What is endometriosis?

There are many fertility disorders that affect birthing people of reproductive age, but few are as pervasive and devastating as endometriosis. Approximately 1 in every 10 people of reproductive age are diagnosed with this disease. Endometriosis is a condition in which some of the uterine cells from the endometrial lining of the uterus find themselves outside of the organ instead of shedding during menses. These transient endometrial cells still behave as though they were inside the uterus, building up and trying to shed during every cycle. Because there is nowhere for this blood to escape, the body believes there is internal bleeding and creates scar tissue to stop the bleeding, in turn causing a consistent inflammatory response in the body, especially in the pelvic cavity.

What are the symptoms of endometriosis?

Endometriosis affects all bodies differently. While some people feel the intense cramping, chronic pelvic and back pain, heavy/irregular bleeding, nausea, and headaches that are often associated with the disease, others don’t even realize they have endometriosis and are only made aware after facing infertility. Other symptoms include pain during intercourse, spotting, painful urination or bowel movements during menses, fatigue, and fever. There are three significant hormone irregularities to be aware of in endometriosis called estradiol, progesterone, and oxytocin. Estradiol helps fuel the growth of endometrial cells, and research shows that people with endometriosis may be able to transmute more testosterone to estradiol, culminating in the rapid ability for endometrial cells to multiply outside of the uterus. Low progesterone levels lead to the body’s inability to get/stay pregnant. Research suggests that oxytocin levels are high in people with endometriosis, possibly causing the intense cramping/contractions during menses.

What causes endometriosis?

While the exact causes of endometriosis are still unknown, there is some consensus among researchers about possibilities. One potential factor is called retrograde menstruation, which is when the uterus contracts during menses and effectively pushes some blood up through the fallopian tubes before pouring into the pelvic cavity. Endometriosis is also genetic and tends to run in families from one generation to the next. Researchers have also found two exogenic causes: pelvic surgery, such as c-sections or tubal ligation, and hormone disrupting pollutants like dioxin and phthalates. There is also research indicating that endometrial tissue can travel through the lymphatic system, affecting more parts of the body outside the pelvic cavity including the heart, brain, and nasal passages.

How is endometriosis diagnosed?

Seeking diagnosis is recommended if someone consistently has short menstrual cycles (less than 27 days) that last 8 days or more and has a lack of fertile cervical fluid. Diagnosis itself is not a foolproof science, as there is only one appropriate method. Laparoscopy surgery allows a surgeon to visualize the disease and take out any lesions, but it is possible to miss the transient endometrial tissue if they’re not looking in the right place. Laparoscopy, while held as the gold standard for diagnosis and as a temporary treatment, should only be done by highly trained surgeons or risk causing further scarring and infertility issues. There is 4 stage system in place to evaluate endometriosis for treatment.5

Somewhere between 20-50% of people who struggle with infertility are diagnosed with

endometriosis, with or without symptoms.

How does this disorder affect fertility?

Infertility from this disease is caused by a number of things. Pain during sex, especially during ovulation, can make it difficult to fall pregnant through this method. A lack of fertile cervical mucus can inhibit sperm transport to the egg. The scar tissue from chronic endometriosis and/or further surgical procedures can cause a block in the fallopian tubes. Scar tissue can also create severe inflammation around the ends of the fallopian tubes, called fimbria. This inflammation can make it difficult for the fimbria to usher in an egg for fertilization. Lastly, people with endometriosis usually suffer from altered immune function which could lead to immune cells attacking the sperm or egg.

What are the treatment options?

Treatment options for endometriosis vary depending on severity and a number of considerations including age, symptoms, number of children, and a desire to have more/any children. While treatment can certainly provide relief for those who receive it, that relief is usually temporary as “remission is rarely permanent”. NSAIDs like ibuprofen or naproxen can help reduce pain and even stop the release of prostaglandins which are responsible for some inflammation4. Hormonal birth control can reduce bleeding but obviously cannot be used in those who are trying to get pregnant. Menopause inducing drugs can reduce severe pain but cause numerous side effects like hot flashes, low libido, vaginal dryness, insomnia, and further inability to get pregnant. As mentioned previously, laparoscopic surgery can be used to excise lesions and drain fluid, but can cause further scarring. Hysterectomy and oopherectomy are also considered treatments, but even the removal of the uterus and ovaries does not guarantee remission.

More natural approaches to endometriosis include diet change, consistent exercise, and pine bark extract, the latter of which has been shown to reduce cramping and pain without negatively impacting fertility. Pregnancy can also put the body into remission due to the increase in progesterone, but this is only temporary, and, as mentioned previously, falling pregnant can be very difficult for those with endometriosis.2 The stage at which a patient’s endometriosis falls can direct a practitioner toward which treatment might be the best fit.

How can a fertility doula help?

A fertility doula can be a helpful asset to someone navigating the diagnosis and potential treatments of endometriosis. If someone is facing infertility or seeking holistic assistance because of period issues, a fertility doula can be the first to suggest a connection between their difficulties and an endometriosis diagnosis. From that point, the doula could support their client by way of knowledge sharing to help them advocate for themselves during diagnosis and treatment. Navigating infertility can be a long and winding road.Fertility doulas can ride along to provide assistance for appointments and surgery, or just be there to hold space for all the feelings and emotions that come along with this journey.