Endometriosis is a pelvic inflammatory condition that can cause infertility and pelvic pain. It is often difficult to diagnose because there are no simple tests that positively identify endometriosis. Every woman who experiences either pelvic pain or infertility may have endometriosis present but those symptoms can also be due to other diseases or problems.
Endometriosis- Uterine Cells Growing Outside of the Uterus
Endometriosis occurs when small cells that normally grow on the inside of the uterus begin to grow outside of the uterus within the pelvis, next to the fallopian tubes, and around the ovaries. These small cells grow over time and produce inflammatory chemicals that can cause pelvic pain and inflammation. This inflammation can then lead to pelvic scar tissue and distortion of the pelvis. These small implants of cells as well as scar tissue caused by these implants cannot be seen by any imaging exam such as ultrasound, and they are difficult to identify on a normal physical exam. There is no evidence that can be seen in blood work.
The only conclusive way to identify and diagnose endometriosis is to perform specific kind of surgery to look into the pelvis and identify these abnormal areas and associated scar tissue. A minimally invasive surgery through the bellybutton, called a laparoscopy, is typically performed to identify endometriosis as the cause of pelvic pain. If endometriosis is identified, these areas of inflammation can be removed and women may have less pelvic pain, but the presence of endometriosis can contribute to infertility even after surgery.
At times, endometriosis can grow within the ovary creating a large cyst that we call an endometrioma. This is the only aspect of endometriosis that can be seen during the ultrasound, and if this type of cyst is seen, there is a greater concern that other areas of endometriosis may be present within the pelvis.
Endometriosis May Be Responsible for Up to 70% of Women Affected With Both Infertility and Pelvic Pain
Endometriosis is a hormone sensitive condition--as the ovaries produce normal hormones each month, endometriosis may grow and worsen. Pain from endometriosis usually occurs right before and during a menstrual cycle. This cyclic pain and the growth of endometriosis can be treated with medications that inhibit ovarian function. This means that the ovaries are not producing eggs during the month, and this will also prevent pregnancy from occurring. That is why it is difficult to treat endometriosis associated with infertility- for couples trying to get pregnant, our fertility treatments often stimulate the ovaries to produce more eggs and more hormones during the menstrual month, and this does not nothing to treat the pain associated with endometriosis. In fact, it can increase the pain. For women with both infertility and pelvic pain related to endometriosis, our goal is to help pregnancy occur more quickly, reducing the amount of time that the patient feels the pain that occurs with the menstrual cycle.
Fertility Treatment the Best Choice for Endometriosis & Infertility
Fertility treatment cycles are usually the best course of treatment instead of laparoscopic surgery for women who are trying to conceive with endometriosis. At times however, surgery for endometriosis may be performed prior to fertility treatments, especially if pelvic pain is a significant factor. Surgery for endometriosis is very good at relieving pelvic pain, but likely only minimally increases the likelihood of a naturally occurring pregnancy or to diminish the need for fertility treatment when the woman is ready to conceive.
Endometriosis, unfortunately, cannot be completely cured. Pelvic pain can be minimized, and infertility can be overcome with treatment, but the pelvic inflammation and the presence of the endometriosis cells within the pelvis usually continues throughout a women's reproductive life. At times endometriosis can progress to cause chronic pelvic pain which is very difficult to treat.
What Else Can You Do If You Have Endometriosis?
As with any chronic condition, there are some ways to manage endometriosis. New medications are being explored and birth control continues to be an adequate way to keep the unwanted cells from proliferating. There are also several studies that are being conducted, including the ROSE study. ROSE is Research OutSmarts Endometriosis and is in conjunction with the Endometriosis Foundation of America, founded by Padma Lakshmi, a well-respected celebrity who when diagnosed with endometriosis came out publicly to support others suffering with the pain of endometriosis. You can read more about this study and see if it's a good choice for you.
If you need help with pelvic pain, infertility or suspected endometriosis, we are here to help.