Endometriosis and Fertility

Endometriosis is one of the most common health problems for women, often associated with pain and infertility, yet is often misdiagnosed.  It gets its name from the word endometrium, the tissue that lines the uterus or womb. Endometriosis occurs when this tissue grows outside of the uterus on other organs or structures in the body, most commonly on the:

  • Ovaries
  • Fallopian tubes
  • Tissues that hold the uterus in place
  • Outer surface of the uterus
  • Lining of the pelvic cavity

According to the Endometriosis Research Center: “It is more prevalent than breast cancer, yet continues to be treated as an insignificant, obscure ailment… The average delay in diagnosis is a startling 9 years, and a woman will go through as many as 5 physicians before she is properly diagnosed and treated.”

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Symptoms:

The most common symptom is pain in the lower abdomen (pelvis) or the lower back, mainly during menstrual periods. The amount of pain is different for each woman, and does not depend on how much endometriosis she has.

Other symptoms of endometriosis can include:

  • Very painful menstrual cramps, which may get worse over time
  • Chronic pain in the lower back and pelvis
  • Pain during or after sex
  • Intestinal pain
  • Painful bowel movements or urination during menstrual periods
  • Spotting or bleeding between menstrual periods
  • Infertility or not being able to get pregnant
  • Fatigue
  • Diarrhea, constipation, bloating, or nausea, especially during menstrual periods
  • Click here for other related health problems

The symptoms of endometriosis diminish during pregnancy. Symptoms also tend to decrease with menopause, when menstrual periods end for good.

Associated health problems

Endometriosis growths are benign (not cancerous), but they still can cause many problems. To understand why, it helps to be familiar with a woman’s menstrual cycle. Every month, hormones cause the lining of a woman’s uterus to build up with tissue and blood vessels. If a woman does not get pregnant, the uterus sheds this tissue and blood through the vagina, IE: as her menstrual period.

Patches of endometriosis also respond to the hormones produced during the menstrual cycle. But misplaced endometriosis tissue and the cells it sheds have no way of leaving the body. Trapped between layers of tissue, they cause inflammation, scar tissue, adhesions and bowel problems. These growths expand over time, adding extra tissue and blood. This is why the symptoms of endometriosis often get worse.

As endometrial tissue grows, it can cover or grow into the ovaries and block the fallopian tubes. Trapped blood in the ovaries can form cysts, or closed sacs. It also can cause inflammation and cause the body to form scar tissue and adhesions (tissue that sometimes binds organs together). This scar tissue may cause pelvic pain and make it hard for women to get pregnant. The growths can also cause problems in the intestines and bladder.

Can I reduce my chances of getting endometriosis?

Because the hormone estrogen is involved in thickening the lining of the uterus during the menstrual cycle, you can try to lower the estrogen levels in your body.

  • Exercise regularly
  • Keep a low amount of body fat
  • Avoid large amounts of alcohol and caffeine
  • Try to keep stress levels as low as possible
  • Balance estrogen levels naturally. Read more here.

Testing

Pelvic exam. Your doctor will perform a pelvic exam to feel for large cysts or scars behind your uterus. Smaller areas of endometriosis are hard to feel.

Ultrasound. Your doctor could perform an ultrasound, an imaging test to see if there are ovarian cysts from endometriosis. During a vaginal ultrasound, the doctor will insert a wand-shaped scanner into your vagina. During an ultrasound of your pelvis, a scanner is moved across your abdomen. Both tests use sound waves to make pictures of your reproductive organs. Magnetic resonance imaging (MRI) is another common imaging test that can produce a picture of the inside of your body.

Laparoscopy. The only way for your doctor to know for sure that you have endometriosis is to look inside your abdomen to see endometriosis tissue. He or she can do this through a minor surgery called laparoscopy. You will receive general anesthesia before the surgery. Then, your abdomen is expanded with a gas to make it easy to see your organs. A tiny cut is made in your abdomen and a thin tube with a light is placed inside to see growths from endometriosis. Sometimes doctors can diagnose endometriosis just by seeing the growths. Other times, they need to take a small sample of tissue and study it under a microscope.

HSG. Women with endometriosis who are struggling to get pregnant can undergo a structural study known as an HSG (hysterosalpingogram). This diagnostic test can be performed in as little as five minutes. The procedure is associated with cramping, but ibuprofen can be used to ease the pain. During the test, radiocontrast media is injected through the cervix into the uterus. An x-ray is taken to examine the internal contour of the uterus and check whether the fallopian tubes are open.

Treatment

Conventional medicine states that there is no cure for endometriosis, but there are many treatments offered to deal with the pain and infertility.  A naturopathic/integrative medicine doctor will suggest a different course of action to clear up endometriosis based on diet, exercise, detox, addressing emotional stress, and/or natural progesterone.

Pain Medication. For women with mild symptoms, doctors may suggest taking over-the-counter medicines for pain. These include ibuprofen (Advil and Motrin) or naproxen (Aleve).

Hormone Treatment. When pain medicine is not enough, doctors often recommend hormone medicines to treat endometriosis. Only women who do not wish to become pregnant can use these drugs. Hormone treatment is best for women with small growths who do not have bad pain. Hormones come in many forms including pills, shots, and nasal sprays. Common hormones used for endometriosis include:

  • Birth control pills to decrease the amount of menstrual flow and prevent overgrowth of tissue that lines the uterus. Most birth control pills contain two hormones, estrogen and progestin. Once a woman stops taking them, she can get pregnant again. Stopping these pills will cause the symptoms of endometriosis to return.
  • GnRH agonists and antagonists greatly reduce the amount of estrogen in a woman’s body, which stops the menstrual cycle. These drugs should not be used alone because they can cause side effects similar to those during menopause, such as hot flashes, bone loss, and vaginal dryness. Taking a low dose of progestin or estrogen along with these drugs can protect against these side effects. When a woman stops taking this medicine, monthly periods and the ability to get pregnant return. She also might stay free of the problems of endometriosis for months or years afterward.
  • Progestins. The hormone progestin can shrink spots of endometriosis by working against the effects of estrogen on the tissue. It will stop a woman’s menstrual periods, but can cause irregular vaginal bleeding. Medroxyprogesterone (muh-DROKS-ee-proh-JESS-tur-ohn) (Depo-Provera) is a common progestin taken as a shot. Side effects of progestin can include weight gain, depressed mood, and decreased bone growth.
  • Danazol (DAY-nuh-zawl) is a weak male hormone that lowers the levels of estrogen and progesterone in a woman’s body. This stops a woman’s period or makes it come less often. It is not often the first choice for treatment due to its side effects, such as oily skin, weight gain, tiredness, smaller breasts, and facial hair growth. It does not prevent pregnancy and can harm a baby growing in the uterus. It also cannot be used with other hormones, such as birth control pills.

Surgery. Women with severe endometriosis — many growths, a great deal of pain, or fertility problems — may consider surgery. Your doctor might suggest one of the following:

  • Laparoscopy can be used to diagnose and treat endometriosis. During this surgery, doctors remove growths and scar tissue or burn them away. The goal is to treat the endometriosis without harming the healthy tissue around it. Women recover from laparoscopy much faster than from major abdominal surgery.
  • Laparotomy  or major abdominal surgery that involves a much larger cut in the abdomen than with laparoscopy. This allows the doctor to reach and remove growths of endometriosis in the pelvis or abdomen.
  • Hysterectomy is a surgery in which the doctor removes the uterus. Removing the ovaries as well can help ensure that endometriosis will not return. This is done when the endometriosis has severely damaged these organs. A woman cannot get pregnant after this surgery, so it should only be considered as a last resort.

The Natural Path. Carolyn Dean, M.D., N.D. states: “While modern medicine insists the cause of endometriosis is unknown and there is no cure, it can be relatively simple to treat and control the symptoms. The standard medical treatment involves taking synthetic hormones, such as the birth control pill, that stops menstruation and therefore stops the buildup of blood and endometrial tissue outside the uterus. But there are new ways of approaching endometriosis that are much kinder to the body and address an underlying problem that certainly relates to the condition.” To learn about turning the tables on endometriosis using alternative methods, click here or here, or speak to a naturalistic doctor for more information.

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Emotional Support

You may want to consider joining a support group (online or in your community) to talk with other women who have endometriosis.

You can find out more about endometriosis by contacting womenshealth.gov at 1-800-994-9662. You also can contact the following organizations:

Endometriosis Association
Phone Number(s): (414) 355-2200
Internet Address: http://www.endometriosisassn.org

The American College of Obstetricians and Gynecologists
Phone Number(s): (202) 638-5577; (202) 863-2518 (for publication requests only)
Internet Address: http://www.acog.org

Endometriosis Research Center
Phone Number(s): (561) 274-7442
Internet Address: http://www.endocenter.org

Eunice Kennedy Shriver National Institute of Child Health and Human Development
Phone Number(s): 1-800-370-2943
TTY: 1-888-320-6942
Internet Address: http://www.nichd.nih.gov

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