March is Endometriosis Awareness Month

Endometriosis, shortened to #endo in Twitter slang, is coming out of the closet. Celebrities like Padma Lakshmi, Jillian Michaels, and Lena Dunham have spoken out about their endo diagnoses and are spreading awareness about this gynecological condition that affects approximately 176 million women worldwide, including five to six million in the U.S. Ms. Dunham, star and producer of the millennial television hit “Girls,’ recently announced she was taking time off to deal with her illness because of its severity. We applaud her candor because not many women want to admit to excruciating menstrual cycle symptoms.

Young woman having abdominal pain

In addition to infertility, a few of the more common characteristics of endometriosis are debilitating periods, painful sexual intercourse, generalized pelvic pain and digestive problems. Also women with endometriosis can have no symptoms, but it still may interfere with their ability to get pregnant.

Common infertility diagnosis
Up to 40% of women having trouble trying to conceive have endometriosis, though conversely a diagnosis does not necessarily mean they cannot get pregnant. Its exact cause is not known, but there appears to be a genetic link since it is more common in daughters of women who have had it.

Endometriosis causes problems beyond the uterus
Endometriosis is misplaced tissue from the lining of the uterus that travels to other areas of a woman’s body. It typically appears in the rectum, ovary, uterus, and fallopian tubes, and adheres there, causing internal scar tissue. There even have been documented cases of endometriosis in organs distant to the pelvic cavity, such as the lungs and the brain. It occurs when endometrial cells enter the pelvic cavity through a back flow of blood during the menstrual cycle and attach to internal organs.

The diagnosis of endometriosis can take a very long time
Endometriosis can be hard to diagnosis and there is often a long delay between a woman going to a doctor about her symptoms and being diagnosed – eight and a half years is the average, but for some women it can be even longer. At HRC Fertility, our infertility specialists can perform a laparoscopy for the evaluation of endometriosis. We often treat the disease during this diagnostic operation.

Endometriosis ranges in severity and its affect on fertility
There is no ‘one size fits all’ endometriosis. It is typically “staged” from one to four, according to its severity and likelihood of causing infertility, with four being the most severe and characterized with extensive adhesions and possibly endometriomas, which are benign, estrogen-dependent cysts.

Endometriosis can affect fertility in many different ways, causing ovulatory problems, inflammation within the pelvic cavity preventing embryos from developing, difficulty with fertilization, and physical damage to the fallopian tubes and other reproductive organs.

Treating Endometriosis
Endometriosis depends on estrogen for growth so drug treatments aim at reducing estrogen levels. It is commonly treated with Lupron, a gonadotropin releasing hormone (GnRH) agonist that will slow endometrial cell growth.

Endometriosis is often surgically removed during a laparoscopy. Fertility specialists meticulously remove all endometriosis lesions as there is some evidence that even small amounts of endometriosis can lower pregnancy rates.
If endometriosis has penetrated and damaged the fallopian tubes, in vitro fertilization (IVF) may be the best treatment option.

The future for women with endometriosis
According to a report in The Guardian published last year, the global financial cost of endometriosis is estimated to be about $10,762 per woman per year, similar to the financial impact of diabetes. Much of that cost is due to lost work and productivity as well as health care costs.

The good news is that there are effective ways to diagnose and treat endometriosis and manage its pain, as well as help women who have it to become pregnant. We hope in the future more research and resources are dedicated to this all too common medical condition that affects the lives, lifestyles and baby dreams for ten percent of women of reproductive age around the world.

“Endometriosis: 20 things every woman (and doctor) should know” The Guardian

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