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Angeline N. Beltsos, MD, is the CEO, Clinical at Kindbody and is board certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility. Dr. Beltsos has received numerous awards and is a popular speaker nationally and internationally, as well as a frequent media resource on the topic of infertility. This article is written from the point of view of Dr. Beltsos based on her more than two decades of extensive experience working with patients facing infertility.
If you and your partner are struggling to have a child, you're not alone. Infertility may affect many people and can be caused by a number of factors. One of these factors is a disorder called endometriosis. Despite its prevalence (about 1 in 10 women of reproductive age has endometriosis), it’s not necessarily a topic that is well understood among the general public or healthcare professionals. Some women use this uncertainty and misunderstanding to increase their drive for answers as they struggle with what a diagnosis could mean for their fertility, especially since approximately one-third to one-half of women with endometriosis have difficulty getting pregnant.
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To help alleviate some anxieties you may be having and address some initial questions about endometriosis, I’ve compiled the most common topics my patients want to discuss when it comes to the disorder below.
What Is Endometriosis, and How Can It Affect Fertility?
Endometriosis is a disorder in which tissue that normally lines the inside of a woman’s uterus (endometrium) grows outside her uterus. The most common sites of endometriosis are the ovaries, fallopian tubes, and the tissue lining the pelvis. The tissue may grow and bleed like the uterine lining does during the menstrual cycle. Surrounding tissue can become irritated, inflamed, and swollen. The breakdown and bleeding of this tissue each month also can cause scar tissue to form.
Endometriosis can sometimes cause severe pain that may become especially heightened during a woman’s period. Common symptoms may be painful periods and impaired fertility. Endometriosis may prevent pregnancy by blocking the fallopian tube and keeping the egg and sperm from coming together, which is required for conception. It is important to remember that having endometriosis does not automatically mean that you will never have children. Rather, it means that it may be more difficult to conceive.
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What Are the Signs and Symptoms?
Endometriosis can sometimes be mistaken for other conditions including pelvic inflammatory disease (PID), ovarian cysts, and even irritable bowel syndrome (IBS). Endometriosis usually develops several years after the onset of menstruation. You should talk to your doctor or healthcare provider if you are experiencing the following symptoms:
- Painful periods – Cramping and pelvic pain beginning before and extending many days into your period, which may include lower back and abdominal pain.
- Pain during intercourse – Discomfort during or after sex.
- Pain with bowel movements or urination – Discomfort that is especially heightened during your period.
- Excessive bleeding – Including heavy menstrual periods or bleeding between your periods.
- Other period symptoms – Including fatigue, diarrhea, constipation, bloating, or nausea.
- Infertility – Struggling to get pregnant with no other reason identified.
Your diagnosis may start with a conversation with a doctor in which you can explain your symptoms, pointing out the location of your pain and when it occurs. Doctors can use pelvic exams, ultrasounds, magnetic resonance imaging (MRI), or laparoscopy to confirm an endometriosis diagnosis.
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So, What Now?
Because endometriosis may be difficult to understand, patients often must advocate for themselves to find someone who can properly diagnose them. From my experience with patients, what makes this more difficult is that endometriosis can be a challenging condition to manage both physically and emotionally. I encourage any woman who suspects she may have endometriosis to speak with a doctor to determine next steps.
If you're having trouble getting pregnant, your doctor may refer you to a specialist, like a reproductive endocrinologist, who focuses on reproductive hormones and optimizing fertility. They may recommend fertility treatments or, in some cases, conservative surgery to remove endometriosis tissue while preserving your uterus and ovaries, which may increase your chances of a successful pregnancy.
Moreover, while attempting pregnancy, some will avoid surgery altogether. Intermittent sonograms may be important to watch for any changes and make sure that there are no immediate concerns for long-term implications.
It’s crucial to find and connect with a doctor you feel comfortable with to help manage and identify treatment options for your endometriosis that may help with fertility. Conversations with your doctor or healthcare provider may help create a plan that makes you feel supported and safe. Joining a support group for women with endometriosis or fertility problems can also be helpful. For more information, support, and resources, visit fertilityjourney.com.
