Dr. Angeline Beltsos of Vios Fertility Institute is back with more Fertility Logia! Today she talks about endometriosis. Get these 10 surprising, must-know facts. [sponsored]
Endometriosis: what you need to know
Millions of women suffer from endometriosis. Many people don’t know what it is, or even if they’re suffering from it. How do you get diagnosed? Can it be cured? Read on for 10 surprising facts you must know about endometriosis.
1. WHAT IS ENDOMETRIOSIS?
When a woman gets her period, the lining of the uterus is shredded. The uterus has an empty space right in the middle where the baby grows, and the lining is called endometrium. The endometrium is soft, velvety, and sticky to allow for a lovely landing spot for the baby embryo. If there is not a pregnancy, the lining of the uterus comes out as menstrual blood which we call a period.
Sometimes the menstrual blood goes backwards out the fallopian tubes and lands in the pelvis. It sticks to things like the ovary and grows there. When uterine lining cells begin to grow outside the uterine cavity, like weeds grow in places we don’t want, we call that endometriosis. It causes inflammation and the body may react to this by covering the area with scar tissue, in attempt to protect delicate membranes. Unfortunately, in the end, this also can cause problems.
There are some other theories for this. One says cells from the menstrual flow travel through the blood stream and spread to areas far away like even in the lungs where it has also been found. A different proposal is that cells in the pelvis forget who they are and begin to act like endometrium, bleeding each month like a period. A fascinating new hypothesis has emerged — a disturbed microbiome may also predispose this condition.
2. HOW MANY WOMEN HAVE ENDOMETRIOSIS?
The odds of a woman getting endometriosis is 1 in 10. 176 million women in the world have in the world. That’s not a small number and many people go through life without ever being diagnosed. Incidentally, that is the number also of people who need to buy a lotto ticket to get a winner. Of the 176 million lotto ticket buyers, one wins. Like with endometriosis, many lose. Endometriosis can be very painful. Delayed diagnosis can make it harder to achieve pregnancy.
3. HOW OLD ARE WOMEN WHO GET ENDOMETRIOSIS?
Endometriosis can creep up any time in the reproductive age, from the first menses in the early teens to perimenopause when women are in their late 40’s. Therefore, when a woman is having pelvic pain, endometriosis is something to consider from ages 13-49. Even from the very first period to many years later, the inflammation and scar tissue can cause problems. Many women and care providers think that painful periods are just normal. But when it is more than some cramping, evaluation for endometriosis is a consideration.
4. WHAT DOES IT FEEL LIKE TO HAVE ENDOMETRIOSIS?
Symptoms of this classically include painful, heavy periods, pain with ovulation, and chronic pelvic pain. Though normal periods can be uncomfortable, endometriosis periods can include nausea, vomiting, and even fainting. These women may feel like they can’t even go to school or work during their menstrual days. Sexual intercourse can also be painful, as well as fatigue. Sometimes the presenting symptom is infertility. Again, a problem is that many women — as well as doctors — may discount their complaints and assume that women, of course, will have pain with periods. However, this can cause a significant delay in addressing those that actually have suffer from endometriosis.
5. HOW IS ENDOMETRIOSIS DIAGNOSED?
How can you tell if you have endometriosis? Start with asking yourself about how the periods really feel and dive deeper into other symptoms like if it makes you vomit or faint. Some have symptoms from organs near the uterus that also act up, like the bladder or bowel. Pain with urination or diarrhea, as well as constipation may occur.
A pelvic exam may or may not pick up swollen pelvic structures like an ovary. It isn’t detected by pap smears, and many assume that if their pap is normal that they don’t have endometriosis. An annual exam cannot rule out endometriosis. Ultrasound is a great tool to start with as it can sometimes find spots of endometriosis. However, it, too, is limited as is MRIs and CT scans.
When there are or fallopian tube problems that may be suspicious for endometriosis, an x-ray called hysterosalpingogrammay be done. Laparoscopy surgery should also be considered to diagnose endometriosis. Insight may also be gained from an endometrial biopsy, where a small biopsy is taken from the uterine lining. Beta 3 integrin by itself is also an option. Recently, another specialized test of the endometrial uterine biopsy, called Receptiva, may help in diagnosis. It checks for beta 3 integrin protein and BCL 6, a sign of inflammation and is performed in the office.
Often, these tests are not done but instead, medicine is given to see if that relieves the pain. This might include anti-inflammatory pills (NSAIDS like ibuprofen), birth control pills, or depot Lupron. If these medications relieve of decrease pain, it may be indicative that endometriosis is the cause of the pain.
6. COULD ENDOMETRIOSIS CAUSE CANCER?
Some studies have suggested that very rarely it could be linked to certain kinds of cancer. It is unclear why these women get cancer after having had endometriosis. Having said this, doing ultrasounds intermittently may be helpful to monitor spots or cysts and surgery is indicated if they look concerning. One cancer linked to this is clear cell carcinoma of the ovary.
7. IS THERE A CURE FOR ENDOMETRIOSIS?
Though there is no known cure per se, drugs like birth control pills or a shot called depot Lupron may help. Surgery can clear away much of the endometriosis and alleviate symptoms as well as well as potentially improve odds of getting pregnant. Pregnancy itself may also relieve the symptoms. Hysterectomy may be performed to remove much of the disease, but it too is not a definitive cure. If ovaries are removed, it may help as well by stopping the ovulation-driven menstrual cycle. Moreover, that will also result in immediate menopause.
8. CAN ENDOMETRIOSIS CAUSE INFERTILITY?
Endometriosis has been strongly linked to infertility by creating an inflammatory process which may disturb the ovary, the eggs, fallopian tube, as well as the uterine lining. This may create a toxic environment for the embryo. With scar tissue that may form, blockage of the fallopian tube can be a big issue. Some women develop swollen tubes which can even interfere with IVF success and cut chances of getting pregnant in half. Furthermore, adhesions around the ovary can interfere with the ovulated egg making it to the tube’s opening and therefore preventing pregnancy.
9. HOW MANY PATIENTS WITH INFERTILITY MIGHT HAVE ENDOMETRIOSIS?
Up to 50% of women who are not able to conceive might have endometriosis. Since it is so common in these women, this must be a working diagnosis as treatment options are considered. It can also be a silent condition, quietly preventing conception when no one suspects it.
10. WHAT DOES A WOMAN DO IF SHE IS NOT FEELING BETTER WITH MEDICINE?
In one study of teenagers with pain who were not feeling better on these medications, 70% were later found to have endometriosis. What’s the point? As a patient, be your own advocate and if not feeling better, push for more evaluation and discussions about treatment choices. It can cause more permanent damage later so earlier diagnosis is important for a variety of reasons. There are many online support groups and informational websites. Make an appointment with me or one of the doctors at Vios or a reproductive endocrinologist in your area to find answers and get the care that you deserve.
Angeline N. Beltsos, MD is CEO and Medical Director of Vios Fertility Institute. She is board certified in Obstetrics and Gynecology and in Reproductive Endocrinology and Infertility (REI), practicing medicine since 1991. Dr. Beltsos is also the Clinical Research Division Director of Vios and participates in a number of research projects and scientific publications. She has received numerous awards in teaching and has been honored as “Top Doctor” from Castle Connelly for several years. She is a popular speaker, both nationally and internationally, and a frequent media resource on the topic of infertility. She is the executive chairperson for the Midwest Reproductive Symposium International, an international conference of fertility experts. Dr. Beltsos is also a contributor to Thrive Global.
As the REI Division Education Director for the Obstetrics and Gynecology residency programs of Illinois Masonic Medical Center, Lutheran General Hospital, and St. Joseph’s Hospital Chicago, Dr. Beltsos helps educate future OB/GYN doctors. She is a Clinical Assistant Professor for the Department of Obstetrics and Gynecology at University of Illinois at Chicago.
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