Endometriosis is a common condition in women of reproductive age. Symptoms of endometriosis may include infertility, pelvic pain or a pelvic mass. It is a widely held myth that endometriosis always causes pelvic pain; in fact, many times the only symptom of this disease will be infertility.

The diagnosis of endometriosis is difficult to make on a physical exam, x-ray or ultrasound. A surgical viewing of the pelvic organs is the best way to diagnose this condition. Laparoscopy, a surgical procedure that requires general anesthesia, is the most common surgical procedure for making the diagnosis and providing surgical treatment. 

Endometriosis is diagnosed when the endometrial glands that usually line the inside of the uterus are displaced and found outside the uterus on the pelvic and abdominal structures. The cause of endometriosis is still unknown, as are the reasons why endometriosis triggers abdominal pain and infertility. This makes treatment of the disease difficult, depending on many individual factors. There is no standard treatment for endometriosis.

Endometriosis and Pelvic Pain
When pelvic pain is a woman’s chief complaint, a trial of various treatments such as ibuprofen or other pain-relievers and birth control pills may first be recommended. However, if the pain persists, a laparoscopy will be recommended. If endometriosis is discovered, one of several surgical methods can be used to remove the visible abnormal tissue. Because it is not known what exactly causes the pain from endometriosis, the removal of the abnormal tissue doesn’t guarantee pain relief.  

Endometriosis is not curable and should be regarded as a chronic disease. Sometimes pain and symptoms may regress spontaneously, but only with menopause does the endometriosis reliably disappear. Patients may try medications intermittently and typically will get pain relief. The use of oral contraceptives is a good alternative to the other medications because it has fewer side effects. Patients with endometriosis should work closely with their physician to establish long-term, individualized plans for treatment. Generally, hysterectomy with removal of the ovaries is viewed as a last resort.

Endometriosis and Infertility
Women who have been diagnosed with endometriosis are more likely to experience infertility, and observational studies have shown that the monthly probability of pregnancy in women with endometriosis is about half of the probability in normal women. In spite of this well-documented association, a true cause and effect relationship has not been established.

When women are having trouble conceiving, physicians must first determine whether an endometriosis diagnosis, which can only be determined via surgery, is necessary. When the woman is under 35, has significant pain with her periods or with intercourse, and her partner has a normal semen analysis, a laparoscopy may be advised. 

Laparoscopic removal of endometriosis is associated with a small improvement in the chance of conception, however treatments have not been shown to bring conception rates into the range of normal fertile women. Surgery may improve pelvic pain, which can be very important for a woman’s quality of life. 

When surgical treatment of endometriosis has occurred, we recommend that the couple try to conceive on their own for at least 3-6 months after surgery. Many times, pregnancy will not occur within the year after endometriosis has been removed, in which case additional treatments commonly used to treat unexplained infertility may be employed. These include ovulation induction, intrauterine insemination and in vitro fertilization. These treatments can be expected to improve the chances for pregnancy significantly in spite of the endometriosis. Endometriosis in women older than 35 may have an additional negative effect on the chance of conception, with or without treatment.

When treating cases of endometriosis and infertility, many factors must be taken into account such as age, length of infertility and any male factor problems. At RHS, we work one-on-one with patients suffering from endometriosis to create individual treatment plans that address all contributing factors and help couples find the best path to pregnancy.