All About Endometriosis

I recently saw a 32 year-old woman in our Coral Gables practice who had been trying to conceive for 18 months. She had terrible pain with periods as a teenager that would often keep her home from school. Placing her on birth control pills made her symptoms much more manageable. When she decided to stop birth control about 15 years later to start a family, her painful periods returned. Here are some of the indicators that led us to a diagnosis.

Her Diagnosis? Endometriosis.

Endometriosis is a medical condition that affects 176 million women worldwide. “Endo” is characterized by uterine tissue growing outside of the uterus. It is a benign disease whose symptoms can range from nothing at all to severely debilitating pain with periods.

Classic endometriosis symptoms include:

• Painful periods (severe dysmenorrhea)
• Chronic pelvic pain
• Pain during urination
• Pain with intercourse (Dyspareunia)
• Chronic fatigue
• Infertility

It can be difficult to diagnose because these same symptoms can have other causes. And a significant number of women with endometriosis have no symptoms at all.

And there does not seem to be a definitive cause.

A popular theory is that endometriosis is caused by retrograde menstruation, where the blood flows backward when you have your period. The endometrial cells in the blood flow back through the fallopian tubes and into the pelvic cavity instead of out of your body. Even though the endometrial tissue is outside the uterus, it is still responsive to hormones, especially estrogen. This tissue can grow throughout the menstrual cycle and cause significant symptoms for many women. Additionally, endometriosis in the ovary can cause cysts called endometriomas. This inflammation in the ovary can have a negative impact on the quality and quantity of eggs. This, in part, can contribute to infertility in patients with endometriosis.

Another potential cause of endometriosis is that endometrial cells may attach to a surgical incision after a hysterectomy or C-section. Or your hormones could transform embryonic cells into endometrial cells located outside of the uterine cavity.

One other possibility that has gained more attention recently is that endometriosis is an autoimmune condition.

When all else fails, blame your mother. Women who have a first-degree relative (mother, sister, and daughter) with the disease are at an increased risk.

Most women are not diagnosed for an average of seven years after reporting symptoms and most are not properly diagnosed until their late 20s! In fact, a definitive diagnosis can only be made through laparoscopy, a minor surgical procedure.

Here’s the good news.

Hormone therapy, progestin-only contraceptives, non-steroidal anti-inflammatory drugs (like ibuprofen), and surgery have been shown to improve symptoms and quality of life. A new oral medication is also showing promise to reduce endometriosis symptoms with significantly less side effects.

More importantly, endometriosis does not automatically mean you will experience infertility. You CAN conceive with endometriosis. While that is not a guarantee, we always like to share the possibility.

As fertility specialists, we use a staging system for endometriosis to determine a treatment plan. In our practice, we find that patients who have been diagnosed with stage 1 or 2 are less likely to experience infertility. For those with stage 3 or 4, we generally recommend IVF rather than trying to conceive naturally.

Can diet make a difference?

There has been a lot of conversation about diet and endometriosis. Some suggest that diets which focus on anti-inflammatory properties and antioxidants may target underlying source of pain. Resveratol, found in the skin of grapes and blueberries, has been show to decrease the number and volume of endometrial implants in animals.

The bottom line is that there has been no definitive medical proof that any one dietary supplement or diet alone can improve this medical condition but, stay tuned!

So here’s our recommendation:

If you experience any of the classic symptoms of endometriosis, consult your gynecologist to discuss options. If you are trying to conceive in addition to having concerning symptoms, we recommend consulting a reproductive endocrine and infertility specialist sooner rather than later. Even if you are not currently ready to start a family, patients with stage 3 or 4 endo, especially ovarian endometriosis, should consider fertility preservation as early as their 20s. When it comes to reproduction, yesterday is always better than today and today is always better than tomorrow!

As for my patient, when we tested her ovarian reserve through blood work and an ultrasound, she was found to have diminished ovarian reserve, meaning lesser quality and quantity of eggs for someone her age. Fortunately, through the use of IVF, she has an excellent chance of becoming pregnant. We’ll keep you posted on her fertility journey!