By Shaun Williams, MD, a Reproductive Endocrinologist with RMA of Connecticut
Top Chef star Padma Lakshmi was diagnosed with endometriosis at the age of 36, despite experiencing symptoms as a teenager. Lakshmi has used her celebrity to shed light on a condition that affects more than 11% of American women in their reproductive years, ages 15 to 44. Endometriosis, a pelvic inflammatory condition that can cause infertility and pelvic pain, is often difficult to diagnose because there are no simple tests that positively identify the condition. Every woman who experiences either pelvic pain or infertility may have endometriosis present, but those symptoms can also be due to other diseases or problems. According to a recent study, endometriosis can affect up to 10% of females, and within that population, up to 50% can experience fertility struggles.
Endometriosis occurs when small cells that normally grow on the inside of the uterus begin to grow outside of the uterus within the pelvis, next to the fallopian tubes, and around the ovaries. These small cells grow over time and produce inflammatory chemicals that can cause pelvic pain and inflammation. This inflammation can then lead to pelvic scar tissue and distortion of the pelvis. These small implants of cells as well as scar tissue caused by these implants cannot be seen by any imaging exam such as ultrasound, and they are difficult to identify on a normal physical exam. There is also no evidence that can be seen in blood work.
The only conclusive way to identify and diagnose endometriosis is to perform a specific kind of surgery to look into the pelvis and identify these abnormal areas and associated scar tissue. A minimally invasive surgery through the belly button, called a laparoscopy, is typically performed to identify endometriosis as the cause of pelvic pain. If endometriosis is identified, these areas of inflammation can be removed and women may have less pelvic pain, but the presence of endometriosis can contribute to fertility problems even after surgery.
Endometriosis is a hormone-sensitive condition. As the ovaries produce normal hormones each month, endometriosis may grow and worsen. Pain from endometriosis usually occurs right before and during a menstrual cycle. This cyclic pain and the growth of endometriosis can be treated with medications that inhibit ovarian function. This means that the ovaries are not producing eggs during the month, and this will also prevent pregnancy from occurring. That is why it is difficult to treat endometriosis associated with infertility. For couples trying to get pregnant, fertility treatments often stimulate the ovaries to produce more eggs and more hormones during the menstrual month, but this does not do anything to treat the pain associated with endometriosis. In fact, it can increase the pain. For women with both infertility and pelvic pain related to endometriosis, the goal is to help pregnancy occur more quickly, reducing the amount of time that the patient feels the pain that occurs with the menstrual cycle.
Fertility treatment cycles are usually the best course of treatment instead of laparoscopic surgery for women who are trying to conceive with endometriosis. However, there are instances where surgery for endometriosis may be performed prior to fertility treatments, especially if pelvic pain is a significant factor. Surgery for endometriosis is very good at relieving pelvic pain, but it is likely to only minimally increase the chances of a naturally occurring pregnancy or diminish the need for fertility treatment when the woman is ready to conceive.
Endometriosis, unfortunately, cannot be completely cured. Pelvic pain can be minimized, and infertility can be overcome with treatment, but the pelvic inflammation and the presence of the endometriosis cells within the pelvis usually continues throughout a woman’s reproductive life. At times endometriosis can progress to cause chronic pelvic pain which is very difficult to treat.
Women who experience endometriosis are certainly not alone and have science, experts, and advocates working hard for them to find more helpful solutions. New medications are being explored and birth control continues to be an adequate way to keep the unwanted cells from proliferating. And when a woman with this chronic condition decides to start building her family, a fertility specialist can help if there are any unwanted delays.
