Endometriosis can often be a very misunderstood and wildly misdiagnosed medical condition. Roughly, 1 in 10 girls and women in America and over 176 million worldwide are affected by endometriosis. Endometriosis is a disease where tissue, similar to the tissue that lines the uterus, can be found throughout the pelvis. Endometriosis is often seen as a reproductive disease and while endometriosis can impact the ovaries, uterus and fallopian tubes, it can also be found on the bowels, bladder, appendix as well as other organs. In rare cases, disease can be found in distal sites such as the lungs.
About 40% of patients with Endometriosis will experience some varying degree of infertility. Endometriosis can result in the formation of scar tissue and adhesions throughout the pelvis. Adhesion related anatomic distortions of the fallopian tubes or ovaries can interfere with the mechanics of fertilization and implantation. Scar tissue and adhesions in and around the fallopian tubes can put Endometriosis patients at a greater risk for ectopic pregnancies, which occurs when the fertilized egg gets caught in the tube and does not implant in the uterus. Theories have also suggested that Endometriosis related inflammation produces chemicals that also may interfere with egg quality, implantation and fertilization.
Some researchers believe that Endometriosis can cause a Luteal Phase Defect, which results from low levels of the hormone progesterone or a poor build-up of the uterine lining after ovulation.
Are there any symptoms?
Yes. Patients with Endometriosis often, but not always, may have one or more of the following symptoms:
- Painful cramps during menstruation (dysmenorrhea)
- Pain during intercourse (dyspareunia)
- Pain with ovulation
- Urinary symptoms, such as frequent urination, especially around the time of menses
- Bowel symptoms, such as pain with bowel movements, constipation or diarrhea, especially round the time of menses.
- Lower back pain or leg pain, especially around the time of menses.
Endometriosis can only be diagnosed through laparoscopy and confirmation of the disease can be achieved through pathological biopsy. While endometriomas and nodules may be been visualized on ultrasounds and MRI’s, the majority of Endometriosis and related adhesions can evade ultrasounds, MRI’s, CAT scans and other testing, such as colonoscopies.
Early diagnosis and treatment of the disease can be beneficial to patients who are concerned about their fertility. Patients who are experiencing Endometriosis symptoms may want to seek out a fertility specialist who will be able to assess fertility based on blood tests, as well as imaging tests, like hysterosalpingograms.
Results of this testing can help guide next steps for patients. Endometriosis patients, whose quality of life is significantly impacted by invasive symptoms, involving multiple systems in the body, may benefit from seeing a specialist who can surgically excise disease from all implicated areas in the pelvis, while also helping to restore reproductive anatomy and reducing inflammatory agents that may be interfering with fertilization and implantation.
Patients may also benefit from fertility treatments such as IVF, which can also help to improve rates of fertilization and implantation. Medical therapies for this disease, such as birth control or GnRH agonists and antagonists, are seen as palliative treatments and while they may mask symptoms for some patients, they are not curative interventions and patients cannot get pregnant while using these medications.
Patients who have been surgically diagnosed with severe Endometriosis and are not ready to start their family building journey may want to consider freezing their eggs for future use as a way to possibly preserve fertility. Endometriosis can be a difficult disease to treat. Patients may also want to consider a multi-disciplinary approach to tackle the disease that can include pelvic floor therapists, acupuncturists as well mental health providers in conjunction with care from a specialist.
Do I have Endometriosis?
Start by asking yourself these questions:
- Do I have painful periods?
- Do I have back pain or pelvic pain during my period that is only relieved by non-steroidal anti-inflammatories/NSAIDS like Motrin, Advil, etc., and not by aspirin alone?
- Is intercourse painful in certain positions or with deep penetration?
- Does anyone in my family have a history of Endometriosis or painful periods, i.e., mother, grandmother, aunts or sisters?
- Am I experiencing any bowel or bladder symptoms (constipation, diarrhea or frequent urination) around the time of ovulation or just before I start my period?