometrial implants which, for many, results in decreased or relieved symptoms.

Endometriosis can be emotionally very difficult to deal with.  Symptoms do not always correlate with the severity of the disease which can be confusing.  Infertility adds another layer of emotional complexity that can become difficult to manage.  Ask your NFC physician or nurse about resources for emotional and educational support.