The pain may begin subtly, so subtly, in fact, you may not realize anything is amiss. Your periods become a bit more “crampy”, sex is uncomfortable, and maybe you’re constipated, or have trouble urinating. Your menstrual flow may become much heavier, and, overtime you experience some excruciating pain. These are the symptoms of endometriosis.
Unfortunately, because these symptoms tend to be unremarkable at first-everyone has the occasional “super period” that comes on like a flood, or leaves you in bed with a heating pad-many women don’t realize they have endometriosis until it becomes a factor in their fertility. Some women will note that their bodies have experienced changes lately, but unless the pain is substantial, many women consider it somewhat “normal”.
Endometriosis occurs when tissue, similar in nature to that which lines the uterus, grows outside of the uterus, within the pelvic cavity, and sometimes, though rarely, abdominal region. This displaced endometrial tissue attaches itself to the ovaries, fallopian tubes, and tissue that lines the inside of your pelvic region.
As your body moves through your normal menstrual cycle, the endometrial tissue breaks down, and bleeding occurs. With endometriosis, the tissue, which would exit the body, if it were located inside the uterus, has nowhere to go. It reattaches inside the pelvic region, grows, goes through your menstrual cycle and forms adhesions and scar tissue. In the case of endometriosis attaching to your ovaries, cysts will begin to form.
Causes of Endometriosis
Although doctors have not found an exact cause for the condition, there is some solid speculation that certain conditions, and procedures, may contribute to endometriosis. They are:
- Impaired Menstrual Flow: When your period begins, the blood which is passed contains endometrial tissue. In a condition called retrograde menstrual flow some of the blood flows through the fallopian tubes, and into your pelvic region. The tissue containing endometrial cells attaches itself within the pelvic area, and begins to grow. This is believed to be the most common cause of endometriosis.
- Genetics: Endometriosis does have a genetic connection as it is often present among family members, such as mother, aunt, and sister.
- A Problematic Immune System: In some instances, a woman’s compromised immune system will fail to identify and destroy endometrial tissue outside of the uterus. Another condition affected by compromised immunities is the transformation of peritoneal cells. These are the cells that line the inner part of your abdomen. Hormones, and immune factors, are believed to transform these cells into endometrial cells, although this is rare.
- Hormonal Imbalances: The hormone estrogen is instrumental in the formation of endometrial cells. When the body’s hormones are out of balance, it could affect endometriosis.
- Prior Surgical Procedures: Cesarean sections, hysterectomies, and even episiotomies, have been found to inadvertently cause endometrial cells to be transferred to those areas. The cells then attach to the surgical scars and grow.
- Transported Endometrial Cells: In some cases, it’s believed the blood vessels, or even the lymphatic fluid, transports endometrial cells to different areas of the body.
Risk Factors for Endometriosis:
No conclusive causes for endometriosis have been identified, however some women are found to be of a higher risk. If you fall into any of these categories, your risk factor is higher:
- Never having given birth
- Menstrual cycles of varying length
- Periods lasting more than 7 days
- Mother, aunt, or sister who has experienced endometriosis
- Any health issue which blocks, or impairs, the flow of your period
- Being underweight
- An imbalance of estrogen
The Impact on Your Fertility
The biggest complication due to endometriosis is infertility. Anywhere from 30%-50% of all women who have endometriosis experience an inability to conceive. In addition to causing obstructions to the fallopian tube, the displaced tissue, and the adhesions and scars it creates, may cause damage to your eggs, or even your partners sperm.
The main issue with advanced endometriosis (Stag 3 and 4) and its impact on fertility is the damage that endometriosis cysts (endometriomas) can do on healthy follicles (eggs). This inflammatory disease, when present inside the ovaries, can damage the healthy eggs and result in a low ovarian egg reserve. Low egg reserve has been found to be present in women at the time of diagnosis of ovarian endometriosis by measurement of low antral follicle counts, elevated FSH and low AMH levels. If such an issue is diagnosed at a young age or happens to be the cause of infertility, egg freezing for fertility preservation and IVF for active treatment of infertility should be strongly considered. These interventions should be considered in the shortest amount of time because the ovarian egg reserve will continue to decline rapidly and cause more dramatic issues.
Up until menopause (unless you are taking hormone replacements after menopause) endometriosis will continue to grow, becoming even more of an impairment to your fertility. There are surgical procedures, certain medical interventions that can help restore your fertility, and, along with assisted reproductive technologies and especially IVF, it is possible to become pregnant.
Although there is no way to prevent endometriosis, there are ways to control your risk factors. Early diagnosis can help preserve your fertility, so if you fall into any of the risk factors, or experience heavy bleeding during your period, painful intercourse, painful ovulation, or unexplained digestive issues, see your doctor. When found early, treatment is usually minimally invasive.