ENDOMETRIOSIS: signs & how it effects fertility

3/6/24ENDO MONTH

March is Endometriosis Awareness Month! I knew most likely had endometriosis when I was in my 20’s. I remember telling my OB/GYN I would be laid out on the floor for hours due to pain when I first started my period. I would be nauseated and could not attend class due to the pain. I am not someone who would describe themselves as having a high tolerance for pain, but I used to be a competitive swimmer and would wake up 3x/ week in high school to spin before class and then workout with weights or run for an hour after school followed by 1-2 hours of swimming. So I also am used to regular muscle pain. I described my pain as the feeling a gremlin was inside my abdomen trying to claw me from the inside out. I finally learned that if I took 600mg ibuprofen, the pain would be gone in 30 minutes to an hour. It took a while for me to learn this. Once it was so bad when I was TTC and off of birth control, I had to pull the car over. I thought I was going to pass out while driving because the pain I didnt have any ibuprofen with me and laid on the bathroom floor when I got home while waiting for it to kick in. Birth control also kept the pain controlled but controlling the hormones that exacerbate endo. 

Endo can range in severity. Sometimes its mild but it can also cause severe damage to the reproductive organs making those with Endo more likely to deal infertility. This scar tissue can affect the way the egg travels, it can also cause damage that makes it hard for implantation. So its important to know 

1. If you may have it 
2. How to manage it so you reduce the havoc it can wreak on your reproductive system
3. What to do when TTC or undergoing IVF

What is Endometriosis?

Endometriosis is a chronic condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterus. This tissue, known as endometrial implants, most commonly affects the pelvic organs such as the ovaries, fallopian tubes, and the outer surface of the uterus. However, it can also spread to other areas of the body, including the bladder, bowel, and even the lungs in rare cases.

Do I have End? What are the signs and symptoms?

The symptoms of endometriosis can vary widely. Some experience debilitating pain while others may have relatively mild symptoms or even be asymptomatic. Common signs and symptoms include:

• Pelvic Pain: Persistent and often severe pelvic pain is the hallmark symptom of endometriosis. This pain may occur before, during, or after menstruation and can worsen over time.
• Dysmenorrhea: Painful menstrual cramps that may be more intense than usual, accompanied by lower back or abdominal pain.
• Painful Intercourse: Pain during or after sexual intercourse (dyspareunia) is common in women with endometriosis.
• Heavy Menstrual Bleeding: Excessive menstrual bleeding or irregular bleeding patterns are often reported by women with endometriosis.
• Gastrointestinal Symptoms: Endometriosis can cause gastrointestinal issues such as bloating, constipation, diarrhea, and nausea, particularly during menstruation.
• Infertility: Endometriosis is a leading cause of infertility in women, affecting around 30-50% of those diagnosed with the condition. The exact mechanisms by which endometriosis impacts fertility are not fully understood but may involve structural abnormalities, hormonal imbalances, and inflammation affecting the reproductive organs.

Traditional Medical Management

Traditional medical management of endometriosis typically involves a combination of pharmacological and surgical interventions aimed at relieving symptoms and slowing the progression of the disease. Common treatment options include:

• Pain Medication: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen/Aleve/Motrin can help alleviate pelvic pain and menstrual cramps associated with endometriosis. Tylenol does not reduce inflammation thus is won’t  be too helpful. 
• Hormonal Therapy: Hormonal medications such as birth control pills, hormonal IUDs, and GnRH agonists may be prescribed to suppress ovulation and reduce estrogen levels, thereby shrinking endometrial implants and decreasing symptoms.
• Surgery: Laparoscopic surgery is often recommended for both diagnosis and treatment of endometriosis. During surgery, endometrial implants and scar tissue can be removed to alleviate pain and improve fertility. **Be sure to discuss this with your reproductive medicine provider or OB/GYN at length to understand the risks and benefits regarding fertility. 
• Assisted Reproductive Technologies (ART): In cases where endometriosis is causing infertility, treatments such as in vitro fertilization (IVF) may be recommended to help women conceive. IUI may be skipped as an option due to the anatomical issues. 

Impact on Fertility

Endometriosis can have a significant impact on fertility, making it difficult for some women to conceive naturally. Several factors contribute to infertility in women with endometriosis, including:

• Distorted Pelvic Anatomy: Endometrial implants and scar tissue can distort the normal anatomy of the reproductive organs, making it difficult for sperm to reach the egg or for a fertilized egg to implant in the uterus.
• Hormonal Imbalances: Endometriosis is associated with hormonal imbalances, particularly elevated levels of estrogen, which can interfere with ovulation and the menstrual cycle.
• Inflammation: Chronic inflammation associated with endometriosis can damage the ovaries and fallopian tubes, reducing fertility.
• Immune Dysfunction: Endometriosis may impair the function of the immune system, leading to abnormalities in the uterine environment that are unfavorable for implantation and pregnancy.

Managing Endometriosis Holistically

While traditional medical treatments can be effective in managing symptoms, many women with endometriosis seek complementary and alternative approaches to support their overall health and well-being. Holistic management of endometriosis focuses on addressing the underlying factors contributing to the condition and promoting balance within the body. Some holistic approaches to managing endometriosis include:

• Nutrition and Diet: Adopting an anti-inflammatory diet rich in fruits, vegetables, whole grains, and omega-3 fatty acids can help reduce inflammation and alleviate symptoms of endometriosis. Avoiding processed foods, refined sugars, and excess caffeine and alcohol may also be beneficial.
• Stress Management: Chronic stress can exacerbate symptoms of endometriosis. Practices such as yoga, meditation, deep breathing exercises, and acupuncture can help reduce stress levels and promote relaxation.
• Herbal Medicine: Certain herbs and supplements may offer relief from endometriosis symptoms. For example, turmeric, ginger, and chamomile have anti-inflammatory properties, while magnesium and omega-3 supplements may help alleviate pain and muscle tension.
• Acupuncture and Traditional Chinese Medicine (TCM): Acupuncture and TCM modalities such as herbal medicine and moxibustion have been used for centuries to manage gynecological conditions, including endometriosis. These therapies aim to restore balance and flow of qi (energy) within the body.
• Exercise: Regular physical activity can help improve circulation, reduce inflammation, and alleviate pain associated with endometriosis. Low-impact activities such as walking, swimming, and yoga are particularly beneficial.

Endometriosis is a complex and challenging condition that can have a profound impact on your physical and emotional well-being. While there is no cure for endometriosis, a multifaceted approach that combines traditional medical treatments with holistic interventions can help manage symptoms, improve fertility, and enhance overall quality of life. By addressing the underlying factors contributing to endometriosis and supporting the body's natural healing processes, women with this condition can empower themselves to live healthier, happier lives.