Apr 04, 2019 12:00 AM


Among the many conditions that can make an impact on women’s reproductive health and fertility is endometriosis, a difficult-to-diagnose condition that affects between 6–10% of women. Endometriosis is defined as the presence of tissue normally found in the uterus implanted in places outside the uterus.

Endometrium, or uterine tissue, is distinctive in that it gets thicker and bleeds each month. Normally, this blood and discarded tissue leave the body as part of a period. With endometriosis, the endometrium is located outside of the uterus, most commonly on the ovaries, fallopian tubes, or within the pelvic region. When the tissue is located outside of the uterus, it has nowhere to go, leading to cramps, painful intercourse, chronic pelvic pain, and infertility.

Endometriosis is difficult to diagnose because the only way to get a certain diagnosis is with an invasive surgery where tissue is removed and examined. This means that diagnosis can take years. “It’s really a process of elimination,” says Megan Link, MD, assistant professor in the OBGYN department at University of Utah Health. “We’ll do a thorough history and exam. There are some things that we can find in family history. If a first-degree relative has endometriosis, it’s much more likely that a woman has endometriosis.”

Although endometriosis can be quite debilitating, this is not the case with every woman who has it. Some women may have the disease and never know about it. About a third of women who have it find that it gets better over time. Another third find that it gets worse, while the final third find that it stays the same.

It is possible for endometriosis to interfere with fertility or to spread to other organs, like the bladder, bowels, and even the lungs.

There are two primary treatment options when it comes to endometriosis: medical management and surgery. “Medical management is considered the mainstay,” Dr. Link says. “We think of this disease like we think of hypertension or other chronic medical conditions. We want to suppress endometriosis with hormone therapy.”

A medical management option can allow a woman to cope with the disease, leading to reduced pain and improved quality of life. Surgery is an option if the symptoms aren’t controlled with medications.

No one is sure what causes endometriosis, but there are many theories, including retrograde menstruation, wherein menstrual fluid goes backward through the fallopian tubes and spurs tissue growth in new areas. Regardless of how it begins, endometriosis is a potentially disruptive condition that can significantly alter a woman’s quality of life.

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