Endometriosis is linked to infertility and affects five to 10 percent of women of child-bearing age. Dr. Jennifer Mills, an obstetrician/gynecologist at Touro Infirmary, discusses the condition, its symptoms and treatment options.
Q: What is endometriosis?
A: Endometriosis is a chronic gynecological condition where the uterine lining — or endometrium — gets outside the uterus. It can stick to the ovaries, bowels or the lining of the pelvis, a tissue called the peritoneum. The endometrium is a very inflammatory type tissue. Think of how bloated and crampy you feel when you have your period. The tissue can cause an inflammatory response locally, and it can also cause scar tissue and form cysts, especially on the ovaries. There are several proposed theories (as to its cause), but retrograde menstruation is the most probable one. It affects between 5 and 10 percent of women.
Q. What increases a woman's risk for endometriosis?
A: It does tend to run in families. If you have an affected first-degree relative, then your chance is increased 7 to 10 percent. There are other risk factors: If you start your period before age 11, have short cycles of less than 27 days, are prone to heavy, prolonged periods (bleeding for seven days). Some things that decrease your risk are having babies and breastfeeding, as well as exercise.
Q: What are symptoms of endometriosis, and how is it diagnosed?
A: There are variable symptoms, and they are unpredictable. Some women have severe endometriosis and have no symptoms at all, and some have extensive symptoms and not a lot of endometriosis. Dysmenorrhea (menstrual pain), menstrual cramps, daily pelvic pain, pain during intercourse and ovarian cysts are some symptoms. The only way to ever know if you have endometriosis is to have surgery, a laparoscopy where a camera is inserted in your belly button, and the endometriosis is seen and removed by a surgeon, and a pathologist confirms that it is endometriosis.
Q: How long does it take to recover from a laparoscopy?
A: It varies depending on the extent of the disease. Recovery is anywhere from one to two weeks, but the laparoscopy is a one-day surgery where you come in that morning and go home that afternoon.
Q: Can endometriosis affect your fertility?
A: Unfortunately, it could. Although there's not a lot that is understood about the fertility link, it is probably twofold and has to do with the inflammatory effects of the tissue. Advanced endometriosis can cause scarring of the fallopian tubes, which causes infertility, or anatomic abnormalities that result in abnormal tubal function.
Q: If you have a laparoscopy to remove endometriosis, does that increase your fertility?
A: It definitely does increase your fertility rate by about 60 percent. For women who are having trouble with infertility, endometriosis is a reason in 38 percent. And again, endometriosis doesn't always lead to infertility, but it is a risk factor. I know a woman who was diagnosed with endometriosis as a teen and was told she would have difficulty conceiving, but she went off birth control pills and conceived the first time she tried at age 37. So it is not necessarily going to cause you bad problems in the future.
Q: Are there any alternatives to surgery for treating endometriosis?
A: A lot of times we use birth control pills and Depo-Provera as the first line for women who have heavy, painful periods, but taking birth control pills is not going to prevent you from getting endometriosis. There is something called Lupron that can actually treat endometriosis — it tricks your body into thinking you are going through menopause. Endometriosis is fed by estrogen, and what Lupron does is turn off your body's ability to make hormones, so the endometriosis that is present withers and dies. It has pretty rotten side effects — hot flashes and mood swings — but women who are having side effects can take small doses of hormone pills. And after you go through menopause, endometriosis completely resolves because it is fed by estrogen.
Conservative management is always best, and for women who are having symptoms that might be endometriosis, if they are able to resolve those by taking birth control pills or anti-inflammatory medications like ibuprofen, then that is definitely what they should do.