Endometriosis and Infertility Treatment 

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Many are familiar with endometriosis and how it results in infertility, so let us discuss it and available treatments for the condition.  What is Endometriosis? Endometriosis is a disorder where tissue similar to the tissue that lines the inside of the uterus grows outside the uterus. Read More

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Endometriosis and Infertility Treatment 

Many are familiar with endometriosis and how it results in infertility, so let us discuss it and available treatments for the condition. 

What is Endometriosis?

Endometriosis is a disorder where tissue similar to the tissue that lines the inside of the uterus grows outside the uterus. The places often affected are the ovaries, the fallopian tubes, and the tissues lining the pelvic organs. The tissue acts like normal uterine tissue, it breaks apart and bleeds at the end of the cycle, but because the blood has nowhere to go, it becomes trapped. When endometriosis involves the ovaries, cysts called endometrioma may form. Surrounding tissues may become inflamed, leading to scar tissue development and adhesions; this is due to bands of fibrous tissues that cause pelvic tissues and organs to stick together. Endometriosis is most commonly found in the ovaries, and it rarely occurs beyond the area where the pelvic organs are located. Endometriosis is very painful, especially during menstrual periods. The condition also negatively impacts the fertility of the affected person.

Picture courtesy: News Medical

What are the types of endometriosis?

There are three main types of endometriosis; they are classified based on their location. They include:

  • Superficial peritoneal lesion – this is the most common. Lesions occur in the peritoneum.
  • Endometrioma – also called chocolate cysts. They are dark, fluid-filled, and form deep in the ovaries. They have the ability to damage healthy tissue and often do not respond well to treatments.
  • Deeply infiltrating endometriosis – this type involves the pelvic organs near the uterus, like the bladder.

What are the stages of endometriosis?

Endometriosis can be classified into stages based on the severity of the condition; these stages include:

  • Stage I – has a few lesions but no scar tissue.
  • Stage II – there are more lesions but still no scar tissue.
  • Stage III – the lesions may be deep, and there may be scar tissue around the ovaries and fallopian tubes.
  • Stage IV – there are many lesions present, and there may be large cysts in the ovaries. There also may be scar tissue around the ovaries and fallopian tubes or between the uterus and the lower part of the intestines.
stages of endometriosis
Picture courtesy: The Yellow Cape

What causes endometriosis?

causes of endometriosis
Picture courtesy: Lybrate

The exact cause of endometriosis is not known; some possible causes include:

  • Immune system disorder – a disorder with the immune system that may make it unable to recognize and destroy endometrial-like tissue that is growing outside the uterus.
  • Retrograde menstruation – this is where menstrual blood containing endometrial cells flows back to the fallopian tubes and into the pelvic cavity. These calls then stick to the pelvic organs and walls, where they grow, thicken and grow throughout each menstrual cycle.
  • Surgical scar implantation – this happens after an abdominal surgery like a C-section or a hysterectomy, where the endometrial cells attach to the surgical incision.
  • Transformation of peritoneal cells – also called the induction theory, it is believed that hormones act on the peritoneal cells lining the inner side of the abdomen and transform them into endometrial cells.
  • Endometrial cell transport – this is when blood or lymph vessels transport endometrial cells to other parts of the body.

What are the symptoms of endometriosis?

endometriosis symptoms
Picture courtesy: Verywell Health

The most common symptom is pelvic pain, usually associated with menstrual periods. Although cramping is normal during menstrual periods, people with endometriosis describe the pain as much more severe than usual. Some common signs seen in endometriosis include:

  • Severe menstrual cramps
  • Blood in the stool or urine
  • Painful sexual intercourse
  • Infertility
  • Pain when urinating during menstruation
  • Fatigue
  • Diarrhea, constipation, or bloating, especially during menstruation
  • Excessive bleeding during menstruation or bleeding between periods

What are the risk factors of endometriosis?

Some factors that cause an individual to be at a higher risk of developing endometriosis include:

  • Early onset of menstruation
  • Disorders of the reproductive system
  • Never given birth
  • A family history of endometriosis
  • Going through menstruation at an older age
  • Heavy menstruation that lasts more than 7 days
  • Higher levels of estrogen or being exposed to higher-than-normal levels of estrogen
  • Any disorder that prevents the flowing of blood from the body during menstruation

How is endometriosis diagnosed?

It is advised that an individual with the above-listed symptoms should seek medical attention. The doctor may suspect endometriosis based on the experienced symptoms. The doctor can get confirmation through the following tests:

  • Pelvic examination – a physical exam is done on the pelvic region to identify any scars or cysts that may exist.
  • Laparoscopy – The doctor inserts a laparoscope into the abdominal space via a small incision. This gives the doctor a view of where and how big the lesions are. It is usually the only way to be fully certain of endometriosis.
  • Imaging tests – this involves taking an image of the pelvic area. This can be done using an ultrasound, an MRI, or a CT scan.
  • Biopsy – this is often done together with the laparoscopy. A tissue sample is obtained, taken to a lab, and tested by a specialist to confirm the diagnosis.

What treatment exists for endometriosis?

This condition has no cure. The treatments that currently exist are targeted toward managing the condition to a reasonable extent. The two main ways are either through surgery or medication. The individual usually needs to try the different types of treatment in order to find which works best in relieving the symptoms, but usually, surgery is the last resort when the more conservative treatments do not work. Some of the therapies include:

Pain medication 

It is usually prescribed by the doctor, who may recommend over-the-counter pain relievers like nonsteroidal anti-inflammatory drugs (NSAIDs), examples of which are ibuprofen or naproxen. They help to ease the pain and cramps experienced.

Hormone therapy

This is sometimes effective in reducing or stopping the pain of endometriosis. Hormone medication slows down endometrial tissue growth and prevents new endometrial tissue implants. It is not a permanent cure for endometriosis, and the symptoms usually return when the therapy is stopped. Some of the treatments used include:

  • Gonadotropin-releasing hormone agonists and antagonists – They help block the production of follicle-stimulating hormones, which then help in lowering estrogen levels and preventing menstruation. Due to the fact that these drugs mimic menopause, taking a low dose of progestin or estrogen along with them helps reduce the side effects experienced during menopause. Menstruation resumes when the therapy is stopped.
  • Hormonal contraceptives – These help to control the hormones responsible for the buildup of endometrial tissue each month. They may come in birth control pills, hormonal patches, or vaginal rings. The use of these hormonal contraceptives may reduce or eliminate the pain felt in some instances.
  • Aromatase inhibitors – These are a class of drugs used to reduce the amount of estrogen in the body. It is usually recommended along with progestin or in combination with hormonal contraceptives to treat endometriosis.
  • Progestin therapy – this may help in relieving the symptoms experienced. Some of the ways of administration of this include intrauterine devices, contraceptive implants, contraceptive injections, or progestin pills. They halt menstrual periods and the growth of endometrial implants.


Surgical removal of endometriosis implants while preserving the uterus and ovaries may increase fertility and the chance of conception in individuals trying to become pregnant; the procedure also reduces severe pain. However, this is not a cure, and the endometriosis and pain may eventually return. The procedure is either done laparoscopically or through traditional abdominal surgery in more severe cases. However, traditional abdominal surgery is less common, as modern advancement has ensured that even the most severe cases can be handled through laparoscopy.

treatment options for endometriosis
Picture courtesy: inviTRA

What are other ways of managing endometriosis?

Lifestyle changes – They can help relieve some of the symptoms experienced; they include:

  • Warm baths and heating pads can reduce the pain
  • NSAIDs
  • Eating right
  • Managing stress
  • Regular exercise

Alternative therapy – some people find relief from their symptoms through some of these therapies, which include:

  • Acupuncture
  • Herbal medicine
  • Massage

However, seek a doctor’s consultation before trying any alternative therapies. There could be side effects that the individual may not be aware of, and also, be very careful about the herbal treatments and not exceed the recommended dosage for them.  

What are the complications seen in endometriosis?

Several serious complications may arise from endometriosis, some of them include:

  • Infertility – this is the chief consequence of endometriosis; it happens to at least a third of women with endometriosis. Endometriosis may cause infertility in several ways; it may cause an obstruction of the fallopian tubes preventing fertilization, and it may also damage the egg or sperm cell. It may also change the body’s hormone composition.
  • Cancer – Endometriosis may raise an individual’s risk of ovarian cancer or adenocarcinoma, which can develop later in the life of individuals that have endometriosis.

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