A common reproductive problem affecting millions of women worldwide, endometriosis can make your periods extremely painful as well as interfere with your ability to become pregnant. However, treatment is available and pregnancy is possible, although it may require a bit of extra help.
What is Endometriosis?
Endometriosis is a condition whereby uterine lining tissue grows on the ovaries or in the abdominal or pelvic cavity of a woman’s body. Endometriosis, also referred to as "endo," has no definitive cause but is thought to be an inherited disease. Current research has speculated on the role of irregular menstruation, genes, estrogen, the immune system and environmental chemicals as possible causes of endometriosis. Endometriosis afflicts about one in 10 American women.
Normally during a women’s menstrual cycle, hormones signal the growth of uterine lining to prepare for a possible pregnancy. If no pregnancy occurs, this lining is shed and expelled from the body with your period. In endometriosis, though, uterine tissue grows in other areas like the pelvic cavity, abdomen and ovaries. When it comes time for the tissue to shed, tissue that has migrated has no way of leaving the body. As a result, accumulated blood is trapped in these areas and creates adhesions and scarring.
Signs and Symptoms of Endometriosis
The symptoms of endometriosis include severe pain and cramps in the intestines and pelvic area, pain with bowel movements and urination, heavy periods, pain during sex, and infertility. Endometriosis can range from a mild condition to a severe disorder. Some women may not realize they have the disorder but may have massive growth of lesions in their abdomen or pelvic areas. Many women do not find out they have the disease until they try to become pregnant and experience problems. Untreated, endometriosis can hinder fertility.
Can Endometriosis Lead to Infertility?
Because of the lesions or implants that may grow in the fallopian tubes, conception may be prevented from occurring, resulting in infertility. When an egg moves from the ovary down the fallopian tube to the uterus to be fertilized, it may be blocked by the scar tissue from the disease. About 30% to 40% of women with endometriosis are infertile. However, many women with mild endometriosis are able to conceive.
According to the Endometriosis Institute of Los Angeles, a woman diagnosed with endometriosis following medical and surgical treatment has a 72% chance of becoming pregnant. Without treatment, she has a 9% chance for a successful pregnancy. Women who develop the condition and would like to have children are often advised to become pregnant as soon as possible since endometriosis tends to worsen over time.
Diagnosis of Endometriosis
Endometriosis can be detected by ultrasound, blood test or a through a procedure called laparoscopy.
Ultrasound
A doctor may choose to use the ultrasound method to check for endometriosis. She may perform a vaginal or abdominal ultrasound that uses sound waves to check for any adhesions or scarring. For a vaginal ultrasound, the doctor will insert a small wand inside your vagina that scans for abnormal tissue. An abdominal ultrasound is when the scanner is moved across your stomach to look inside your pelvis.
Blood Test
A blood test may be conducted to check for a special protein, CA-125, that is often found in the blood of women with this condition.
Laparoscopy
After you are put under an aesthetic, the doctor will make a small incision in your abdomen and insert a laparoscope where she can more closely identify any signs of endometriosis in your pelvic and abdominal cavity. A laparoscope is a telescopic tube with a camera attached that sends back video images to a screen. When necessary, laparoscopy can also be used to treat endometriosis.
Treatment of Endometriosis
The treatment options for endometriosis include pain relievers, hormonal replacement therapy and surgery. Which is best for your will depend on whether or not you would like to preserve your fertility.
Pain Relievers
Some women diagnosed with endometriosis may be prescribed pain relievers for their chronic pain and cramps. However, if pain relievers do not provide adequate relief, you may need to turn to another treatment.
Hormonal Replacement Therapy
Since hormones place a central role in activating endometriosis, hormone therapy is a common method use to treat endometriosis. Different kinds of hormonal drugs can be used to help with endometriosis and include:
- Birth control pills
- Gonadotropin-releasing hormone (Gn-RH)
- Danocrine
- Depo-Provera
Birth control pills prevent you from becoming pregnant and also control the hormones that build up the endometrium in the uterus. The other hormonal drugs listed will stop menstruation and relieve the endometriosis symptoms but many have negative side effects, such as: hot flashes, acne and facial hair, weight gain, depression and bone loss.
Women who are looking to conceive, though, may not find hormone replacement therapy to be very useful, as this treatment typical prevents you from menstruating and therefore hinders pregnancy.
Surgery: Conservative or Hysterectomy?
Surgery can be an effective way of treating endometriosis. However, it can also have permanent affects on your fertility.
Conservative Surgery
Women with endometriosis who are trying to become pregnant may elect for conservative surgery to remove abnormal growths and adhesions. To perform this surgery a doctor may use a laparoscope and eliminate growths with a laser. Otherwise she could perform a traditional abdominal surgery for more invasive adhesions. While this treatment can be helpful and does preserve your fertility, it does not permanently get rid of the growths.
Hysterectomy
A hysterectomy is involves removing your uterus and may also include the removal of your ovaries, fallopian tubes and/or cervix. This procedure will provide permanent relief from the pain of endometriosis, but will cause you to be completely infertile. Hysterectomy is only used in the most severe cases of endometriosis.
Alternative Treatments
Chinese medicine recommends the use of herbal remedies and acupuncture to treat endometriosis. Herbal remedies rely on the therapeutic qualities of plants and flowers to help restore balance to the body. Chinese acupuncture practitioners believe that irregular menstrual flow, PMS and heavy bleeding are all due to blockage of natural energy flow or "chi" in the body. Acupuncture and herbal medicine can help restore the body’s natural harmony. After a thorough evaluation, an acupuncture treatment may last for about an hour and subsequent treatments can continue anywhere from a few weeks to a few months depending on the patient’s specific needs.
Infertility Treatments
Many women with this condition are able to conceive within a longer time period. If medication, hormone treatments or surgery do not allow a woman to conceive, she may seek out infertility treatments like in vitro fertilization (IVF). Recent studies have shown that if a woman with endometriosis is given certain hormone replacement drugs for up to six months before receiving IVF, they have a better pregnancy success rate.
If you have endometriosis and would like to get pregnant, discuss your plans with your doctor so you can decide upon the correct treatment for you.
