Endometriosis derives its name from the word endometrium, the lining of the uterus that your body produces every month in case an egg implants itself. If you do not conceive during the same month, then your body will shed the endometrium which is why menstrual period occurs.
Sometimes, this endometrial tissue travels out of the end of the Fallopian tube and into the abdomen. In some women, the tissue will attach to other organs. The hormones made in the next menstrual cycle stimulate this extra tissue to grow and later shed just like the tissue in the uterus. However, this bleeding and tissue shedding has no way to exit the body, which causes inflammation and irritation of local tissue. Usually, the inflammation causes the pain that patients often experience with endometriosis.
How Does Endometriosis Affect Fertility and Pregnancy?
Common symptoms of endometriosis include
- discomfort before and during menses
- painful intercourse
- abnormalities in urination or bowel movements around the time of menses breakthrough bleeding between menses
- immune disorders such as asthma, eczema, and fibromyalgia
About one-third of women with endometriosis have trouble with fertility and struggle to get pregnant. Once pregnant, many women also worry about the effect of their endometriosis on their pregnancy and delivery.
The inflammation and irritation caused by the endometriosis can affect fertility.
- Inflammation of the fimbria, which picks up the egg and transports it into the fallopian tube, causes swelling and scarring so the egg may not reach its destination.
- The inflammation damages the sperm and eggs when they are exposed to the inhospitable environment caused by the endometriosis. Therefore the quality of the egg is ruined.
- problems with the embryo travelling down the tube and implanting in the wall of the uterus due to damage from endometriosis
- The endometriosis starts to cause adhesions, and the pelvic organs become stuck to each other, resulting in decreased function. Endometriosis can also block the fallopian tubes.
Pregnancy and Endometriosis
Fortunately, pregnancy actually improves endometriosis. Pregnancy does not cure endometriosis, but symptoms appear to improve during pregnancy. This is because higher progesterone levels can suppress the endometriosis. The hormones produced during pregnancy cause most of the endometriosis to resolve. When the endometriosis is so severe that conception does not happen, then a laparoscopy is necessary.
After surgery, the best chances of conceiving are during the first few months following the procedure. Once conception has occurred and most of the endometriosis has resolved, your doctor can take steps to prevent the endometriosis from reoccurring. Breastfeeding slows the growth of endometriosis as do birth control pills. Once a patient finishes breastfeeding, we recommend starting birth control pills until she wants to conceive again.
To diagnose endometriosis and other conditions that can cause pelvic pain, your doctor will ask you to describe your symptoms, including the location of your pain and when it occurs. Tests to check for physical clues of endometriosis include:
The gynaecologist may feel nodules of endometriosis at the top of the vagina and around the uterus or may suspect the presence of endometriosis by the fact that the uterus is tethered, rather than quite mobile, or that the ovaries are similarly tethered and perhaps tender to touch.
This test uses high-frequency sound waves to create images of the inside of your body. To capture the images, a device called a transducer is either pressed against your abdomen or inserted into your vagina (transvaginal ultrasound). Both types of ultrasound may be done to get the best view of your reproductive organs. Ultrasound imaging won’t definitively tell your doctor whether you have endometriosis, but it can identify cysts associated with endometriosis
Most endometriosis needs to be accurately and directly diagnosed by seeing it. This means that the patients need to have at least a minor form of surgery called a laparoscopy.
In this operation, a small incision is made in the umbilicus and then a telescope is inserted into the abdominal cavity to look carefully at all the pelvic organs and surfaces. In this way, endometriosis can be correctly identified and its severity assessed.
Treatment for endometriosis is usually with medications or surgery. The approach you and your doctor choose will depend on the severity of your signs and symptoms and whether you hope to become pregnant. Generally, doctors recommend trying conservative treatment approaches first, opting for surgery as a last resort.
- Pain medications
Your doctor may recommend that you take an over-the-counter pain reliever, such as the no steroidal anti-inflammatory drugs, to help ease painful menstrual cramps.
If you find that taking the maximum dose of these medications don’t provide full relief, you may need to try another approach to manage your signs and symptoms.
- Hormone therapy
Supplemental hormones are sometimes effective in reducing or eliminating the pain of endometriosis. Hormone medication may slow endometrial tissue growth and prevent new implants of endometrial tissue.
Hormone therapy isn’t a permanent fix for endometriosis. You could experience a return of your symptoms after stopping treatment.
- Conservative surgery
If you have endometriosis and are trying to become pregnant, surgery to remove as much endometriosis as possible while preserving your uterus and ovaries (conservative surgery) may increase your chances of success. If you have severe pain from endometriosis, you may also benefit from surgery — however, endometriosis and pain may return.
- Assisted reproductive technologies
Assisted reproductive technologies, such as in vitro fertilization, to help you become pregnant are sometimes preferable to conservative surgery. Doctors often suggest one of these approaches if the conservative surgery doesn’t work.
In severe cases of endometriosis, surgery to remove the uterus and cervix (total hysterectomy), as well as both ovaries, may be the best treatment. A hysterectomy alone is not effective — the estrogen your ovaries produce can stimulate any remaining endometriosis and cause pain to persist. A hysterectomy is typically considered a last resort, especially for women still in their reproductive years. You can’t get pregnant after a hysterectomy.
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