Common Conditions
Endometriosis
This is a condition where the lining of the inside of the uterus grows outside of the uterus. The most common sites for endometriosis are the ovaries and the peritoneum (the thin lining that covers the organs in the pelvis). The cause of endometriosis is widely debated but currently unknown.
The two most common symptoms of endometriosis are pain and/or infertility. However, many women have no symptoms at all.
The chance a woman has endometriosis depends on her family and medical history, as shown below:
Chance of Having Endometriosis |
|
General population |
2% |
Sister or mom has endometriosis |
7% |
Infertility with no other cause found |
20% |
Chronic pelvic pain |
40% |
Chronic pain and infertility |
70% |
How Endometriosis Causes Pain
Investigators are still uncertain of all the mechanisms by which endometriosis causes pain. We do know some women with endometriosis have abnormally high levels of free radicals as well as chemical messengers which trigger pain perception. Another source of pain can be due to endometriosis growing in a confined space or due to anatomy distortion from endometriosis induced scarring.
How Endometriosis Causes Infertility
Endometriosis causes infertility in a variety of ways. In cases where scar tissue or adhesions develop, the woman’s reproductive anatomy can become distorted. In some cases, sheets of adhesions can create a barrier between the ovary and the tubes, blocking the ability of the tubes to capture an egg after ovulation. In other cases, adhesions can cause an ovary or a tube to become stuck in an unnatural location, making it difficult for the egg and the tube to meet.
For reasons not fully understood, endometriosis can also affect the quality of a woman’s eggs. This does not mean a woman is more likely to have a baby with a birth defect. It simply means that she may be less likely to become pregnant.
Diagnosing Endometriosis
While patient history, physical examination and studies such as an ultrasound or hysterosalpingogram may suggest that a woman has endometriosis, the condition is only diagnosed by surgical evaluation.
Important Facts
Like normal endometrium (uterine lining), endometriosis grows in response to the estrogen produced by the ovaries. In most cases, it stops growing and may regress in the presence of progesterone. When a woman is pregnant, she produces high levels of progesterone; thus endometriosis often regresses and pain improves during pregnancy. Similarly, when a woman becomes menopausal, she stops producing estrogen and endometriosis rarely causes symptoms after menopause.
Treating Endometriosis
Like most disorders, the treatment for endometriosis depends on the patient’s goals.
Pain: There are three common ways to treat pain: 1) Medications to mimic pregnancy, 2) Medications to mimic menopause, or 3) Surgery to remove endometriosis.
- Mimicking pregnancy: Oral contraceptive pills, and oral or injectible progestational agents
- Mimicking menopause: Lupron injections cause the ovaries to stop producing estrogen – similar to menopause.
- Surgery: remove the lesions. Or one can remove the ovaries and cause actual menopause.
Each of these treatments has its advantages and disadvantages. Selecting the best treatment for you should involve an informative collaboration with your doctor.
Infertility: Because the extent of endometriosis (causing anatomy distortion) and the detrimental effect on egg quality is so widely variable among patients, it is difficult to predict what treatments are required to achieve pregnancy. Some patients only need oral ovulation induction medicines such as clomiphene citrate. Other women will require artificial insemination, superovulation, or even in vitro fertilization (IVF).
In severe cases, a woman may even require egg donation.
Sometimes endometriosis associated infertility can be overcome by having surgery. If a woman has mild endometriosis, surgery may be of benefit; however, fewer than 1 in 10 women actually benefit from surgery. In rare cases, if the anatomy is distorted so badly that the ovary and the tubes are separated from each other, getting pregnant naturally can be a real challenge. Restoring normal anatomy may improve these chances, but most of these women will still require more advanced fertility treatments such as IVF.