It is estimated that more than 175 million women in the world suffer from endometriosis or what is the same, one in 10 women. In addition, between 30-50% of them have fertility problems. Check out more articles on our site.
This is how the Basque Fertility Institute (IVF) explains it, which speaks of “a silent disease that causes a significant psychological impact on the woman who suffers from it” , since her quality of life is diminished by pelvic pain and ignorance about part of society.
Fortunately, advances in medicine open the door for most women with endometriosis to become mothers if they wish.
What is endometriosis
The Mayo Clinic explains that it is an often painful disorder in which tissue similar to the tissue that normally lines the inside of the uterus (the endometrium) grows outside the uterus. It most commonly affects the ovaries, fallopian tubes, and the lining of the pelvis, although it can rarely spread beyond the pelvic organs.
The endometrial-like tissue acts as endometrial tissue would: it thickens, breaks down, and bleeds with each menstrual cycle. But because this tissue has no way out of the body, it gets trapped. It usually develops several years after the start of menstruation, and the signs and symptoms of endometriosis may temporarily improve with pregnancy and may disappear completely with menopause.
- Pelvic pain , often associated with menstrual periods, although menstrual pain is much worse than usual . Pelvic pain and cramping can start before and continue for several days after your period.
- Pain during or after sex .
- Pain with bowel movements or urination , especially during a menstrual period.
- Sporadic heavy menstrual periods or bleeding between periods.
- Sterility . It is sometimes diagnosed in those seeking treatment for infertility .
- Women may also experience fatigue, diarrhea, constipation, bloating, or nausea , especially during menstrual periods.
The intensity of the pain is not necessarily an indicator of the severity of the disease: you can have mild endometriosis with severe pain or advanced endometriosis with little or no pain.
Diagnosis of endometriosis
It is not easy to discover. In fact, specialists take an average of eight years to diagnose the disease. For this reason, experts advise carrying out a previous female fertility study if you want to be a mother, since the disease has no cure and worsens over time.
In general, the definitive diagnosis is confirmed with a pelvic examination, a vaginal ultrasound and in cases of severe endometriosis by laparoscopy, a simple surgery to assess the presence of cysts (also called endometriomas or chocolate cysts) or pelvic adhesions.
There is also the possibility of performing a blood test to analyze the levels of the Ca 125 antigen, a tumor marker that can be elevated in certain cancers, and in other diseases such as endometriosis I and II.
Types of endometriosis
There are three basic forms of presentation of the disease:
- 1. endometriosis peritoneal superficial (tipo I)
- 2. ovarian endometriosis (type II)
- 3. deep endometriosis (type III)
The three types of injury may be found separately or in combination, and the associated inflammatory component may stimulate pelvic nerve endings and thus cause pain, impair tubal function, decrease endometrial receptivity, and impair oocyte and embryo quality. Also, these injuries can cause adhesions that can block the fallopian tubes and cause infertility.
The group of patients with type I and II endometriosis is the largest (more than 90%), they usually present less severe symptoms, and can be treated from primary care.
According to the American Fertility Association , we can classify endometriosis into four stages. In stage 1 endometriosis is minimal, in stage 2 it is mild, in stage 3 it is moderate and in stage 4 it is severe. This scoring system correlates with the success of the pregnancy.
Thus, women with severe endometriosis (stage 4) are the ones who face the greatest difficulty in achieving pregnancy , since at this stage the disease causes considerable scar formation, blocks the fallopian tubes and damages the ovaries. For this reason, it is often necessary to resort frequently to advanced fertility treatments.
Endometriosis risk factors
It is not known exactly what causes the disease, although different causes have been suggested, such as retrograde menstruation, an immune system disorder or after surgery, such as a hysterectomy or cesarean section , since “endometrial cells can adhere to a surgical incision”.
However, the Mayo Clinic ensures that there are factors that imply a higher risk of developing endometriosis:
- Never having given birth.
- Having the first rule at a young age.
- Short menstrual cycles (less than 27 days).
- Heavy menstrual periods that last more than seven days.
- Having higher levels of estrogen in the body or a higher lifetime exposure to the estrogen your body makes.
- low body mass index
- Direct relatives with endometriosis (mother, aunt or sister).
How to treat endometriosis to achieve pregnancy?
Endometriosis is one of the most enigmatic and controversial diseases in gynecology, therefore, there is no ideal treatment for it.
At the moment there is no treatment capable of achieving the four basic therapeutic goals : suppress symptoms (pelvic pain), restore fertility, eliminate visible endometriosis and prevent disease progression.
Medical therapy is effective in the treatment of pain, but there are no effective drugs in the definitive elimination of endometriosis.
We can divide the treatment of endometriosis into:
- a) Hormonal treatment
- b) Analgesic drugs
- c) Surgical treatment
Getting pregnant with endometriosis
According to the Mayo Clinic, the main complication of endometriosis is impaired fertility . For pregnancy to occur, an ovary must release an egg, which must travel through the neighboring fallopian tube, be fertilized by a sperm, and attach to the uterine wall to begin development.
Endometriosis can block the tube and prevent the egg and sperm from joining. But the condition also appears to affect fertility in less direct ways, such as by damaging the sperm or egg.
Hence, the search for the so-called “conventional” pregnancy is complicated in some cases and it is necessary to resort to fertility treatment.
For this reason, from the IVF they advise freezing the ovules to preserve fertility and achieve pregnancy when the patient wishes, since endometriosis is a progressive disease that affects a woman’s fertility.
In addition, they explain that experts usually opt for less invasive medical treatments than surgery, “but it is possible that the fertility specialist recommends performing a laparoscopy before starting treatment and thus improve the probability of pregnancy with endometriosis.”
One of the techniques with the best results for patients suffering from moderate or severe endometriosis is In Vitro Fertilization , both conventional IVF or through the ICSI technique. It is also the treatment of choice when success has not been achieved after Artificial Insemination .
For those cases in which previous surgeries may have damaged healthy tissue during and, therefore, have caused a greater deterioration of fertility, egg donation treatment may be an alternative with high success rates.
In addition, pregnancy improves the symptoms of the disease since the menstrual cycle is withdrawn during pregnancy due to the absence of secretion of the hormones responsible for ovulation. The ovaries do not produce estrogen and the hormones that favor the growth and development of endometriosis foci remain at rest.
That is why the importance of an early diagnosis, since many times it is not discovered until the woman does not go to a fertility clinic because she does not get pregnant. But, even with a “somewhat late diagnosis, it is possible to get pregnant.”