What is Endometriosis and How Does it Impact Fertility?

Endometriosis affects up to one in ten women of reproductive age, making it a relatively common condition. It is marked by two main symptoms: pelvic pain and infertility.

In this Q+A, RMANJ Dr. Marcy Maguire breaks down everything you need to know about endometriosis.

 

What is endometriosis?

Dr. Maguire: This is a condition where cells from the endometrial lining implant and grow outside of the uterus (including on the ovaries, the pelvic cavity and the fallopian tubes), causing inflammation and scar tissue that can lead to pelvic pain and infertility. Endometriosis is a lifelong condition, but treatment is available.
 

What causes endometriosis?

Dr. Maguire: There are several potential causes of endometriosis, including the following:

  • Retrograde menstruation: During menstruation, while most of the blood and tissue flows out of the vagina, a small amount of blood and tissue travels up backwards through the uterus and fallopian tubes and into the pelvic cavity. In most women, the immune system gets rid of that blood and tissue. By contrast, the immune system of women with endometriosis is unable to fully eliminate the backflow. Therefore, tissue from the uterine cavity is able to stick to and invade areas outside of the uterus.
  • Blood or lymphatic system spread: endometrial cells can spread to other parts of the body (the pelvic cavity in particular) through blood.
  • Coelomic Metaplasia: in this case, cells in other parts of the body unrelated to the uterus turn into endometrial cells.

 

Is endometriosis confined to the pelvic cavity?

Dr. Maguire: Usually, yes. In rare cases, endometriosis can spread to other parts of the body, like the lungs, the bladder, or the bowel.
 
endometriosis

Are there different stages of endometriosis?

Dr. Maguire: Yes. There are four stages of endometriosis: from minimal to mild to moderate to severe. Patients with moderate to severe endometriosis have more lesions and scar tissue than women with minimal or mild disease. The higher the stage, the more trouble a woman has getting pregnant. This is because endometriosis creates scars that physically block the sperm from meeting the egg, and also causes inflammation that impairs embryo implantation.

While the stage of endometriosis impacts a woman’s fertility, endometriosis stage does not correlate with pain – a woman with stage IV endometriosis may have minimal pain while a woman with stage I endometriosis may have severe pain.
 

What are the symptoms of endometriosis?

Dr. Maguire: As mentioned above, pelvic pain, infertility, and pelvic masses are the main symptoms of endometriosis. All of them can be treated, but not necessarily at the same time. In some cases, women with endometriosis have no symptoms at all and are diagnosed only after they seek a reproductive endocrinologist’s help in getting pregnant.
 

Are there other risks to women with endometriosis?

Dr. Maguire: Women with endometriosis are at higher risk for ovarian cancer. Long term use of birth control pills lowers this risk.
 

How is endometriosis diagnosed?

Dr. Maguire: While checking for symptoms and performing a physical exam is an important first step, the only real way to diagnose endometriosis is through a biopsy obtained during surgery. It is important to note there is no blood test for endometriosis.
 

How do you treat endometriosis?

Dr. Maguire: When treating endometriosis, it is important to first identify whether a patient is mainly concerned with addressing her pain versus treating infertility. It is not always possible to simultaneously relieve a patient’s pain and also help her to become pregnant. If a woman is not looking to conceive and just wants to alleviate her pain, over the counter pain killers like Advil or Motrin, as well as hormonal treatments like birth control pills or the Mirena IUD, can help.

Patients whose main concern is pregnancy will likely require treatment with fertility medications and either artificial insemination or in vitro fertilization (IVF). IVF is the most effective treatment for infertility in patients with endometriosis because it bypasses pelvic scar tissue and enables the sperm and egg to meet in a controlled environment. However, even in IVF, women with endometriosis have slightly lower pregnancy rates than other individuals with infertility.

Once a woman with endometriosis conceives, the pregnancy itself typically reduces her pelvic pain (most likely due to progesterone secreted by the placenta). However, women with endometriosis still have higher rates of miscarriage, ectopic pregnancy, pre-term delivery, placental abnormalities and C-section compared to women without endometriosis.
 

How can you eliminate endometriosis altogether?

Dr. Maguire: For most women with endometriosis, it is a lifelong, yet manageable condition. Endometriosis typically fades after menopause as a woman’s estrogen levels decline.

To learn more about endometriosis and to help spread awareness, please visit endometriosis.org.

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