Endometriosis is a condition in which cells that are similar to the lining of the uterus (endometrial lining) grow outside of the uterus. It is most commonly seen on the ovaries, but may also be seen on the fallopian tubes, pelvic cul de sac, intestines, and bladder. It’s estimated that over 11% of American women between the ages of 15 and 44 may have endometriosis.
Endometriosis can cause pain and infertility issues. Scar tissue from endometriosis, also called pelvic adhesions, can also cause fertility issues. For example, if the fallopian tubes are blocked or full of scar tissue, this can prevent the egg from traveling through the fallopian tubes down into the uterus. In some cases, this can lead to an ectopic or “tubal pregnancy,” where the embryo implants outside the uterus and in the fallopian tube.
What Are the Symptoms & Causes of Endometriosis?
Endometriosis is caused by cells from the lining of the endometrium (endometrial cells) being misplaced in the pelvis or even other areas of the body. This leads to inflammation, pain, scar tissue, and infertility in 30-50% of endometriosis patients.
Symptoms of endometriosis typically include:
- Menstrual pain (dysmenorrhea)
- Painful intercourse (dyspareunia)
- Abdominal pain with bowel movements or urination
- Chronic back and leg pain
There are multiple theories on the causes of endometriosis, ranging from retrograde menstrual blood into the pelvis, dislocation of primitive endometrial cells, lymphatic or vascular spread of cells, and abnormal transformation of endometrial cells called metaplasia.
Who Is Most at Risk of Developing Endometriosis?
Individuals who may be more likely to develop endometriosis are those who:
- Do not have children
- Have a family history of endometriosis
- Have a short interval between periods
- Have longer days of bleeding with periods
- Have medical conditions which stop the normal path of menstrual blood
How Is Endometriosis Diagnosed?
Endometriosis can sometimes be tricky to diagnose. If a patient has a history of pelvic pain, it’s often an indicator that endometriosis may be the cause. During diagnosis, a pelvic exam may reveal an immobile uterus or enlarged ovaries. A pelvic ultrasound may reveal the growth of cysts, suggesting the presence of endometriomas (i.e., a collection of endometriosis fluid on the ovary).
Endometriosis & Diagnostic Laproscopy
The most definitive way to diagnose endometriosis is by surgical evaluation of the pelvis, usually performed by laparoscopy. Laparoscopy involves small incisions on the abdomen to inspect for lesions of endometriosis, which can be dark brown, blue, red, or even white. Additionally, scar tissue called adhesions may be seen, and the endometriomas can be removed. At the time of surgery, the endometriosis is treated and staged based on the extent of the disease. Interestingly, the extent of disease seen at the surgery does not always correlate with the pain.
How Is Endometriosis Treated?
Treatments for endometriosis may include:
- Laparoscopy (surgical removal of the endometriosis)
- Hormonal treatments that inhibit the growth of endometriosis
- In-vitro fertilization (IVF) for endometriosis-related infertility
Medical management of endometriosis may involve nonsteroidal anti-inflammatory drugs (NSAIDs) or various hormones. NSAIDs help with menstrual pain and bleeding, while the hormones attempt to slow and prevent the new growth of endometriosis. Common hormonal options include oral contraceptive pills, patches, vaginal rings, and intrauterine devices (IUD) are common hormonal options.
Endometriosis is sometimes treated with gonadotropin-releasing hormone (GnRH) agonists. GnRH agonists temporarily stop the normal ovarian hormones, which shrinks the endometriosis cells, thus relieving the pain. However, the side effects of the medicine can be significant, resulting in hot flushes, vaginal dryness, and bone loss, thus the medicine cannot be used for prolonged periods continuously, and cannot be used when trying to conceive.
Depo-Provera is a progesterone injection given either monthly or every 3 months to help relieve the pain. However, side effects with the medicine can limit its use, including irregular bleeding, hair loss, and mood changes, as well as bone strength issues with long-term use.
Surgery is the definitive way to make the diagnosis and treat endometriosis. During surgery, visible lesions are ablated or burned and scar tissue is removed. Endometriosis can be recurrent in 40-80% of patients in as little as 2 years from surgery, so expeditious time to conception is often recommended for infertility patients. For patients who are not responsive to medical or laparoscopic management, and do not wish to carry a pregnancy or conceive, hysterectomy is the definitive treatment.
IVF for Endometriosis
In vitro fertilization (IVF) is one option to treat fertility concerns related to endometriosis. IVF involves the retrieval of eggs from the ovaries, which are then fertilized with sperm outside of the body. The resulting embryos are then transferred back into the uterus. IVF can help bypass the reproductive challenges caused by endometriosis and increase the chances of achieving a successful pregnancy. However, the success of IVF in women with endometriosis may vary depending on the severity and extent of the condition, and individual factors of each patient. Close monitoring and personalized treatment plans are essential in optimizing the outcomes of IVF for women with endometriosis.
Advanced Fertility Care for Endometriosis in Florida
The Reproductive Medicine Group has many years of experience diagnosing and treating Endometriosis and its related fertility concerns in Florida. With locations in North Tampa, South Tampa, Brandon, Clearwater, and Wesley Chapel, our expert team of fertility specialists is ready to answer all your questions and provide personalized fertility care. Schedule a consultation with The Reproductive Medicine Group.