Have you been diagnosed with endometriosis or are wondering if you could have it? Read more below to find answers to some common questions about endometriosis.
What is endometriosis?
Simply put, endometriosis is where the lining of the uterus grows in places outside of the uterus, meaning where it does not normally occur and where it does not belong. It is estimated that approximately 5-10% of reproductive aged women have endometriosis, although the exact numbers aren’t known since making the diagnosis requires an invasive procedure that most women haven’t had (more on that below).
How does the uterine tissue get where it doesn’t belong?
The answer isn’t clear but the most widely held belief is some uterine tissue – the lining of the uterus that normally sheds during a menstrual period – gets refluxed backwards through the fallopian tubes and sticks and grows inside the body. Surprisingly, doctors think that almost all women experience some of this backwards flow during a period (called “retrograde menstruation”), but most of the time, the tissue either dissolves or otherwise goes away. It is only in the small percentage of women with endometriosis that the tissue is able to persist, possibly because there are differences in the tissue that make it more tenacious than normal or because the immune systems of women with endometriosis aren’t able to effectively clear the tissue pieces.
Why should I suspect endometriosis? What are the symptoms?
Another complicating factor of endometriosis is that not all women with this condition experience symptoms, and furthermore, the severity of the symptoms doesn’t always correlate with the extent of the disease. One common symptom is pelvic pain, especially during menstrual periods or with intercourse. Some women may experience pain or even bleeding with bowel movements. During a physical exam performed by a health care provider, the uterus may be tender or immobile due to being scarred into a fixed position, or one or both ovaries may be enlarged due to cysts.
How do I know if I have endometriosis? Is there a simple test?
Unfortunately, there isn’t an easy way to diagnose endometriosis, such as with a blood test. A physical exam or medical history are also insufficient to make the diagnosis. While sometimes an ultrasound will show cysts in the ovaries that are suspicious for endometriosis, the correct way to confirm the diagnosis is by performing a surgery to examine the pelvic organs and take tissue samples (biopsies) that are then examined under the microscope.
It is only when the tissue samples are shown to be pieces of the endometrium (the uterine lining) that a diagnosis of endometriosis can be made. Usually the type of surgical procedure to identify endometriosis is a laparoscopy, which is where a camera and/or other instruments are placed into the body through small incisions on the skin. This allows your doctor to see inside the body and closely examine the pelvic organs. Abnormal areas can be sampled or removed. Removing abnormal tissue can improve symptoms associated with endometriosis for many women.
What are the treatments for endometriosis?
Treatments for endometriosis are broadly divided into two categories: surgical and medical therapy. Surgical therapy involves removing the area of abnormal endometrial tissue, usually by burning and destroying them (ablation) or cutting them out. Ovarian cysts containing endometrial tissue can be drained or removed. Uncommonly, more extensive procedures such as removing and repairing a portion of the intestines may be required if there is extensive endometriosis.
Medical treatments often consist of hormone therapy that tries to suppress and prevent the growth of endometriosis implants. One important thing to note is that many of the medical treatments suppress normal function of the ovaries and thus women are not able to become pregnant while undergoing medical therapy.
Will endometriosis affect my ability to become pregnant?
In severe cases of endometriosis the pelvic anatomy, such as the fallopian tubes, can be distorted or damaged by scar tissue. This may make it difficult to become pregnant or increase the risk of developing an ectopic pregnancy, which is one that occurs outside of the uterus and is most frequently in the fallopian tube. Surgical procedures to treat endometriosis, particularly those which involve removing cysts from the ovaries, may also result in loss of healthy eggs as a side effect and thus could reduce future fertility. Fertility treatments such as IVF can still be effective for women with endometriosis, although they are not always required to achieve pregnancy.
The good news is that treatment for endometriosis continues to advance, and many women who have been diagnosed with endometriosis are able to manage the condition and become pregnant with or without fertility treatment. If you are concerned about endometriosis, speak up! Your health care provider can get more information and individualize recommendations for you.
Content contributions by RESOLVE Physicians Council member: Dr. Jani Jensen
About Dr. Jensen: A Wisconsin native, Dr. Jani Jensen graduated from the University of Wisconsin medical school and completed her residency training in Obstetrics and Gynecology at the University of Colorado followed by fellowship training in Reproductive Endocrinology and Infertility at the University of Texas Health Science Center at San Antonio. She is board certified in both general Obstetrics and Gynecology as well as Reproductive Endocrinology and Infertility. Dr. Jensen practices in the Twin Cities of Minneapolis and St. Paul, Minnesota.