Causes, Diagnosis and Treatment of Endometriosis

• What Causes Endometriosis?

No one is certain of the cause of endometriosis, but several good theories exist. Some believe that menstrual cycle flow can go backward from the uterus, move up through the fallopian tubes, and spill into the pelvis. Others suggest that endometrial cells can be carried through the blood and lymph vessels to various parts of the body. Still others suggest a more complex method involving antibodies and changes at the cellular and hormonal level. Endometriosis seems to occur most commonly in women who are in their 30s and 40s. It also occurs more frequently in women who have never had children. Endometriosis appears to have a genetic component. In fact, women with a mother, sister, or daughter who have endometriosis are more likely to have it themselves

• How Is Endometriosis Diagnosed?

First, your doctor will take a detailed medical history and perform a physical exam, including a pelvic exam. If you and your doctor are suspicious that you may have endometriosis, your doctor may perform a laparoscopy to view the inside of your pelvic cavity. If endometriosis is found, your doctor will determine the extent of the disease and in some cases also destroy or remove the tissue at the same time.

• How Is Endometriosis Treated?

Treatment for endometriosis depends on the extent of the disease, your symptoms, and whether you want to have children. Endometriosis can be treated with medication, surgery, or a combination of both. You should be aware that treatments may temporarily relieve pain and infertility, but the symptoms will most likely eventually return. That’s because whatever process caused the endometriosis in the fi rst place is probably still taking place within your body.

In some cases of endometriosis, medications are prescribed to relieve pain and cramping discomfort. Nonsteroidal anti-infl ammatory (NSAID) medications such as Motrin, Advil, Aleve, or Anaprox may be recommended. Various hormones, such as birth control pills, gonadotropin-releasing hormone (GnRH), progestin, and danazol, are sometimes prescribed. Such hormones may relieve pain and also help to slow the growth of the endometrial tissue and new adhesions. These hormonal medications almost always prevent pregnancy and therefore are not used when a woman is trying to become pregnant.

In many cases of endometriosis, surgery is the best choice for treatment. Surgery is usually performed via laparoscopy. During the laparoscopy procedure, the endometrial tissue is either destroyed or removed. After surgery, you may have relief from pain and your doctor will be able to discuss your fertility chances. Some studies have shown that pregnancy rates after surgery for women with moderate endometriosis can be as high as 47 percent. Rates for those with severe endometriosis may be about 38 percent. These rates may not seem great, but they are much better than the chances of conceiving without treatment

Endometriosis and its affects on your Fertility

Endometriosis is a medical condition where the tissue that lines the inside of your uterus (also called the endometrium) spreads to other areas of your body, usually to your pelvic organs. Endometrial tissue found on your fallopian tubes or ovaries can lead to scarring, adhesions, and blockages within your pelvis.

Endometriosis is estimated to affect about 7 percent of women of childbearing age. However, endometriosis is found in approximately one-third of infertile women. Therefore, endometriosis is a major factor when considering the causes of female fertility problems.

The main symptom of endometriosis is pelvic pain. The pain and cramping occurs most often just before and during your menstrual cycle. The pain sometimes occurs during sexual intercourse, urination, or bowel movements. The amount of pain does not always tell you the severity of your condition. For example, some women with slight pain may have a severe case of endometriosis. However, those with signifi cant pain may actually have mild endometriosis. And some women with endometriosis have absolutely no symptoms. In many situations, endometriosis is only diagnosed as part of an infertility evaluation, after a woman has been unable to conceive on her own.

• What Does Endometriosis Do? How Does It Affect My Fertility?

It’s important to understand exactly what endometriosis does and how it affects your fertility. Under normal circumstances, the only place that endometrial tissue can be found is the inside of your uterus. However, if you have endometriosis, that means endometrial tissue is also growing somewhere else within your body. It most often appears in various places within your pelvis, such as the ovaries, fallopian tubes, outside surface of the uterus, space behind the uterus, bowel and rectum, and bladder. It may occasionally be found in more distant parts of the body, though this is rare.

Wherever endometrial tissue is found within your body, it basically still acts the same as that found within your uterus. Endometrial tissue is very responsive to changes in your hormones. So during your menstrual period, the tissue breaks down and bleeds, just the same way that the lining of your uterus does. This bleeding can cause pain, especially just before and during your period. The breakdown and bleeding of the endometrial tissue located throughout your pelvic organs can cause scar tissue and adhesions.

Oftentimes the scarring and adhesions cause various pelvic organs to bind together and distort the normal pelvic anatomy. This could cause the ovaries to become anchored in an awkward position so that the egg cannot properly reach the opening of the fallopian tube. In another case, the scarring and adhesions may block the fallopian tubes so that an egg cannot pass from the ovary into the uterus. Endometrial tissue may grow within an ovary and cause a cyst, usually called a chocolate cyst or endometrioma. The affected ovary and cyst may not be able to ovulate and function normally. Sometimes an ovary cannot properly release an egg because the egg is trapped within the follicle by scarring on the ovary’s surface.

Endometriosis may also reduce fertility in other ways besides the scarring and adhesions already discussed. For example, toxic substances may be released by the endometrial tissue scattered about your pelvis. In this case, even if the egg is successfully released from the ovary and passes to the fallopian tube, the toxins might diminish the egg’s ability to become fertilized. In addition, endometriosis can lessen fertility by giving off an immune response. That means that the endometrial tissue outside the uterus sends a signal to release destructive cells within the pelvis that can destroy eggs, sperm, and even an embryo

Is advancing age a cause of Infertility in women?

The current social trend seems to be for women to wait longer before starting a family. Advantages to waiting to start a family include established career, fi nancial security, and overall maturity. However, there may also be a price to pay for delayed childbearing. Many women find it more diffi cult to become pregnant than they expected. That’s because, from a hormonal standpoint, most women reach their reproductive peak between the ages of 20 and 25. As you age, various changes within the reproductive system occur that may reduce your fertility. For example, fewer eggs are capable of forming a viable embryo.
Also, the follicles, which are saclike structures surrounding each egg and are supposed to rupture and release the egg during ovulation, may not be as sturdy as they were when you were younger and thus may not be capable of effective ovulation. The quality of your eggs is one of the major determinants of whether you can become pregnant.
It’s known that the release of reproductive hormones diminishes after a woman’s 20s, and therefore most women will ovulate less reliably. Consequently, most women over the age of 35 have fewer viable eggs and may ovulate less regularly.
In addition, the incidence of pelvic disorders, such as endometriosis or uterine fibroids, seems to increase as a woman gets older. Endometriosis may reduce your fertility. Uterine fi broids that are located inside of your uterus and compromise your uterine cavity may also limit your fertility.