Millions of women around the world suffer from endometriosis — a condition in which uterine tissue migrates and grows abnormally outside of the uterus. Some women have no symptoms, while others experience severe pain, especially during their menstrual period.
The American College of Obstetricians and Gynecologists (ACOG) estimates that about one in 10 reproductive-age women suffers from endometriosis.
Endometriosis occurs when displaced endometrial tissue, behaving just as the lining of the uterus ordinarily would every month, thickens and sloughs during menstruation. When the menstrual blood from endometrial tissue has no place else to go, it is released into the surrounding tissues, causing inflammation and in some cases forming cysts (called endometriomas), scar tissue, or adhesions.
Occasionally, endometriosis can be found on organs or even old surgical scar tissue outside the pelvic cavity; these growths are called endometrial implants. While the majority are benign, they have been associated with an increased risk for developing cancer.
Chronic pelvic pain is the most common symptom of endometriosis, but some women have no symptoms, and others may suffer excessive bleeding or pain during sex or when using the bathroom. Most women are first diagnosed with endometriosis while seeking care for infertility.
Almost 40% of women with infertility have endometriosis. That’s because the internal scarring or adhesions from endometriosis may interfere with the release of eggs from the ovaries or block progress of the sperm. The associated inflammation also creates an environment inconsistent with fertilization.
Regardless, many women with mild to moderate forms of endometriosis can conceive normally and have healthy, term pregnancies. Because the condition can worsen over time, however, women with endometriosis who are certain they want to have a baby might consider conceiving sooner rather than later.
Diagnosing endometriosis is a process that usually begins with a pelvic examination. If endometriosis is suspected, the only way to absolutely confirm it is through laparoscopy, usually an outpatient procedure in which the physician inserts a long, slender scope with a tiny camera through a small incision to view internal tissues up close.
Treatment for confirmed endometriosis can be prescription of medications such as anti-inflammatory pain relievers or hormones delivered via contraceptive pills, which can inhibit endometrial tissue growth. In more serious cases, surgery is considered, but usually as a last resort. Surgery can physically remove endometrial tissue and improve fertility. Unfortunately, endometriosis often returns within two years of surgery. In the most severe cases, some women and their physicians choose total hysterectomy as well as the removal of both ovaries because estrogen from the ovaries can stimulate any remaining endometriosis.
Recent studies have identified a number of adverse pregnancy complications that are associated with endometriosis, and researchers encourage healthcare providers to be alert for potential risks among expectant women with a history of endometriosis. Their investigations found serious complications such as spontaneous rupture of the uterus, postpartum hemorrhage, and obstructed labor (dystocia) among these patients. Some patients had ruptured endometriotic cysts and ruptured ectopic pregnancies, though these occurrences were rare.
A related study identified poorer pregnancy outcomes among women diagnosed with endometriosis. These patients had a higher risk for miscarriage, ectopic pregnancy, placenta displacement, peripartum hemorrhage, and preterm birth.
Another study published in February 2017 showed that women with endometriosis: “had a statistically significant increased risk for having preeclampsia (1.4 fold), severe preeclampsia (1.7 fold), hemorrhage in pregnancy (2.3-fold), placental abruption (2.0-fold), placenta previa (3.9-fold), premature rupture of membranes (1.7-fold), retained placenta (3.1-fold), and hemorrhage after 22 gestational weeks (2.3-fold). Analyses of neonatal complications showed significantly increased risks of preterm birth before 28 weeks (3.1-fold) and before 34 weeks (2.7-fold), being small for gestational age (1.5-fold), a low Apgar score (1.4-fold), a diagnosis of a malformation within the first year (1.3-fold), and neonatal death (1.8-fold) for infants born to women with endometriosis.”
The exact cause of endometriosis is not known. However, women carry a greater risk if they:
• have never given birth;
• started their period at an early age;
• went through menopause later than average;
• have short menstrual cycles (less than 27 days);
• have high estrogen levels;
• drink alcohol;
• have a low body mass index; or
• have close family members with endometriosis.
March is National Endometriosis Awareness Month (with March 3-9 designated Endometriosis Awareness Week). While there is no cure for endometriosis, with appropriate care, its sufferers are able to mitigate symptoms and live quality lives. Many can have healthy pregnancies.