Endometriosis can cause infertility

By Richard Waldman, MD

Congress of Obstetricians and Gynecologists

Up to 50 percent of child-bearing-age women struggle with endometriosis, a condition that can cause mild to severe pelvic pain before and during menstruation and can lead to infertility in women. Endometriosis is most common among women in their 30s and 40s, but it can occur in menstruating women of any age. Women who have never had children and those who have a mother, sister, or daughter with endometriosis may be at increased risk.

In a normal menstrual cycle, endometrial cells thicken the lining of the uterus in preparation of supporting a fertilized egg. If no egg implants, the lining sheds off during menstruation. In most women, a small amount of endometrial cells flows back through the fallopian tubes and into the abdomen or travels through blood and lymph vessels.

Endometriosis occurs when these cells attach to other places such as the ovaries, fallopian tubes, rectum, intestines, bladder, ureters, and the surface of the uterus. The misplaced cells behave just like the endometrial cells inside the uterus they may bleed before and during menstruation and cause scar tissue to develop.

Women with endometriosis may experience pain during sex, urination, or bowel movements, before or during menstruation, or may have menstrual bleeding more than once a month. Some women do not have symptoms and may be first be diagnosed when they have trouble getting pregnant.

Endometriosis can only be truly confirmed through surgery. Laparascopy is the most common surgical procedure used. A lighted scope is inserted through a small incision in the abdomen and allows your doctor to view your pelvic organs. If endometriosis is found during the procedure, it can often be removed at the time of the exam.

Endometriosis can also be treated with medication. Your doctor may prescribe ibuprofen, naproxen, or other pain-relief drugs. Birth control pills may be prescribed to control the menstrual cycle and shrink areas of endometriosis. Other hormonal methods such as progestin or gonadotropin-releasing hormones may be used, but they can cause side effects, such as hot flashes, loss of bone density, bloating, headaches, vaginal dryness, mood changes, sexual problems, and weight gain. Though hormonal medications can suppress endometriosis, they are not effective in treating infertility caused by the disorder.

Surgery to remove endometriosis and scar tissue may be necessary in severe cases. While surgery and treatment may help on a short-term basis, about half of women who have surgery will experience symptoms again within a year. Many women report improvement in their symptoms after menopause.

For more information, the American Congress of Obstetricians and Gynecologists Patient Education Pamphlet "Endometriosis" is available at the group's Web site located at www.acog.org/publications/patient_education.

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