Endometriosis and Infertility - FAQs
Table of Content
A Multidimensional Approach to Infertility Management
The inner lining of the uterus is called the endometrium and it responds to changes that take place during a woman's monthly menstrual cycle. The cycle usually is about 28 days.
First, the endometrium grows and thickens to prepare for a possible pregnancy. If pregnancy does not occur, the endometrium is shed by bleeding.
These changes are triggered by hormones (oestrogen and progesterone) made by the ovaries.
A. Normally endometrium grows only on the inside of the uterus. But it may grow in other places; on the outside of the uterus, ovaries or tubes. It can even grow on the bladder, intestines, ureters or rectum. When this happens it is called endometriosis. Endometrial tissue that grows in the ovaries may cause a cyst (called endometrioma) to form.
A. In patients with endometriosis, the endometrial tissue looks and acts like tissue in the uterus and responds to changes in hormones. It breaks down and bleeds like the lining of the uterus during the menstrual cycle and this can irritate the organs and other structures that it touches, causing pain. The irritation can cause adhesions (sticking together) or scar tissue on these organs. Adhesions can cause pain or bind organs together.
Some women have endometriosis with no symptoms but most have one or more of the following:
- Severe menstrual cramps, often worsening over the years. Cramps may be bad enough to prevent usual activities.
- Chronic pain (lasting 6 months or more) in the lower abdomen or back.
- Pain during or after intercourse.
- Pain with urination or bowel movements, and/or during menstrual periods.
- Heavy periods.
- Bleeding or spotting between periods, or for several days before menstrual flow.
- Infertility-lnablity to become pregnant within 12 months of having regular intercourse without using any kind of birth control.
Although these symptoms may be a sign of endometriosis, they could also be signs of other problems, consult the doctor.
A. Endometriosis is most common in women in their 30s and 40s, but it can occur any time in women who menstruate. Endometriosis occurs more often in women who have never had children. Women with a mother, sister, or daughter who have had endometriosis also are more likely to have it.
A. No one is certain of the cause of endometriosis but it is thought that a small amount of blood and endometrium flows backwards through the fallopian tubes into the abdomen during the periods and attaches to other places and grows. Endometrial cells also may be carried through blood and lymph vessels.
Many women with endometriosis have no symptoms. Also the amount of pain does not always tell how severe the condition is. Some women with slight pain may have a severe disease. Others who have a lot of pain may have a mild disease.
Some women may find out that they have endometriosis only when tested for infertility.
If a woman's health history and symptoms sound like endometriosis, the doctor may ask for sonography or MRI of abdomen and pelvis.
The extent of the disease can be confirmed by looking directly inside the body. This can be done by laparoscopy (examination of the internal organs of the abdomen using a laparoscope). Sometimes a small amount of tissue is removed during the procedure to be studied in a lab and this is called a biopsy.
Often, the endometriosis tissue and the scarring that may occur can make it difficult or impossible for a woman to get pregnant. It may change or block the fallopian tubes because of which an egg can't travel to the uterus, or prevent the fertilised egg from attaching to the uterus. Surgery to remove the endometrial growths is often helpful. For women still unable to become pregnant after endometriosis treatment, advanced fertility treatments such as in vitro fertilization may be recommended.
Endometriosis is found in about one third of infertile women.
Treatment for endometriosis depends on the extent of the disease, symptoms and whether a woman wants to have children. It may be treated with medications, surgery, or both.
In some cases of endometriosis, medications may be used to relieve pain e.g. NSAIDs (nonsteroidal anti-inflammatory drugs). These drugs will not treat any other symptoms of endometriosis.
In some women, hormones also may be used to relieve pain and help slow the growth of the endometrial tissue and prevent the growth of new adhesions, but will not make them go away.
Some of the hormones most often prescribed include: oral contraceptives, gonadotropin releasing hormone (GnRH), progestin, danazol etc.
These medicines could also decrease the problem of heavy bleeding associated with endometriosis.
During laparoscopy, areas of endometriosis and adhesions can be removed by cutting, burning, or laser. For women with very severe pain who already have children and do not want more, surgery to remove the uterus (hysterectomy), with or without removal of the tubes and ovaries, may be considered if other treatments don't work. Sometimes a procedure called laparotomy (opening the abdominal wall to allow diagnosis of a disease or investigation of an abdominal organ) may be needed.
Many patients are treated with both surgery and medications to help extend the symptom-free period.
For more information, contact your doctor.