Endometriosis: What You Need to Know

by Brian M. Williams

EndometriosisThis common condition gets it name from the endometrium, the glandular mucous membrane that lines the uterus.

In some women, this tissue grows outside the uterus. It attaches other places, like the ovaries, fallopian tubes, bladder and tissue lining of the pelvis.

Endometriosis affects about 10 percent of women. At least 5.5 million women in North America have endometriosis, but it is a subject not discussed and often undiagnosed.

Symptoms can include pelvic pain during sex or when you use the bathroom. You could experience symptoms during menstruation where there is excessive bleeding during periods or bleeding and spotting between periods and infertility.

One third to one half of women with this condition experience difficulty getting pregnant.

Risk Factors

Although the causes still remain unknown, the factors listed below could suggest that you're at an increased risk of developing endometriosis:

  • Endometriosis may be hereditary. If your mother or sister has been diagnosed, you are six times more likely to develop the condition.
  • You have a heavy period that last more than seven days.
  • Women who have not had children are more likely to have endometriosis.
  • A previous infection in the pelvic region increases the risk.

Currently, research doesn't show any definite way to prevent the condition. Since the hormone estrogen is involved in thickening the lining of the uterus during the menstrual cycle, some suggest that lowering levels of estrogen in your body could be beneficial.

To keep lower estrogen levels in your body, you can exercise regularly, maintain a normal weight and avoid chemicals that mimic hormones such as BPA.

Endometriosis Treatment

Unfortunately there is no cure for the conditions but medications or surgery can help ease symptoms. Because medication is a more conservative treatment, doctors will often start there.

While the term might make you think of politics, it has a different meaning during your therapy. A conservative treatment tries to maintain your fertility.

Pain medications: Over-the-counter pain medications lessen the pain for about 85 percent of the women. You might need a prescription pain medication if OTC medications don't decrease your pain [Editor's note: Pain relief medications such as aspirin and ibuprofen are not recommended during pregnancy].

Hormonal drug therapy: Medication that reduces estrogen levels and GNRH-agonist are about 85 percent effective at reducing pain during treatment and shortly thereafter. Cyclic use of contraceptives seem less effective.

Laparoscopy: Conservative surgery is used to diagnose, remove growths, relieve pain and increase the chances of pregnancy. Radical surgical options include hysterectomy.

Alternative therapy: Vitamins and herbs, diet changes, acupuncture, and Chinese medicine enable some women to manage endometriosis.

Endometriosis and Getting Pregnant

Getting pregnant can be a problem for as many as half the women with endometriosis. The trend to delay children and the onset of this condition often coincide. Those under 25 experience a 12 percent infertility rate while almost half of those 35 to 44 with endometriosis are unsuccessful at getting pregnant.

Various treatments can improve your change of getting pregnant according to Dr. Pamela Stratton. Her team evaluated data and found some therapy more effective than others.

Here's a summary of the findings, from least effective to most effective:

-- Least effective: Stopping ovulation a few months had no effect on getting pregnant. It did not improve pregnancy rates, but simply delayed other, more effect attempts.

-- Stimulating ovulation resulted in a higher pregnancy rate than no treatment.

-- Most effective: IVF resulted in a higher pregnancy rate than with other treatments, but still lower pregnancy rates than women undergoing IVF who do not have the condition.

In addition, surgery might benefit those with minimal lesions. Two studies showed opposite results.

The first study, which was the Canadian "Endo Can" study, followed women with stage 1 or 2 endometriosis for 36 weeks after surgery. Thirty-one percent of those who received surgery conceived versus 18 percent of those who did not have laparoscopy.

A second study in Italy found that surgery did not increase pregnancy rate. Twenty percent of those who had surgery conceived, compared to 22 percent in no treatment group. Researchers say that ongoing fertility problems and more advanced endometriosis might have caused the difference between studies.

During Pregnancy

The main complication of endometriosis is decreased fertility. Even after you get pregnant, you might need special care.

According to a large Swedish study, endometriosis in pregnant women is a major risk factor for preterm birth. Those with the condition are 1.33 times more likely to have their baby early.

Nearly twice as many of this group delivered their baby by cesarean section. Women with endometriosis were also found to suffer more from preeclampsia. Postpartum bleeding was also more common.

If you have endometriosis, which treatment has worked best for you in controlling the symptoms? Are you getting the support you need?

Medical references:
-- Falconer, H. et al. "Women With Endometriosis Need Special Care During Pregnancy". European Society for Human Reproduction and Embryology (2009, July 1). Accessed March 26, 2012.
-- Pamela Stratton, October 29, 2002) "Endometriosis: Scrambled eggs and killer cramps." Accessed March 26, 2012.
-- (October 17, 2011) "Fact Sheet: Endometriosis" Accessed March 27, 2012.