The uterine cavity has a tissue base that is known as the endometrium. When this endometrium spills over or spreads to the other parts of the reproductive organ, it begins to punch through the uterine lining. Such a condition creates complications and even infertility, and is known as endometriosis.

Read on to know more about endometriosis and how it can cause infertility.

Endometriosis

When the endometrium tissue spreads to areas like the ovaries, and the abdominal cavity, it can lead to numerous complications. Apart from pain, this may also cause infertility. 5 to 10% of the women worldwide suffer from this condition and have trouble conceiving. Additionally, about 30 to 40% of the infertility cases are due to endometriosis, not all cases. These figures are all confirmed by various medical studies.

How does it cause infertility?

Endometriosis can prevent ovulation, which is the process that occurs every month. During the ovulation process, the ovaries release eggs that may be fertilised in order for the woman to conceive. In this condition, the fimbria of the fallopian tubes also has trouble in capturing the egg, which prevents conception from taking place. This leads to infertility in the long run. Endometriosis also interferes with the proper production of the hormones that are required for normal ovulation and fertilisation of the egg.

Diagnosis: The diagnosis of the condition can be done with the help of lab tests and ultrasounds as well as imaging tests that can create the image of the womb and the endometrium lining. This will help in showing the severity and damage caused by the tissue. A surgical procedure called a laparoscopy may be carried out by the doctor to ascertain whether the patient is suffering from this condition. In this procedure, a small incision will be made and a camera will be inserted to view the insides on a screen, to learn more about the tissue s spread and the kind of treatment that will be required. The doctor will also diagnose the condition on the basis of various symptoms like irregular and heavy bleeding.

Treatment:

Treatment for endometriosis associated with infertility needs to be individualized for each woman. There are no easy answers, and treatment decisions depend on factors such as the age of the woman, the severity of the disease and its location in the pelvis, the length of infertility, and the presence of pain or other symptoms. Some general issues regarding treatment are discussed below.

Treatment for Mild Endometriosis

Medical (drug) treatment can suppress endometriosis and relieve the associated pain in many women. Surgical removal of lesions by laparoscopy might also reduce the pain temporarily.

However, several well-controlled studies have shown that neither medical or surgical treatment for mild endometriosis improve the pregnancy rates for infertile women as compared to expectant management (no treatment).

For treatment of infertility associated with mild to moderate endometriosis, controlled ovarian hyperstimulation with intrauterine insemination - IUI is often attempted and has a reasonable chance to result in pregnancy if other infertility factors are not present.

Details about IUI success rates with endometriosis

IUI and endometriosis

Success rates with IUI for endometriosis have been variable in studies, showing:

A pregnancy rate of 6.5% for women with endometriosis vs. 15.3% per cycle for unexplained infertility
A pregnancy rate of 5.6% for women with advanced endometriosis vs. 22.7% per cycle for mild endometriosis vs. 25.7% for no endometriosis
Pregnancy chances with insemination for natural cycle IUIs (no drugs) with endometriosis are about 2% per cycle vs. 11% with injectables plus IUI for endometriosis
Treatment for severe endometriosis

Several studies have shown that medical treatment for severe endometriosis does not improve pregnancy rates for infertile women.

Unfortunately, the infertility in women with severe endometriosis is usually resistant to treatment with ovarian stimulation plus intrauterine insemination. If the pelvic anatomy is very distorted, artificial insemination is unlikely to be successful. These women often require in vitro fertilization in order to conceive.

Although the studies of in vitro fertilization for women with severe endometriosis do not all show similar results, pregnancy success rates are usually good if the woman is relatively young (under 40) and if she produces enough eggs during the ovarian stimulation.

Endometriosis - How It Results in Infertility?

Cancer that originates in the uterus is termed as Endometrial Cancers. The cancer is known to originate in the endometrium i.e. lining as well as the cells of the uterus. Abnormal vaginal bleeding causes the cancer to be detected early and a consultation with the doctor should be done immediately. When other cancers originating from the uterus are considered, endometrial cancer is found to be the most common.

Causes
The exact cause for endometrial cancer is not known clearly. The cells in the endometrium tend to become abnormal due to the occurrence of a genetic mutation, which causes rapid multiplication of cells that ultimately lead to the formation of a tumour like mass. They begin to spread to other parts and proceed to affect the tissues in the surrounding areas.

Symptoms
The typical symptoms of endometrial cancer include:
1. Irregular bleeding in between periods
2. A watery discharge from the vagina
3. Bleeding from the vagina postmenopausal
4. Pain in the pelvic floor muscles

Risk factors that might increase the chances of being affected by endometrial cancer include:
1. Aging increases the chances of this disease, especially post menopause.
2. Obesity can cause hormonal imbalance.
3. Certain drugs used in hormone therapy
4. Early onset of menstruation, especially before 12 years of age

Treatment for Endometrial Cancer Includes:
1. Radiation therapy: This treatment procedure involves using radiations, such as X-rays to target and destroy the cancer cells. The two forms of radiation therapy are external radiation therapy (external machine is used to direct radiation on the cancer cells) and internal radiation therapy (radioactive substance enclosed within small and consumable items is placed near to or directly at the spot of cancer).

2. Hormone therapy: Medications are administered to eliminate imbalances in hormone levels and prohibit the growth of cancer cells in the body. This remedy is preferred if the cancer progresses to an advanced stage.

3. Chemotherapy: This form of treatment uses oral administration or injection of chemicals into the veins so that the growth of cancerous cells is curbed, either by elimination of the cells or by prohibiting cell division.

4. Surgery: In this surgery, the areas affected by cancer are surgically removed; i.e. the uterus in this case. The surgical procedures that might be used include total hysterectomy (total removal of uterus), radical hysterectomy (removal of the cervix, uterus and part of the vagina) and Bilateral salpingo-oophorectomy (removal of both the ovaries and the fallopian tubes)

All About Endometrial Cancer

The tissue that lines the uterus is known as the endometrium. In some cases, it can grow outside the uterus. This is known as endometriosis. Endometriosis usually involves organs in the pelvic cavity such as the ovaries, fallopian tubes, bowel and lining of the pelvic cavity. In rare cases, it may involve the vagina, cervix and bladder as well.

Depending on the location and extent of endometrial tissue, it can be classified into four stages ranging from minimal to severe. Most cases of endometriosis fall into the minimal or mild category which involves mild scarring and superficial tissue implants. Moderate or severe endometriosis can cause cysts and severe scarring. Infertility is also commonly associated with severe endometriosis.

Pain in the pelvic area just before and during menstruation is one of the most characteristic symptoms of this disorder. This is because the overgrown endometrial tissue acts like normal endometrial tissue and is shed during menstruation. The only difference is that since there is no exit for this overgrown tissue, it is trapped in the pelvic cavity. The location of the implantation of endometrial tissue also plays a role in the amount of pain experienced. The deeper the implant, more the pain. Implants near areas with high nerve density are also more likely to be painful than implants in areas with low nerve density.  These implants may also release substances into the blood stream that can cause pain.

Other symptoms associated with this disorder are:
  Painful intercourse
  Painful urination
  Pain during bowel movements
  Infertility

These symptoms especially the pelvic pain can vary from month to month in terms of duration and intensity.

A few simple changes in your diet can help manage the symptoms associated with this disorder and in some cases, prevent it as well. Avoid processed food and foods that are high in sodium content. You should also avoid high-fat dairy and food that is rich in arachidonic acid. Instead, increase your consumption of carbs and green leafy vegetables. You could also add two tablespoons of walnut oil a day to your diet to help combat inflammation and the other effects of arachidonic acid.

Early stages of this disease can be treated with hormone therapy, but if it has progressed to the later stages, surgery may be needed. This surgery is performed laparoscopically and aims at removing all the implanted tissue from outside the uterus. However, in cases where the anatomy of the pelvic organs has been distorted by the implants, a hysterectomy may be required. This option, however, it usually considered only in cases where a woman does not have any plans of conceiving more children. 

Endometriosis - How It Is Affecting Your Life?

One of the silent diseases in the female population, endometriosis can be symptomless for years and sometimes even decades, but can sometimes manifest itself quickly. The uterus is lined on the inner side by a tissue known as endometrium. When this tissue is found in other parts (fallopian tubes, abdomen, near the ovaries, etc., it is known as endometriosis.

Causes: The exact cause for endometriosis is not clear. There is a possibility that during the regular period, there could be spilling of the tissue back into the fallopian tube, from where it reaches the ovaries or other organs and gets implanted.

There are certain predisposing factors for a woman to develop this condition, including genetic correlation and non-menopausal women. The female hormone estrogen is essential for the development of endometriosis. There are also immunological reasons attributed to the development. It can range from minimal to mild to moderate to severe.

Symptoms: From being completely benign to causing severe pain, endometriosis can present itself in varying ways. The implanted tissue can be minimal like a small lump to large clumps. The symptoms are not dependent on the size of the implanted tissue, however, 

1. Painful menstruation: One of the most common causes of non-menstrual cramps, the pain is different from usual menstrual pain, starts a few days before the period and can last up to after the period.

2. Pelvic pain: One of the most common causes of pelvic pain, this can happen wherever the implanted tissue is. In severe cases, this tissue can also bind different organs, forming what are called adhesions. The bladder or the bowels may adhere to the uterus. These are more painful than individual lumps of tissue outside the uterus.

3. Intermenstrual bleeding: There could be spotting to severe bleeding between the regular cycles.

4. Painful sex: There is a deep pain within the pelvis and it can lead to losing interest in sex.

5. Infertility: The most severe symptom and complication is not being able to become pregnant.

Diagnosis: A detailed patient history, discussion on symptoms followed by ultrasound and laparoscopy can help in diagnosing endometriosis.

Treatment: If there is no symptom and fertility is not an issue, then it is possible that no treatment is required. However, depending on symptoms and complications, the following are done.
- If pain is the only main problem, painkillers are administered
- Surgical treatment may be required if there is severe bleeding and adhesions complicating the situation. 

This will also relieve other symptoms
1. Hormone therapy is also an option for treating endometriosis.
2. If you are having pelvic pain and irregular bleeding, bring it up with your doctor. Even if it is not endometriosis, a thorough check up will put your mind at rest.

Endometriosis and Complications Associated With It

The abnormal growth of the endometrium tissue outside the uterus is known as endometriosis. Ideally, the abnormal tissue is supposed to break down and exit the body. However, in this condition, the tissue is unable to pass out of the body. As a result, the surrounding tissue tends to get irritated and leads to the formation of scar tissues.

The various causes of endometriosis include:

Immune system disorder: Complications in the immune system might render it incapable of destroying the endometrial tissue that grows outside the uterus.
Surgical scar implantation: Certain surgeries such as a C-section may result in the attachment of endometrial cells to the incision area.
Embryonic cell transport: These cells may be transported to other parts of the body by the blood vessels which may lead to endometriosis.
Retrograde menstruation: Instead of passing out of the body, under this condition, the blood flows back into the pelvic region via the fallopian tubes. When these cells attach themselves to the pelvic cavity, it causes endometriosis.
Symptoms
1. Pain during sexual intercourse
2. Pain during periods including pelvic pain, especially during periods, lower back pain and abdominal pain.
3. Excessive bleeding during periods
4. Fatigue
5. Constipation
6. Bloating

The major complication that results is fertility problems. Endometriosis may prevent the combination of the egg and the sperm and thus, impairs your ability to conceive. It is recommended not to delay pregnancy if you have endometriosis. This disorder also tends to increase the risk of ovarian cancer in some women.

How can it be treated?

Endometriosis is usually done using surgery or medications. 

Medication: It usually involves painkillers.
Hormone therapy: Some of the hormonal therapies include:
Hormonal contraceptives
Progestin therapy
Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists
Conservative surgery: If a patient wants to become pregnant, surgery is done as much as possible without harming the uterus and ovaries. Suggested procedures include laparoscopy and traditional abdominal surgery.
Assisted reproductive technologies: An example of this form of treatment is In Vitro Fertilization.
Hysterectomy: Under severe circumstances, total hysterectomy is conducted in order to facilitate the removal of cervix and uterus. If you wish to discuss about any specific problem, you can consult a gynaecologist and ask a free question.

Endometriosis - 4 Reasons Behind it!

What is Endometrium?

The uterus is where the fetus grows and develops. It has three linings- the outermost lining, the middle layer and the innermost lining. The innermost layer is called Endometrium. The endometrium is made of mucosal tissues.

How the endometrium changes and what is its function?

Before ovulation, when an egg is released, the functional layer of the endometrium undergoes a change. Vascularization takes place i.e. a buildup of blood vessels and tissues that thickens the endometrium in anticipation of implantation of a fertilized egg. If conception does not take place, the tissues and cells are shed from the endometrium lining. This is when a woman gets her period.

When conception does take place, the fertilized egg attaches itself to the endometrium. The endometrium also supports the placenta, which provides the fetus with oxygen and nutrition.

What is the ideal thickness of the endometrium?

In pre-menopausal women, the thickness of the endometrium should be-

  Between 2-4 millimetres during menstruation,
  5-7 millimetres at the onset of the early proliferative phase
  Around 11 millimetres during the late proliferative phase
  16 millimetres during the secretory phase



What is a poor/thin endometrium?

If the endometrium lining does not meet standard thickness and is not conducive to implantation, it is called a poor endometrium.

Causes behind thin endometrium

There could be many reasons that can lead to a poor endometrial layer-

  Inadequate secretion of estrogen
  Insufficient blood flow
  Prolonged use of birth control pills
  Substandard quality of endometrial tissues
  Presence of fibroids (small uterine tumours)
  Amenorrhea (unnatural periods/ excess bleeding or too little bleeding)
  Intrauterine adhesions (scar tissues form between the layers of the uterus and glue them together)
  Pelvic inflammatory disease
  Use of clomiphene

What are the symptoms of poor endometrium?

  Infertility (inability to conceive)
  miscarriage
  Irregular menstruation
  Painful periods
  Inadequate bleeding during menstruation

Treatment for poor endometrium

  Since the most common cause of poor endometrium is insufficient estrogen, doctors prescribe estrogen pills that can raise estrogen levels.
  If poor endometrium is the result of poor blood flow, an Ultrasonography Test will reveal that. Then doctors prescribe Vitamin E pills and L-arginine amino acid pills to thicken the endometrium layer.
  Regular exercising increases blood flow to the uterus
  Acupuncture is a very effective stress buster. Chronic stress could lead to a shrunk uterine wall. Acupuncture can allay the stress and promote the health of the uterus.
  Intrauterine adhesions can be extracted through surgery.
  Natural remedy (through natural therapy) includes asparagus, royal jelly, cover and they help in thickening the endometrium layer.
  Granulocyte Colony Stimulating Factor if injected into the body raises endometrial thickness and combats infertility.

Only an endometrium of normal thickness can support a pregnancy. If the lining is not thick enough medical intervention may be necessary.

Poor Endometrium - Can It Be Treated?

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