March is Endometriosis Awareness Month and we are bringing attention to this often-times debilitating condition because it is one of the top causes of infertility. Not sure what endometriosis is, or how it can affect fertility? Read on to find out!
What is endometriosis?
To understand why endometriosis is such a big deal, it is important to understand what it actually is.
The endometrium, or the tissue that lines the inside of the uterus, is what builds and sheds a lining each month. Endometriosis is a disease in which endometrial tissue is found outside the uterus, usually in the abdominal cavity. It is common for the endometrial tissue to be found on the outside of the uterus, the fallopian tubes or ovaries, or the bowels, stomach, bladder, and other pelvic organs. This endometrial tissue reacts in an identical way to endometrial tissue found in the correct place – it responds to hormonal fluctuations to create and shed a lining.
Unfortunately, when endometrial tissue is found outside the uterus, the shed lining has nowhere to go. The endometrial lining is shed into the abdominal cavity which can cause bloating, cramping, and discomfort all the way to severe pain, internal adhesions to muscles and organs, internal scar tissue, and a significant impact to their quality of life.
To make endometriosis more complicated, not everyone with endometriosis will present with symptoms. In fact, approximately 30% of those with endometriosis will experience no symptoms at all.
Who is at risk?
Anyone with a uterus, who is also menstruating, can develop endometriosis. The disease itself is often under-diagnosed due to a number of factors, including the variance in symptoms and the old belief that menstrual pain is normal (news flash: it’s not).
While science is still unsure why endometriosis develops or who is most at risk, they have identified some patterns. Individuals who have never given birth, who have menstrual periods longer than 7 days or shorter than 27 days, or who have an immediate relative who has been diagnosed with endometriosis. There have also been links shown between endometriosis and other conditions, including allergies, asthma, autoimmune conditions, chronic fatigue syndrome, fibromyalgia, and some cancers such as breast and ovarian cancer.
Diagnosis and Treatment
The only definitive way to diagnose endometriosis is with surgery. A laparoscopic procedure with biopsy is the best way to find small areas of endometriosis. For individuals with advanced endometriosis, a pelvic exam, ultrasound, or MRI may be sufficient to see lesions and cysts.
Treatment varies by individual and is typically based on symptom presentation. For some, medications such as hormonal birth control are enough to manage symptoms. However, these treatments have obvious downsides, particularly those who are planning to become pregnant soon.
For people that cannot take hormonal treatments, there are other options. The first is non-medicinal treatments such as diet changes, lifestyle changes, alternative medicine including acupuncture and chiropractic, or naturopathy and Traditional Chinese Medicine. These treatments may help with symptom relief.
For those that have not been helped by medication, lifestyle changes, and alternative medicine, surgery may be an option. A laparoscopy can help to clear away any endometrial tissue present outside the uterus. For many individuals, this procedure immediately reduces or eliminates the pain they were experiencing and can also help them to conceive and carry a pregnancy to term. However, around 50% of patients will see an eventual return of symptoms and many will have multiple surgical procedures related to their endometriosis over their lifetimes.
Endometriosis and Infertility
Research suggests that 30-50% of people with endometriosis, including our own Meaghan Grant, will experience infertility. Although research has as few definitive answers as to why endometriosis causes infertility as they do to why endometriosis develops, they do have some theories.
Endometriosis can cause physical inhibition to pregnancy. Whether endometrial tissue on the ovaries is preventing ovulation, or scarring and adhesions are blocking fallopian tubes or uterus, endometriosis can cause physical barriers.
There is also a theory that the inflammation caused by excess endometrial tissue increases the production of a body chemical knowns as cytokines which can cause difficulty in fertilization between sperm and egg.
For most individuals, treating the root cause of their infertility – the endometriosis – is the first step in their fertility journey.
Although endometriosis can cause health issues including infertility, it is not a life sentence either. While there are no reliable statistics on how many people with endometriosis will have children, it is estimated that 60-70% of individuals with a diagnosis of endometriosis will achieve fertility and have children.
If you suspect or are wondering if you have endometriosis, you can take this quiz and discuss the results with your doctor.
