By Seth G. Derman, M.D. Princeton HealthCare System
Endometriosis, a painful condition that affects nearly five million American women, can often interfere with a woman’s quality of life.
Not only can it keep women from work, school, and social activities, it can keep them from getting pregnant.
Endometriosis occurs when tissue similar to the tissue that lines the womb grows outside the uterus on other organs or structures in the body, most commonly the ovaries, or on the peritoneum, a thin layer of cells that lines the abdomen and pelvis.
When this happens it can cause inflammation, pain, and scar tissue that can impact the function of the ovaries and block the fallopian tubes, which can lead to infertility.
At Princeton IVF Laboratory, leading fertility specialists help women manage endometriosis and offer a range of treatment options to help them conceive.
But the first step is recognizing the symptoms and getting a proper diagnosis.
The most common sign of endometriosis is pain in the lower abdomen or pelvis, or lower back, mainly during menstruation. Commonly, the pain from endometriosis also occurs around two weeks prior to menstruation when a woman is ovulating, or with intercourse. However, in some cases, this disease is painless and the first sign of endometriosis may be infertility.
Endometriosis is most common in women in their 30s and 40s and is more likely to occur in women who have a family history of the disease. While the exact cause of the disease is a subject of debate, researchers have found a number of abnormalities in the immune systems of women with endometriosis, leading many to conclude that endometriosis is an autoimmune disease.
Diagnosing endometriosis typically begins with a pelvic exam and may also include an ultrasound to see if there are ovarian cysts caused by endometriosis called endometriomas. Yet the only sure way to diagnosis the condition is through laparoscopy, a minimally invasive surgical technique that enables doctors to look inside the abdomen to see the often small implants of endometriosis.
Though there is no cure for endometriosis, there are a variety of treatment options to help women manage the disease. Determining the best option depends on your symptoms, age and plans to get pregnant.
• Pain medication. If your symptoms are mild, your doctor may simply recommend over-the-counter pain medication, such as ibuprofen or naproxen.
• Birth control pills and progestins. These help prevent the overgrowth of normal endometrial tissue and may reduce the risk for this type of tissue growing in other areas. Because birth control pills suppress endometriosis, many women with the disease are able to conceive shortly after discontinuing the medication.
• GnRH agonists (leuprolide). These drugs suppress hormones produced in the pituitary gland and ultimately reduce the amount of estrogen in the body, and as result, the implants of endometriosis lose their hormonal support and whither away. This is similar to what occurs naturally during menopause. For that reason, side effects may include hot flashes, mood swings, and bone loss. Low dose progesterone and estrogen therapy can help reduce these side effects.
• Aromatase inhibitors (anastrazole, letrazole). These drugs, which are used to treat breast cancer, have recently been shown to help pain by suppressing the estrogen production in the endometriosis implants. They are unsafe to take during or just before pregnancy and should be used with caution in women considering pregnancy.
• Surgery. While medication therapy is an effective approach to managing endometriosis in women who are not trying to get pregnant, surgery is often the most effective treatment for women who want to simultaneously control the pain and conceive. It is also recommended for women who have severe symptoms that have not responded to medication.
Surgery is performed laparoscopically, through tiny incisions in the abdomen that allow doctors to insert a small video camera and surgical instruments. Doctors then either cut or burn away the endometriosis tissue and repair any scar tissue. Recovery from laparoscopic surgery is much quicker and less painful than from traditional abdominal surgery.
In severe cases, when the pain of endometriosis has become too much or conservative medical or surgical management has failed, a hysterectomy may be necessary. This, however, is a last resort and is not recommended until a woman is finished having children. At University Medical Center at Princeton, specially trained surgeons are able to perform hysterectomies using a minimally invasive approach resulting in a shorter recovery time and smaller scars.
• Alternative treatments. In addition to medication and surgery, many patients with endometriosis report relief from alternative therapies such as acupuncture and pelvic physical therapy. Healthy lifestyles including exercise and weight loss may also help improve the pain.
Endometriosis can take a toll on women, as well as on couples trying to conceive. If you have symptoms of endometriosis, including unexplained infertility, consult your doctor about a treatment approach that is right for you. Fortunately, with a little help, endometriosis does not have to stand in the way of getting pregnant or leading a normal life.
Princeton IVF Laboratory is a partnership between University Medical Center at Princeton and Princeton IVF in Lawrenceville and is dedicated to helping couples with infertility issues realize their dreams of having a child.
For more information about Princeton IVF Laboratory call (609) 896-4984.
Seth G. Derman, M.D., F.A.C.O.G., is board-certified in gynecology and reproductive endocrinology. He is a Fellow of the American College of Obstetricians and Gynecologists and a member of the medical staff at UMCP.
