What is endometriosis?
Endometriosis is a common gynecological condition that affects many women during their reproductive years. To explain how endometriosis works, let me give you a little background. During a normal menstrual cycle, the lining of the uterus will grow and thicken in response to hormones. When a woman gets her period, the uterus sheds this lining that has built up over that past month. That’s a normal and important process to essentially restart the body before another cycle.
The difference, is that for women with endometriosis, the uterine lining doesn’t just grow INSIDE the uterus (where is it supposed to be growing every month), but it will ALSO grow and implant OUTSIDE the uterus in other parts of pelvis. That’s where the problems arise. These “implants” can then cause inflammation and scaring, which can lead to pain and/or infertility. Sometimes these implants will grow on the ovaries and form cysts that we call “endometriomas.”
How do you know if you have endometriosis?
The only way to truly know is to have surgery—for a gynecologist to look inside the pelvis, take a biopsy, and confirm it under the microscope. But naturally we don’t want to operate just to answer that question. So, we have to rely on other clues. Patients with this condition may have symptoms of pelvic pain, back or rectal pain, and/or very painful periods. Sometimes these women will have pain with intercourse. Mainly, we can get a pretty good idea of whether someone has endometriosis, at least the most severe forms, with a pelvic ultrasound. On ultrasound we often can see those cysts—or what we call endometriomas.
The tricky part is that there is no one-size-fits-all when it comes to this condition. Not all patients with endometriosis will have pain, and in fact some patients with very advanced endometriosis may have no pain whatsoever. And some patients with very minimal endometriosis will have horrible pain. Does that make sense? It doesn’t always make sense to us physicians either, which is why there is continuing research in this area of our field.
If you do have endometriosis, what do you do about it?
If you are experiencing pain and you are not trying to conceive, there are a variety of hormonal medications that can help alleviate the pain. If you are trying to conceive, do not panic. Having endometriosis does not mean that you will be infertile. That being said, endometriosis is associated with a higher risk of having infertility, and it can get worse over time, so it’s important to have a plan.
When should you see a fertility specialist?
In general, any patient that has been trying to conceive for over 1 year should seek a fertility evaluation. If you are over 35, we recommend testing after 6 months of trying. With a diagnosis of advanced endometriosis, we would recommend an evaluation regardless of your age, particularly if it has been more than 6 months of trying.
How will a fertility doctor help?
Your doctor will make a personalized treatment plan by taking into account your age, the stage of your endometriosis, and the duration of your infertility.
Whether or not to have surgery or more surgery is controversial and a case-by-case decision. Given more recent studies, we are no longer as apt to recommend surgery. We realize now, that repeated surgery may be detrimental to a woman’s ovarian reserve, and does not necessarily lead to an improvement in fertility.
Women with infertility with advanced endometriosis are likely best served by fertility treatment to increase their odds of conceiving. These options include superovulation with intrauterine insemination (IUI) using oral or injectable medications; the highest chance of pregnancy per cycle results from in vitro fertilization (IVF).
Since endometriosis can take many forms, and the success rates of these treatments varies, your doctor will outline your best treatment options with an individual plan for you.
Editor’s Note: This post was originally published in December 2015 and has been updated for accuracy and comprehensiveness as of March 2018.