If you’re a woman with endometriosis, it can be painful, affect your quality of life, and it’s also a cause of female infertility. Endometriosis affects anywhere from 2 to 10% of American women between the ages of 25 and 40.
The following are key things to know about this gynecological condition.
What is Endometriosis?
Endometriosis is a condition named after the endometrium. The endometrium is the tissue lining the uterus.
During your menstrual cycle, as a woman, the tissue builds up and sheds if you’re not pregnant. If you have endometriosis, tissue develops that looks and behaves like endometrial tissue outside of the uterus. This typically means the tissue gathers on other reproductive organs inside the pelvis or potentially in the abdominal cavity.
The misplaced tissue responds to hormonal changes of your menstrual cycle by building up and breaking down as the endometrium would normally. The result of that is then some bleeding inside the pelvis.
The bleeding in the pelvis can lead to scarring, swelling, and inflammation of normal tissue.
If your ovary is involved, then blood can get embedded in your ovarian tissue. That creates a blood blister, which is then covered by a cyst. The fibrous cyst is called an endometrioma.
The most common sites where the buildup of abnormal tissue is found include:
- Ovaries
- Fallopian tubes
- Ligaments supporting the uterus
- The space between the uterus and rectum, known as the posterior cul-de-sac
- The space between the uterus and the bladder known as the anterior cul-de-sac
- The pelvic cavity lining
- The outer surface of the uterus
Less commonly, the tissue can be found in places like the intestines, the rectum, the bladder, and the cervix.
What Are the Symptoms?
Every woman might experience the symptoms of endometriosis differently, but in general, they can include:
- Pain and excessive menstrual cramps, usually being especially pronounced in the lower back or abdomen
- Pain during sex
- Infertility
- A heavy or abnormal menstrual flow
- Painful urination
- Painful bowel movements during periods
- Gastrointestinal problems like nausea and diarrhea
If you have severe pain, it doesn’t necessarily mean you have more severe endometriosis and vice versa.
Infertility and Endometriosis
According to the American Society for Reproductive Medicine, endometriosis is one of the three main reasons for female infertility. It can be found in anywhere from 24% to 50% of women who have infertility.
If you have a mild or moderate case of infertility, your infertility may not be permanent. Surgeries to remove cysts, scar tissue, and adhesions can help you regain fertility. In some cases, it’s not possible to restore fertility.
Doctors and researchers aren’t exactly sure why endometriosis causes infertility, but it’s thought the scar tissue the condition creates might block the release of the egg from the ovary, and then it can’t be picked up by the fallopian tube.
The pelvic changes that occur could also affect fertility.
How Is it Diagnosed?
Your gynecologist or another health care provider can make a diagnosis of endometriosis. To diagnose the condition, your health care provider will go over your medical history and do a complete physical exam, including a pelvic exam.
Laparoscopy also has to be done to make a diagnosis. During a laparoscopy, the doctor can biopsy suspicious tissue for a definitive diagnosis. A laparoscopy is a surgical procedure where a thin tube with a camera on the end is put through your abdomen via a very small incision. This procedure can help your health care provider determine not only a definitive diagnosis but also the location, size and extent of the growths related to your endometriosis.
Ultrasounds, CT scans, and MRI scans are sometimes used during the diagnostic process too.
There are stages of endometriosis starting with Stage 1, which is minimal, and going up to Stage 4, which is severe.
Treatment
The treatment approach your health care provider advises depends a lot on your preferences, the extent of your disease and your symptoms. Additionally, your doctor will take into account your desire to get pregnant when choosing a treatment plan.
For some women, no treatment is necessary, or your doctor might advise watchful waiting.
Some women might take over-the-counter pain medicines as needed.
Hormone therapy is another possible treatment with oral contraceptives, progestins, or medications that stop hormone production.
Surgeries for endometriosis include laparoscopy, also used in diagnosis, laparotomy, which is a more extensive surgery, and hysterectomy which removes the uterus and sometimes the ovaries.
Endometriosis is a difficult diagnosis, but if you have symptoms, it’s essential to talk to your health care provider.