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The Basics of Endometriosis
It's been suggested to you that you might have endometriosis. Or maybe you're new to the online infertile world and are curious about why the term #EndoSister seems to follow a lot of tweets. Maybe you've come across the word doing research on your own symptoms, or maybe you've been newly, officially diagnosed.
Endometriosis is a long, scary word that more than likely you don't know too much about until you have to know about it. (Like a secret women's Fight Club). So what is it, exactly?
Normally, during every cycle your uterus builds up tissue (endometrium) and at the end of the month, if conception hasn't occurred the tissue is shed during a period. With endometriosis, that tissue doesn't just grow inside your uterus but outside. The tissue can appear on your ovaries, tubes, or even the lining of your abdomen. When it is outside of your uterus it acts just like it would normally - it thickens, breaks down and bleeds, but because it's in the wrong place it has no way to exit your body and becomes trapped. This can cause pain (anywhere from mild to severe), or in more severe cases even scarring and cysts. It's also entirely possible that you may have little to no symptoms.
Endometriosis is an unfortunately fairly common and sometimes painful disorder among women. Some women have lots of pain as a result, and some women are asymptomatic. It's most common for women in their 30s or 40s, but any women post-puberty and pre-menopause can have it. It's estimated that 6 to 10 out of 100 women have some degree of the disorder - and the reason there's not a more precise estimate is because many women have it without realizing that they do.
To help get a sense of the basics of the disorder, it's treatment and how it may affect fertility, I spoke to Dr. Vicken Sahakian, a reproductive endocrinologist at Pacific Fertility Center of Los Angeles, who in addition to all of the facets of ART has done extensive research on endometriosis.
So what exactly causes endometriosis, and are there people who are more at risk?
"Hereditary factors confer a tendency for development of endometriosis and recent studies have suggested that the immune system may be involved," Dr. Sahakian explains. "The exact cause however is not yet established."
The most common symptoms involve some form of pelvic pain. "Premenstrual pelvic pain, worsening pain with periods and intercourse are the most common symptoms of endometriosis, although the degree of pelvic pain seems unrelated to the severity of the disease process."
Does the diagnosis mean that you are automatically going to have fertility problems?
"Endometriosis is often associated with infertility but it is also important to understand that many women with endometriosis have multiple children," Dr. Sahakian says. He does, however, point out that it is thought that 15% of infertile patients have the disorder, and that "endometriosis should always be considered a possibility in infertile patients, particularly in the presence of a positive family history or other symptoms suggestive of the disease."
As far as having children or just treatment of the disease itself, there are options.
"The treatment of endometriosis could be difficult and should be directed towards the problem. If pain is the main complaint, surgical treatment with laparoscopy with “fulguration” or burning of the endometriosis is often very successful," says Dr. Sahakian. "Even if the presenting complaint is that of infertility, it is important to determine is the tubes are open. If they are, conventional treatment with ovulation induction and insemination can be tried for few cycles and if unsuccessful proceed to IVF. In cases where
there is anatomical disease with scarring and damaged tubes or ovaries, IVF would be the most suitable treatment from the outset."
If you have symptoms of endometriosis and/or have a family history of the disease, the best thing you can do is actively seek treatment with a specialist. While there is no cure yet, there are treatment options available and it's important to be monitored by a knowledgeable Doctor. If you're confronting endo while trying to conceive, there are options, success stories and perhaps most importantly to know, you are by no means alone.