What is endometriosis?

Endometriosis is a disorder that occurs when the tissue that normally lines the inside of the uterus (endometrium) is outside the uterus. Endometriosis can develop outside the uterus, in the ovaries and tubes, and even in the bladder or intestines. This tissue can irritate the structures it touches and thus cause pain and adhesions (scar tissue) in these organs.

How can I know if I have endometriosis?

Many women with endometriosis suffer from pelvic or abdominal pain, particularly with menstrual bleeding or having sex. Some women do not have symptoms. Endometriosis can decrease the chances of getting pregnant. In fact, 30% to 50% of infertile women have endometriosis. Sometimes, endometriosis can grow inside the ovary and form a cyst (endometrioma). Unlike other endometriosis tissues, this can usually be seen on ultrasound. The only way to know with certainty if you have endometriosis is through a surgical procedure called laparoscopy.

Does endometriosis cause infertility?

If you have endometriosis, it may be harder for you to get pregnant. From 30% to 50% of women with endometriosis may experience infertility.
Endometriosis can influence fertility in several ways: it distorts the anatomy of the pelvis, produces adhesions, leaves scars on the fallopian tubes, causes inflammation in the structures of the pelvis, alters the functioning of the immune system, changes the hormonal environment of the ovules, harms the implantation of pregnancy and alters the quality of the ovule.
At the time of surgery, the doctor can evaluate the amount, location and depth of the endometriosis and give it a “score”. This score determines whether your endometriosis is considered minimal (stage 1), mild (stage 2), moderate (stage 3) or severe (stage 4). This scoring system correlates with the success of pregnancy. Women with severe endometriosis (stage 4), which causes considerable scar formation, blocks the fallopian tubes and damages the ovaries, are those who face greater difficulty in becoming pregnant and often require advanced fertility treatment .

How is endometriosis treated?

Endometriosis needs the female hormone called estrogen to develop and grow. Contraceptive pills and other medications that decrease or block estrogen may be effective in improving pain symptoms. Patients who wish to become pregnant may consider medical therapy before attempting conception, but this treatment usually does not improve pregnancy rates.
If endometriosis is seen at the time of surgery, your doctor will surgically destroy or eliminate the endometriosis and remove the scar tissue. This treatment will restore your normal anatomy and allow your reproductive organs to function normally again. The chances of getting pregnant improve after surgical treatment, especially if your endometriosis is in the moderate or severe range. The combination of medical and surgical therapy may be beneficial in patients attempting to conceive through in vitro fertilization (IVF). In general, the treatment is highly individualized for each patient.

Revised in 2012

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