Endometriosis is a condition where endometrium, the type of tissue that lines the inside of the uterus (womb), grows in other parts of the body. Unlike in the uterus, where this tissue is shed every month during the menstrual period and then exits the body, the tissue shed by this misplaced endometrium has no exit and remains in the body, irritating it. The two most common problems this causes are pain, which can be quite severe, and infertility which can be devastating.
How Common Is Endometriosis?
The exact number of women with endometriosis is not known because many women who have it don’t have symptoms and are never diagnosed. It’s estimated that between 5-10% of all women of reproductive age have endometriosis. Because a recent study found that an additional 10% of women with no symptoms had endometriosis, the actual total could be as high as 20%. Endometriosis is most common in women in their 20s or 30s.
What Causes Endometriosis?
Unfortunately, the exact cause of endometriosis is not currently known. Because it tends to run in families, there is a genetic component to it. It’s believed that menstrual flow that has endometrial cells spill back through the fallopian tubes and into the pelvic-abdominal cavity. Endometrial cells that spill can stick on to the peritoneal layer and stay there permanently instead of being removed by the immune system. In most women these cells are almost always present at the time of menstruation, but some women cannot clear these cells from their pelvis and thus end up with endometriosis. It’s possible that the immune system in some women may be dysfunctional causing the development of endometriosis.
How Is Endometriosis Diagnosed?
The only way to confirm that a woman has endometriosis is through a laparoscopy. This is a minor surgical procedure where the doctor makes a small incision in the abdomen and inserts a tiny viewing instrument with a light, called a laparoscope. This allows the doctor to take a look at the reproductive organs and nearby tissues to see if there are any patches of endometrium present where it doesn’t normally occur. Sometimes endometriosis can be confirmed by visualization; at other times, the doctor will also do a biopsy, taking a small piece of the suspected tissue to look at it under a microscope.
Because laparoscopy is surgery, it is only performed after taking a very detailed history of a woman’s symptoms, including where the pain is felt, its location and its timing during the menstrual cycle. A pelvic examination must also be done. And blood tests, ultrasound and an MRI may follow, to rule out other conditions such as infections, kidney problems or tumors before a laparoscopy will be done.
Do I have Endometriosis?
Patches of endometrium are most common on areas near the uterus: the ovaries, fallopian tubes, bowels and bladder. During the menstrual cycle, this misplaced tissue goes through the same changes as the lining of the uterus does, bleeding or becoming inflamed, but it is in an area of the body that is not designed for it. This can be extremely painful. The most common types of pain are abdominal cramps, back or pelvis pain and pain that occurs during sexual intercourse, urination or bowel movements. Studies suggest that up to 75% of all women with pelvic pain may have endometriosis.
The pain is often not only limited to the time around the menstrual period. It can occur at any time. If you do experience these symptoms, consult with your obstetrician-gynecologist.
Can Endometriosis Cause Infertility?
The short answer is yes, but not always. It’s estimated that 30-50% of women with endometriosis have fertility problems, but some fertile women may also have evidence of endometriosis.
Over time, misplaced endometrial tissue can cause inflammation and scarring. When this occurs on or around the ovaries or fallopian tubes, it can prevent proper release, pick up or implantation of eggs, making it impossible to become pregnant. The misplaced endometrial tissue can release chemicals that may be toxic to the sperm, egg and the embryo, and cause infertility. Additionally, women with endometriosis may have abnormalities in their endometrial layer (inside the uterus), lowering their chances of implanting an embryo.
If you have a diagnosis or suspicion of endometriosis and considering having a baby in the future, you should consult with a fertility specialist because the consequences of endometriosis on fertility can be quite significant. Endometriosis can result in low egg reserve, especially if it’s moderate or severe and in such cases fertility preservation using egg freezing can be helpful. Early intervention can improve long term results and help achieve a successful pregnancy.