In honor of March’s Endometriosis Awareness Month, Dr. Meike Uhler sheds light on endometriosis and its potential effects on fertility.

For some 176 million women worldwide, severe pain during a monthly cycle may actually be caused by a painful, chronic disease called endometriosis. Endometriosis, of which there is no known cause or cure, can affect fertility, bowel function, gynecological health and most importantly, quality of life.

“Millions of women around the world have endometriosis, and it is one of the most common causes of infertility,” explains Dr. Uhler. “It is important that women and those close to them understand the disease, as well as how to alleviate symptoms and overcome fertility challenges.”

Understanding Endometriosis:
Each month during menstruation, the endometrial lining found inside the uterus sheds from the body. When the endometrial tissue normally found inside the uterus grows outside the uterus or in other places of the body, it is known as endometriosis.

Each month, endometrial tissue continues to break down and shed as it would during a normal menstrual cycle. Without the ability to drain from the body as it would in normal menstruation, inflammation and pain result.

Endometrial growths have been found on the ovaries, fallopian tubes, bladder, on the outside of the uterus, lining the pelvic cavity and between the vagina and rectum. While rare, growths have also been found in the arm, thigh and lung.

How Endometriosis Affects Fertility:
Scarring and adhesions from endometriosis can restrict movement of the ovaries, change the position of the fallopian tubes and ovaries as well as block the fallopian tubes. Endometriosis can also increase production of prostaglandins and other hormones that can affect fertility. Roughly 35 to 50 percent of women diagnosed with endometriosis also have infertility, with endometriosis being one of the top three causes of female infertility.

To improve fertility, doctors can surgically remove adhesions and scar tissue. Stimulation of the ovaries with fertility medication and combined with in vitro fertilization will often overcome the impact of endometriosis on fertility without surgery. Approximately 60 to 70 percent of women with endometriosis conceive, and it is important to note that not all individuals with endometriosis are infertile.


7 Common Questions about Endometriosis

How is endometriosis diagnosed?
Laparoscopy, a common surgical procedure with a camera that is inserted into the abdominal cavity to directly see endometrial growths, is needed for the diagnosis of endometriosis. Diagnoses can also be made through a biopsy of tissue samples.

What are common symptoms?
Symptoms include painful menstruation, pain during sexual activity, painful urination or bowel movements during menstruation, infertility, fatigue, recurrent yeast infections, chemical sensitivities, allergies, and gastrointestinal issues such as nausea, constipation and diarrhea.

Can only older women be diagnosed?
Endometrial tissue only forms in women with active ovarian hormone production, restricting diagnoses to women of reproductive age. Symptoms may arise during adolescence, but many women are not diagnosed until they are older.

What is the cause?
The cause of endometriosis remains unknown.

How many women have endometriosis?
Roughly 176 million women worldwide.

Is there a cure?
There is no known cure, but there are solutions available to alleviate symptoms.

How can you lessen symptoms?
Through hormonal treatments such as birth control pills, symptoms can be lessened but not eradicated. Symptoms tend to lessen during pregnancy.


What is endometriosis?

It usually takes 10 years from symptom onset to receive an accurate diagnosis of endometriosis, according to the Endometriosis Foundation of America. Endometriosis is commonly misdiagnosed, often multiple times. The long diagnostic process is due to a lack of knowledge among the general public and medical community.

Each month during menstruation, the endometrial lining found inside the uterus sheds from the body. Endometriosis occurs when this lining, which is normally found inside the uterus, grows outside the uterus or in other parts of the body.

The endometrial tissue growing in other parts of the body cannot drain from the body as it normally would when it breaks down and sheds during a normal menstrual cycle. This causes inflammation and pain. Besides the uterus, endometrial lining can grow on the ovaries, fallopian tubes, bladder, on the outside of the uterus, lining the pelvic cavity, between the vagina and rectum, as well as distant organs.

How does endometriosis impact fertility?

Roughly 35-50% of women diagnosed with endometriosis also have infertility. This makes endometriosis one of the top three causes of female infertility. Not all women with endometriosis experience infertility. Approximately 60-70% of women with endometriosis are able to get pregnant.

The development of scar tissue and adhesions in the pelvic region can cause blockage in the fallopian tubes and damage the ovarian reserve. Endometriosis can create a hostile environment for sperm and eggs, or simply cause the ovaries and tubes not to function correctly. Surgery and medical treatments can resolve issues in some cases. Outpatient surgery is often necessary to diagnose the extent of endometriosis, but other non-invasive approaches like ultrasound or other radiologic techniques can be helpful.