Though one of the leading causes of infertility in women, Endometriosis often goes undetected. However, March marks Endometriosis Awareness month, a national effort to raise awareness about the condition that affects millions of women as well as the treatments available to women today unlike the women of generations past, who were forced to endure it.
Women frequently learn that they have endometriosis only after seeking help for infertility. Two women who are having trouble getting pregnant may both have the condition, but it can manifest itself very differently. One woman may have abdominal pain, lower back pain, pain with intercourse, irregular bleeding, or diarrhea and constipation, while another may have no symptoms.
More than 5 million women in the U.S. have endometriosis, according to the Department of Health and Human Services Office on Women’s Health. With endometriosis, cells from the lining of the uterus grow in other areas of the body. These cells attach themselves to other pelvic organs, such as the bowel, bladder, or ovaries, often causing pain and frequently implicated in infertility. The Centers for Disease Control and Prevention reports that 2.1 million, or 7.4 percent of married women ages 15 to 44 are unable to get pregnant for 12 consecutive months, the definition of infertility.
“Endometriosis can be masked by many other things,” says Jane Frederick, M.D., a reproductive endocrinologist and infertility specialist with HRC Fertility in Newport Beach. Some women assume the pain of endometriosis is due to severe menstrual cramps and ignore it, she says. She urges women to come forward and seek help if they are experiencing symptoms of endometriosis.
“Nobody should be out there having pelvic pain,” added Frederick.
The cause of endometriosis remains unidentified. The condition runs in families, says Frederick.
“If a woman’s mom, aunts, and sisters had endometriosis, there’s a pretty good chance that she will have it, too,” she says.
While endometriosis is a leading cause of infertility, not all women who have the condition have trouble getting pregnant. Frederick recalls delivering the last of a patient’s several children by C-section and discovering during the procedure that the woman had very severe endometriosis. She had no symptoms and was unaware that she had the condition.
Treating endometriosis may include nonsteroidal anti-inflammatory medications such as ibuprofen and naproxen sodium to manage the pain, Frederick explains. Acupuncture also provides relief from the pain of endometriosis, she says. If pain is a woman’s primary concern and she does not want to get pregnant, Frederick says she may prescribe a continuous dose of oral contraceptives, which stops a woman’s menstrual periods altogether. This treatment decreases the growth of the endometrial implants and lessens the pain, she says.
Sometimes surgery is required to remove endometrial implants. The outpatient procedure, called laparoscopy, involves making a small incision near the belly button, and removing the endometrial implants and scar tissue with a laser or cauterization. Frederick says most patients are back to normal activity in two or three days.
In women with extensive endometriosis, surgically removing endometrial implants and scarring may free up the area around the Fallopian tubes and sometimes allows a previously infertile woman to become pregnant, Frederick says.
Less than a generation ago, women who had symptoms of endometriosis were likely to be told that they had to live with it. Although there is still no cure, research on the condition has advanced and symptoms can be managed.
“We’re better able now to diagnose, treat, and give relief,” says Frederick.