Women who find themselves having a hard time getting pregnant may have endometriosis to blame. The condition is one of the most common causes of infertility. Dr. Michael A. Giudice, a physician of obstetrics and gynecology with University of Maryland St. Joseph Medical Center, explains what causes the condition and how to treat it.
What is endometriosis?
Endometriosis is a chronic gynecologic disorder that causes infertility and pelvic pain. It occurs in 6 to 10 percent of women of reproductive age, but in up to 50 percent in women with infertility and 80 percent of women with chronic pelvic pain.
Endometriosis occurs when glands from the endometrium (lining of the uterus) attach and implant on the abdominal organs, such as the intestines or bladder, or pelvic organs, such as the ovaries, fallopian tubes or uterus. These lesions cause a chronic inflammation in the fluid inside the abdominal cavity as well as changes in the nerves of the pelvic organs, both of which lead to pelvic pain. When endometriosis is mild, inflammation affects sperm function and causes hormonal changes which decrease fertility. When the disease is severe, ovarian cysts and scarring of the pelvic organs can prevent pregnancy.
How is the disease detected?
Endometriosis can only be definitively diagnosed by microscopically examining lesions removed at the time of surgery. There are no blood tests which can accurately diagnose the disorder, and imaging studies can only find pelvic masses that are frequently caused by endometriosis.
Who is more likely to get the disease?
Endometriosis does not have a racial predisposition but does appear to have a familial association. Girls are 7 to 10 times more likely to develop endometriosis if their mother had the disorder. Inheritance is complex and appears to be multifactorial.
What are the symptoms and can they vary from person to person?
Women with endometriosis frequently have painful menstrual cycles, chronic pain, pain with intercourse and pelvic masses. Endometriosis can also cause bowel and bladder problems, including pain with bowel movements or urination, constipation, diarrhea or blood in the urine.
Endometriosis has a highly variable clinical course, and severity of the disorder, which can only be determined at the time of surgery, frequently does not correlate with the degree of symptoms a patient experiences. Some women may have severe pain and infertility but minimal visible disease at the time of surgery, while other women are asymptomatic and have several children, but have severe disease which is found incidentally at the time of surgery for other reasons.
How does having endometriosis contribute to infertility?
When endometriosis is mild, inflammation affects sperm function and causes hormonal changes which decrease fertility. When the disease is severe, ovarian cysts and scarring of the pelvic organs can prevent pregnancy.
What other health risks are associated with endometriosis?
Endometriosis is not associated with any other diseases or conditions.
How is endometriosis treated?
Treatment of endometriosis depends on the severity of symptoms and desire for future fertility.
First-line treatment is usually birth control pills or other hormones to decrease the frequency of menstrual cycles to prevent cyclic pain. If hormones do not work, there are medications which essentially turn off the ovaries to stop a woman's cycles temporarily, which usually will stop the patient's pain. For women that continue to have symptoms, surgery to remove scar tissue or pelvic masses and destroy the endometriosis frequently will help.
For women who do not want to preserve fertility, the definitive treatment is hysterectomy, or removal of the uterus and both ovaries.
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