|Endometriosis: Don’t let it rule out pregnancy|
How hormones help
Treating endometriosis is a bit like doing a balancing act. The dilemma: Relieving pain and preserving fertility don’t always coincide. So doctors have to weigh a woman’s family plans carefully when recommending treatment options or performing surgery. Hormonal medications, for instance, provide effective pain relief, but they don’t promote pregnancy. Some work by fooling the body into thinking it’s pregnant, suppressing ovulation and menstruation, and others trick the body into thinking it’s menopausal. Both methods achieve similar results: eliminating implants’ response to the menstrual cycle and stalling the growth of additional endometrial tissue.
Nancy and her husband had been trying to have a baby for six months. Frustrated, the 24-year-old made an appointment with her Ob/Gyn. She had no symptoms to report other than failure to conceive, but during the exam, Nancy noticed more discomfort than usual. And then her doctor told her he felt beadlike bumps behind her uterus. The diagnosis: endometriosis.
Nancy is just one of 5 million American women who have endometriosis, a disease in which tissue that normally lines the uterus is found outside the organ. The stray tissue, called implants, commonly latches onto the ovaries, the fallopian tubes and other pelvic organs. Problems develop because the implants respond to the monthly menstrual cycle as if they were in the uterus. With no outlet for the blood and tissue, inflammation and scarring result. Among possible symptoms are painful periods and spotting and discomfort during intercourse and bowel movements. Often, endometriosis is silent, producing no symptoms except unexplained infertility.
Leading cause of infertility
Extensive scarring around the reproductive organs essentially “freezes” the ovaries, the fallopian tubes and the uterus. Eggs may remain “stuck” in the ovaries or be unable to make their way through swollen fallopian tubes. Some experts believe endometriosis causes changes to the immune system that further disrupt a woman’s ability to conceive.
Although endometriosis can be treated, it can’t be cured—and it usually gets worse. That’s why women with the disease who want to have a baby would do well not to delay childbearing. In the mildest stages of the disease, doctors may take a wait-and-see approach since many women with early endometriosis eventually get pregnant without any treatment. However, recent research findings suggest surgery may be effective at this stage, particularly for women who are concerned about fertility. As for women with moderate to severe endometriosis who want to start a family, surgery is undoubtedly the best option.
For women who hope to get pregnant, the goal of surgery is to remove as much endometrial tissue as possible without creating new scars. With the aid of a laparoscope, doctors can destroy the stray tissue using several techniques, including laser surgery, electrocautery (in which the tissue is killed with an electric current) and curettage (scraping). Drug therapy may also be used to further boost a woman’s chances of conceiving.
Close attention needed
If you have endometriosis, it’s important for your doctor to keep a close eye on the condition. Together, you can work to relieve symptoms and help you plan for the future.
© 2014 Dowden Health Media