What is endometriosis?
Endometriosis, or endo, is a chronic disease in which the endometrial tissue that forms the lining of a woman’s uterus grows outside of the uterus. The tissue, called endometrial implants, may grow on the outer surface of the uterus itself or on surrounding organs like the ovaries, fallopian tubes, or even the bladder. Endometriosis affects about 10% of women of childbearing age. Doctors haven’t found the exact cause, but genetics, hormonal imbalances, or retrograde menstruation — when menstrual flow goes backward — may play a role.
How does endometriosis affect fertility?
While pelvic pain and infertility are common symptoms of endometriosis, women with endometriosis can still get pregnant. Endometriosis does not cause infertility, but there is an association between the two in that up to 50% of women with infertility may have endometriosis. On the other hand, for women who have endometriosis, up to 50% may have trouble getting pregnant.
“Certainly women with endometriosis can get pregnant,” said Dr. Mary Jacobson, Alpha’s Chief Medical Officer. “So even if you have a diagnosis, it doesn’t condemn you to infertility.”
The severity of endometriosis may impact fertility, according to Dr. J. Endometriosis occurs in 4 stages, and stages 3 and 4 may impair fertility the most. As the disease progresses, more lesions and scar tissue may develop, making it harder to become pregnant. Here’s how.
One way that endometriosis can impair fertility is by physically obstructing an egg or sperm during the fertilization process. In the more severe stages of endometriosis, adhesions and scar tissue form as the endometrial implants bleed, break down, and inflame surrounding tissue, blocking reproductive pathways in the process.
These blockages may prevent the egg from entering the fallopian tubes during ovulation. Sperm may not be able to reach the egg to fertilize it. Blockages can also obstruct the transport of a fertilized egg, increasing the risk of an ectopic pregnancy, which is when a fertilized egg implants outside of the uterus and the fetus doesn’t survive as a result.
There are other theories for how endometriosis impacts fertility. The inflammation from endometriosis may damage sperm or eggs. Fluid or chemicals from endometriosis may be toxic to the developing embryo and can impair implantation. Endometriosis may even interfere with how often an egg is released or impair the quality of the egg.
The formation of an endometrioma, a cyst resulting from endometriosis, can eat away at ovarian tissue, according to Dr. J. Surgery may be required to remove the cyst and optimize fertility.
How do I know if I have endometriosis?
If you experience painful cramps, back and pelvic pain, pain during sex, heavy periods, or difficulty getting pregnant, you may have endometriosis, but it’s not a guarantee.
“One mistaken belief is that endometriosis can be diagnosed by a patient’s symptoms and that’s not correct. Endometriosis is a surgical diagnosis,” Dr. J said.
Though ultrasounds and physical exams can lead to a mostly accurate diagnosis, the only way to know for sure if a patient has endometriosis is through a surgical procedure called a laparoscopy. A doctor needs to extract and examine a tissue sample to confirm the diagnosis.
What does treatment for endometriosis look like?
Though there’s no cure for the disease, it is possible to live with endometriosis. Women seeking treatment for endometriosis should consult with their doctor to discuss options. Dr. J says treatment would depend on a number of factors, including a patient’s age, stage of endometriosis, medical history — including past operations — and whether they’re trying to get pregnant.
“I would have to know all the information,” she said. “I would do a detailed history, because some women are told they have endometriosis and they’ve never had surgery before. They just have painful periods.”
Patients can manage symptoms through medication. If you’re not trying to get pregnant, hormonal contraceptives can help relieve endometriosis pain. Alpha’s options include the birth control pill, patch, ring, or shot. We also provide Norethindrone, a form of the hormone progesterone, that can be used as birth control and to treat endometriosis.
How can I get pregnant with endometriosis?
If you haven’t been trying to get pregnant, even if you have endometriosis the first step would be to try to conceive for some time. If that doesn’t work, medication is an option to treat endometriosis and possibly increase chances of pregnancy.
For example, Alpha provides gonadotropin-releasing hormone (GnRH) agonist or antagonists, medication that stops the body from producing hormones like estrogen. Because endometrial implants thrive with estrogen, less estrogen can make them inactive and prevent them from growing.
Some women with severe endometriosis may need surgery to get rid of endometrial growths. Dr. J says those who have had surgery should try to get pregnant soon after. Because endometriosis cannot be cured over time, if a patient has surgery, the sooner she tries to conceive, the better. In vitro fertilization, or IVF, is also an option, though it’s expensive.
How can Alpha help?
In short, endometriosis is a chronic condition associated with heavy periods, pain and infertility. If you’re experiencing some of these symptoms, we recommend you consult with a doctor. Alpha makes it easy. Once you sign up and answer some questions about your symptoms, our doctors will review your responses within 24 hours. Any medication we prescribe will be mailed directly to you with free shipping. Living with endometriosis can be painful and frustrating, but it doesn’t have to be. Get started with Alpha today!