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Endometriosis is a little understood, but relatively prevalent female reproductive disease. In this post, we explore what endometriosis is, what the symptoms can be, what the treatment options are and if you can get pregnant with endometriosis.

What is endometriosis?

Endometriosis is a female disorder that affects the reproductive system and surrounding organs. The word itself comes from the root "endometrium", which is the tissue that lines the uterus and that sheds during a menstrual period. Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. The bladder, bowel, ovaries and other surrounding organs can be affected by this growth, and the presence of endometrial tissue in these areas can lead to adhesions, scarring, and nodules.

An estimated 176 million women suffer from endometriosis worldwide, with around 8.5 in North America. All in all, an estimated one in 10 women suffer from endometriosis during their reproductive years.

Many risk factors can play a role in the development of endometriosis, however. They include:

  • Being "nulliparous" — not having given birth to a baby
  • Starting your periods earlier than average
  • Going through menopause later than most women
  • Short menstrual cycles — an average of less than 27 days
  • Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen
  • A low body mass index
  • Alcohol consumption
  • Genetic factors, such as one more close female relatives (mother, aunt or sister) with endometriosis. The Endometriosis Foundation of America points out that a woman whose mother has or had endometriosis is seven times more likely to develop the condition herself.
  • Any medical condition that prevents the normal passage of menstrual flow out of the body
  • Uterine abnormalities

The cause of endometriosis is still, unfortunately, unknown, but possible explanations include:

  • Retrograde menstruation, where menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
  • Experts propose that hormones or immune factors lead to the transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial cells.
  • Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial cell implants during puberty.
  • Surgical scar implantation, which can happen after a surgery within the pelvic region, such as a hysterectomy or c-section. After surgery, endometrial cells can attach to a surgical incision.
  • Endometrial cell transport, where the blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
  • It's possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that's growing outside the uterus.

Awareness about endometriosis is surprisingly lacking, especially considering that the condition is so prevalent. Endometriosis can come with a significant amount of symptoms, but it can also sometimes be symptomless. Even for women who do have symptoms, it can take as long as a decade to receive the proper diagnosis, among other reasons because they may see their symptoms as normal and do not seek help. Endometriosis comes in several stages, determined on the basis of the amount, depth, and locations of the endometrial tissues or implants. Healthcare providers will look at whether the fallopian tubes are blocked, and to what extent the patient has adhesions as well. The stages are:

  • Stage I — minimal
  • Stage II — mild
  • Stage III — moderate
  • Stage IV — severe

What are the symptoms of endometriosis?

The symptoms do not always correspond to the patient's stage of endometriosis, contrary to popular belief and perhaps contrary to common sense as well. A woman with mild endometriosis may experience significant symptoms, while one with severe endometriosis may not have any noticeable symptoms whatsoever. Where symptoms do occur, their severity can vary immensely. Some of the symptoms that are associated with endometriosis are:

  • Pelvic pain and cramping may begin a few days before your period and they may extend several days into your period. Pelvic pain and cramping may be accompanied by lower back and abdominal pain.
  • Severe menstrual pain, also known as dysmenorrhea.
  • Pain during intercourse.
  • Pain during bowel movements and blood in bowel movements or urination, especially during periods. Even diarrhea, constipation, bloating are an occasional occurrence.
  • Rectal pain.
  • Irregular vaginal bleeding between periods (menometrorrhagia) or after sexual intercourse.
  • Heavy periods (menorrhagia).
  • Infertility, ectopic pregnancy, and miscarriage.
  • Nausea and vomiting.
  • Fatigue.

Most of these symptoms are enough to point to some kind of medical problem, even when they present in isolation. As with many reproductive conditions, the symptoms described above can be the result of a number of different diseases. It is not, in other words, safe to assume that you must have endometriosis if you have most of the symptoms on this list. What you can be sure about, if you have some of these symptoms, is that you need to see a doctor. Seeking medical help means you are a step closer to full testing and a proper diagnosis. Endometriosis cannot be diagnosed on the basis of symptoms alone, and instead there are several options that can enable a proper diagnosis of the disease: 

  • pelvic exam,
  • ultrasound,
  • magnetic resonance imaging (MRI) or
  • surgical biopsy of a small piece of tissue from the endometrium, which is the lining of the uterus.

Treatment and getting pregnant with endometriosis

Treatment of endometriosis depends on a wide variety of factors. When a woman is diagnosed with the disease, she will have a detailed discussion about the possibilities with her healthcare provider. The treatment depends on the following factors: 

  • The symptoms a woman has and the extent of her endometriosis are important factors that need to be considered. Treatment may not be necessary if your symptoms are mild, you have no fertility problems, or you're nearing the menopause, when symptoms may get better without treatment.
  • Other things you and your doctor would examine after an endometriosis diagnosis include your own opinions and preferences, and particularly whether you would like to get pregnant.

Types of endometriosis treatment 

  • To manage the pain that is often associated with endometriosis, you may be offered painkillers such as ibuprofen, which also act as anti-inflammatory medications.
  • There are many hormonal treatment options available for those women who do not wish to get pregnant. These include combined oral contraceptives, patches, or other hormone-based contraceptives, which prevent ovulation and alter the menstrual cycle:
    • the combined oral contraceptive pill or contraceptive patch can help relieve milder symptoms, and can be used over long periods of time;
    • a levonorgestrel-releasing intrauterine system (LNG-IUS) (Mirena), a T-shaped contraceptive device that fits into the womb;
    • gonadotrophin-releasing hormone (GnRH) analogues, synthetic hormones that bring on a temporary menopause by reducing the production of estrogen;
    • progestogens, synthetic hormones that behave like the natural hormone progesterone;
    • antiprogestogens, also known as testosterone derivatives;
  • A "hormonal menopause" can also be induced. Women who don't want to get pregnant also sometimes opt to have a hysterectomy, a removal of the womb.
  • For those women who would like to have a child, laparoscopic surgery is sometimes recommended to remove endometrial implants. Endometrial implants will usually return following such a procedure, but the woman's chances of getting pregnant with endometriosis go up greatly within the first year of having the surgery.

Infertility and endometriosis 

Between 30 and 50 percent of women who have endometriosis are infertile. Infertility depends on the extent of the endometrial implants and adhesions, and surgery can increase a woman's chances of conceiving naturally. Though endometriosis has been shown to have a negative impact on IVF success chances, most women who have IVF due to endometriosis-related infertility will still be able to conceive. This is one option you may like to discuss with an infertility doctor.

How can diet ease endometriosis symptoms? 

  • Eat omega-3 fats that act as the building blocks of your body’s inflammation- and pain-relieving molecules.  
  • Avoid trans fats, especially processed foods - a study found that women who ate the highest amounts of trans fats had increased the risk of endometriosis by almost 50%.
  • Reduce consumption of red meat.
  • Eat a high-antioxidant diet with plenty of fruits, vegetables and whole grains. 
  • Limit caffeine and alcohol intake.

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