Endometriosis is a condition in which tissue similar to the lining of the uterus, called endometrium, grows outside the uterus–often in and around organs in the pelvis. The condition affects an estimated 5-15% of reproductive-aged women in the US and is often under diagnosed and under-treated. Endometriosis can cause serious symptoms and impact your fertility.
Learn more about endometriosis and fertility and what’s available to support your fertility journey.
What is Endometriosis?
In endometriosis, tissue similar to that in the lining of your uterus grows in areas where it does not belong. The tissue usually grows in and around the pelvic organs, such as the ovaries, fallopian tubes, and abdomen. In severe cases, endometriosis can even grow on the bladder or intestines.
The tissue growths swell and bleed like your uterus lining does during your period. The tissue irritates the surrounding areas, often causing adhesions (scar tissue). Endometriosis can also cause chronic pelvic, back and stomach pain, heavy menstrual bleeding, severe cramps or digestive problems.
What Causes Endometriosis?
We aren’t 100% sure what causes endometriosis, but there are some theories:
- Retrograde menstruation: Menstrual blood flows backward through the fallopian tubes into the pelvic cavity instead of leaving the body. This blood contains endometrial cells (the tissue from the lining of the uterus), which can stick to the walls of the pelvis and other organs, growing and bleeding with each menstrual cycle.
- Transformed peritoneal cells: Some experts believe that certain hormones or immune factors might change the cells lining the abdomen, known as peritoneal cells, into ones similar to the uterus lining.
- Embryonic cell changes: During puberty, hormones like estrogen might transform embryonic cells into endometrial-like cells that grow outside the uterus.
- Surgical scar complications: Endometrial cells can attach to scars from surgeries, such as C-sections.
- Endometrial cell transport: Blood vessels or tissue fluids may carry these cells to other areas.
- Immune system: A compromised immune system might prevent the body from recognizing and getting rid of these out-of-place endometrial cells, allowing them to grow and cause endometriosis.
Although research has yet to fully uncover the cause of endometriosis, some observed risk factors exist.
Risk Factors
Several factors can increase the risk of developing endometriosis. Women with a family history of the condition, particularly if a mother or sister has it, are at higher risk. Starting your period at an early age, having shorter menstrual cycles (less than 27 days), or having longer, heavier periods can also raise the likelihood of developing endometriosis.
Other risk factors include low body mass index (BMI), elevated estrogen levels, and conditions that prevent the normal flow of menstrual blood out of the body. While endometriosis can affect any woman of reproductive age, these factors may increase the chances of experiencing it.
Symptoms frequently don’t appear until years after your first period and tend to improve during pregnancy temporarily. Some women’s pain will lessen during menopause unless they are undergoing any type of estrogen therapy.
Can Endometriosis Affect the Ability to Get Pregnant?
Endometriosis is one of the leading causes of infertility in women, and up to 30-50% of women with Endometriosis may experience infertility. While we do not have a definitive answer on how endometriosis affects fertility, researchers think it’s due to scar tissue on the fallopian tubes, inflammation in the pelvic organs or overall hormonal fluctuations that can alter your reproductive cycle and egg quality.
The Link Between Endometriosis Type and Fertility
If you’ve been diagnosed with endometriosis, your healthcare provider may have mentioned your having one of three types of endometriosis: Superficial peritoneal endometriosis, ovarian endometrioma and deep infiltrating endometriosis. Additionally, there are four commonly recognized “stages” of endometriosis. The severity of your endo may further impact your fertility.
Superficial Peritoneal
Superficial peritoneal endometriosis occurs when endometrial-like tissue grows on the abdominal cavity's lining, known as the peritoneum. This is the most common subtype of endometriosis, affecting up to 50% of those with the condition. Typically diagnosed as stage I or II, the lesions and scarring are not as deep compared to other forms.
Endometriomas
An endometrioma is a cystic mass formed from ectopic endometrial tissue that grows on the surface or within the ovaries. The mass, sometimes called “chocolate cysts,” contains thick, brown, tar-like fluid/menstrual blood and may stick to the surrounding organs. People with endometriomas usually have stage III or IV endometriosis, which generally means scar tissue develops on the fallopian tubes and ovaries and can begin affecting ovulation.
Deeply Infiltrating
In deeply infiltrating endometriosis, the tissue growths and adhesions begin to grow near the uterus, affecting the vagina, bladder and bowels. It is considered the most severe form of endometriosis and classified as stage IV. The tissue growths are deep with scarring in the ovaries, uterus and rectum, and can cause severe and persistent pelvic pain.
How Can I Tell if I Have Endometriosis?
Endometriosis symptoms vary from person to person. You may be asymptomatic, while others experience painful periods. The most common signs are:
- Painful, heavy, or irregular periods,
- Pain in the lower abdomen, pelvis, or lower back, especially around the time you are ovulating
- Persistent pelvic pain that lasts longer than six months with no other apparent reasons
- Painful sex
- Pain while urinating or having a bowel movement
- Difficulty becoming pregnant
Less common symptoms can include bleeding from the rectum, unexplained fatigue, pain around the belly button (especially during your period), and, in very rare cases, coughing up blood. While there is a widely-used rating scale for healthcare providers to diagnose endometriosis, there doesn’t seem to be a correlation between the stage of endo and symptoms. So, you can have stage II and may only experience heavy periods, while someone else has stage I and deal with chronic pelvic pain.
Additionally, you may not know you have endometriosis until you try to get pregnant– as many as 25% of people are asymptomatic and are not aware they have the condition.
Having Endometriosis Doesn't Mean You Can’t Conceive
Yes, endometriosis can impact your fertility, but that doesn’t mean you cannot get pregnant. If you have mild-moderate endometriosis, research shows that there is a better chance of a natural pregnancy. For women with severe or later-stage endometriosis, you might need to seek treatment or help to become pregnant. Each journey is different.
You Can Still Try to Get Pregnant on Your Own
You can absolutely try and get pregnant naturally if you have endometriosis. You can look at making certain dietary adjustments, start tracking your ovulation cycle, and add a fertility supplement to your daily routine to support optimal nutrition. If you do not get pregnant after trying for one year (the clinical definition of infertility), speak with a fertility specialist. They can outline your treatment options and work with you.
There Are Also Many Treatment Options
If you cannot get pregnant naturally, there are still other options. The first step is to speak with a fertility specialist or your ObGyn for an evaluation. They will take an ultrasound or use other diagnostic tools to determine the health of your fallopian tubes, ovaries and uterus. From there, you have a few options to help you get pregnant:
- Medicine: There are hormonal medications such as combined oral contraceptives, progestins, and gonadotropin-releasing hormone agonists or antagonists (GnRH analogs) that can help reduce lesions and growths. Once the lesions are reduced, you can try again to get pregnant naturally.
- Surgical treatment: Laparoscopic surgery is another option. A doctor makes a small incision and uses thin, fine tools to carefully remove lesions and scar tissue. You can then try to get pregnant again.
- Assisted Reproductive Technologies (ART): If you cannot get pregnant naturally, you can explore procedures like intrauterine insemination (IUI) and in-vitro fertilization.
Getting pregnant with endometriosis isn’t impossible. The most important thing is to seek help. You are not alone on this journey. Learn more about
