ENDOMETRIOSIS AND INFERTILITY (part 2)

 

 Diagnosis and treatment plans

Cases of extremely painful menstruation in young women are considered due to Endometriosis until proven otherwise.

Radiography and Ultrasounds are essential tools.  Diagnostic laparoscopy assists to take needed biopsies for pathologic review.

33% of infertile women have some form of Endometriosis and 40% of sufferers of Endometriosis are infertile. At Varying stages Endometriosis can account for the infertility; at the early stage, inflamed tissues are evident whereas late stages have adhesions that block and distort the pelvic anatomy.

 

Visualization of the inner organs will be possible through ultrasound studies and laparoscopy to note the exact areas affected.

Pains experienced can be constant and debilitating or intermittent before, during and after the period.  The most severe types of pain are during the menses, with intense emotional sufferings, social isolation and feelings of depression.

Treatment of Endometriosis ranges from medical suppression of ovulation to reduce activity of the endometrial implants to radical surgery with total abdominal hysterectomy (to remove the womb along with both of the ovaries). Varying amounts of anti-inflammatory pain medications to relieve the extreme incapacitating pains suffered are standard management.

How can Endometriosis be managed?

While Endometriosis cannot be cured, there are two types of interventions:

• Pain management
• Treatment of endometriosis –associated infertility

The diagnosis of endometriosis is confirmed during surgery. Further steps depend on circumstances; women without infertility can be managed with hormonal medication that suppresses the natural cycle and pain medication, while an infertile woman may be treated expectantly after surgery with fertility medication or with assisted reproductive technology (IVF)

 

Pain management for women with Endometriosis

Women suffering from recurrent and cyclical menstrual pain must try as much as possible to avoid drug abuse. See your physician to prescribe necessary NSAID medication.

 

There are certain home remedies and lifestyle changes that have palliative effect on pain associated with endometriosis and they include:

• Warm application which includes warm bath, use of hot water bottle, warm drinks
• Adequate hydration: increase fluid intake
• Maintain healthy lifestyle; avoid cigarette smoking, alcohol drinking, avoid narcotics  (addictive drug affecting moods and behaviour).
• Eating lot of veggies, studies have shown that there is a connection between low vegetable intake and endometriosis.
• Eat foods rich in omega-3
• Cut down on animal product, eat more organic diet, low gluten and avoid soy as much as possible

Infertility Issues and Endometriosis

Infertility can stem from many issues.  Over 30% of infertile women have blocked tubes. This tubal blockage can be due to scar tissue from previous surgery, injury, pelvic inflammatory disease (PID), birth defects and even endometriosis. Some of these conditions can be repaired by surgery, or a combination of hormonal treatment / surgery and others are not treatable.

As mentioned, the varying inflammations and adhesions can block the fallopian tubes resulting in ability of the matured egg to reach the proper site of fertilization and implantation to form the baby (infertility).

Important to note, if the pains are modest and do not impair daily life, hormonal suppression of your period can be helpful.  But in cases of severe pains that have not responded to medical care or the oral contraceptives, then microsurgery techniques, i.e. laser and laparoscopic surgery, can reduce the adhesions while maintaining the ability to generate children.

Rectal or bladder bleeding may arise from the inflamed endometrial implants on surrounding tissues.  Dysmenorrhea or painful menses occur possibly due to increased production of certain hormones.  Polymenorrhea (short cycles) and hypermenorrhea (excessive flow) are common even without extensive ovarian disease.  Inability to perform daily activities can result from incapacitating pain pre and post menstrual cycle lasting up to 2 weeks.

Incidence of infertility tends to coincide with the extent of endometriosis.  But even, a few adhesions can result in infertility, Interference with the motility of the fallopian tube and motility of egg transport has been the theories.

Dyspareunia or pain during intercourse is often associated with endometriosis and is due to the irritation of the nerve fibers in the area of the cervix from the pressure of sexual activity.  Depending on the severity of the pain, lubricants or even surgery can assist.

Treatment Of Endometriosis To Enhance Fertility:

 

Infertility associated with endometriosis, can become progressively worse, hence women attempting to have babies are encouraged to begin efforts as early as possible, if they show signs and symptoms of the disease.

Treatment includes hormone medication and surgery to remove the lesions of endometriosis or the organ involved. The hormonal treatment would stop or suppress the ovulation of the egg, thereby reducing the pains this is because without ovulation the inflammations would not happen.  Pregnancy often eliminates the symptoms during the baby’s development and for some time after too. But, if you have extensive disease, it may be recommended to remove both of the ovaries along with the womb. The removal of the organs would prevent the incapacitating constant pains.

It is vital to see your infertility expert who will develop the individualized plan of management.

The use of Assisted Reproductive Technology is a key component in the management of cases of Endometriosis. Choices ranging from In Vitro Fertilization (IVF) to surrogacy will allow women with endometriosis to experience the joy of motherhood too.