FAQs about Endometriosis

Can a woman suffering from endometriosis get pregnant naturally?

Yes, she can. However, she also runs the risk of worsening the disease while waiting.

Is it advisable to undergo a laparoscopy surgery to remove endometriosis cysts while trying to get pregnant? 

Laparoscopy has very specific roles to play:

  • To make a diagnosis and to staging
  • To remove large chocolate cysts when they are obstructing the IVF process or are > 4 cm in size.
  • When the woman is in excessive pain throughout the month and laparoscopy is done to reduce the disease burden. 

A few years ago, it was the trend to jump to surgery the moment one saw endometriotic cysts. However, today that treatment has its pitfalls. Therefore, it’s recommended only in very specific situations. 

Should one get chocolate cysts removed or drained?

  • When fertility is not the goal, the removal of cysts is the right choice. As the chances of recurrence of the cyst are low. 
  • However, when fertility is the goal, removal of the cyst may reduce the number of eggs in the ovarian reserve by 40 to 50% over the next 6 months. You might not recover from this loss. Owing to this potential loss of eggs, draining cysts may be a better choice. 
  • Your doctor will be in the right position to discuss with you and decide which is the right treatment for you 
  • The idea of me saying this was just to make you more aware so that you can discuss it with your doctor before jumping blindly into a procedure. 

What kind of doctor should you see if you suspect you have endometriosis?

It is important to talk to an OB/GYN about any symptoms related to your reproductive health. Do not be afraid to seek a second opinion if you do not receive the care you deserve.

Can pregnancy stop the progression of endometriosis?

It can stop the progression temporarily. Pregnancy and the increase in progesterone levels often relieve symptoms, but they typically return after birth and/or after stopping breastfeeding.

How and why does endometriosis cause infertility?

Researchers are still trying to understand the relationship between endometriosis and infertility, but endometriosis is one of the top three causes of female infertility. Many women are unaware of their infertility or endometriosis until they attempt to get pregnant. 

In some women, endometriosis goes untreated, and the disease progression allows the endometrial lesions to block the fallopian tubes and inhibit ovulatory functioning. Some studies also suggest that endometriosis may alter the uterus in a way that disrupts embryo implantation. However, this notion requires more research.

What is the cause of endometriosis? Are you born with it?

Research is still ongoing to determine the exact cause of endometriosis, but some studies suggest a genetic component. 

Can endometriosis be inherited?

More research is necessary to fully understand the genetic characteristics of endometriosis. With one first-degree family member affected (mother, sister, daughter), a person has an increased risk of having endometriosis.

Are there any links between endometriosis and cancer?

This is an area of research that is just beginning to expand. 

If I get a hysterectomy, will my endometriosis pain stop?

When the uterus is removed, there is no longer any chance of becoming pregnant. Doctors do not recommend a hysterectomy as a sound treatment option for endometriosis. Pain associated with endometriosis does not necessarily stop when a hysterectomy is completed as the ovaries continue to produce estrogen, facilitating disease progression. Additionally, lesions may still be found on other organs (perhaps unrelated to the reproductive system), which may cause symptom manifestation.

Can birth control cause other problems like blood clots?

Birth control can cause a range of side effects. However, many patients say they are much easier to manage than the symptoms of endometriosis. The risks of any medication or intervention must be discussed with your doctor. 

How is endometriosis different from uterine fibroids?

Uterine fibroids are similar in that they develop from the cells of the lining of the uterus. However, they typically remain inside the uterus and are often asymptomatic. 

How is endometriosis different from ovarian cysts?

Ovarian cysts can occur when the egg-releasing follicle in the ovary continues to grow. They remain in or on the surface of the ovary and are typically harmless. However, can rupture, causing pain.

Can endometriosis be transmitted through sex or person-to-person contact?

No, endometriosis cannot be transmitted through sexual contact or person-to-person contact.

What if my period comes once and then not again for three or four months?

During puberty, there are often menstrual irregularities that occur. These usually stabilize over time. However, if you have specific questions or concerns, you can always contact your doctor to be sure.

What normally happens to this lining of the womb, in the normal course of a cycle?

The lining starts to form and grow thicker after the menstrual period’s end. This process continues for 25 to 28 days and then if the woman has not gotten pregnant that month then the lining breaks down and is shed, along with blood, through the vagina. This is what we call Periods or Menstrual bleeding.

How do we Stage the various degrees of Endometriosis?

There are 4 stages of the disease. The staging is only valid when it is done when viewing through laparoscopy. Stage I represents the mildest form of the disease in terms of spread and Stage IV represents the most advanced one.

The ironic part is that staging does not always correlate with the severity of the disease. So one can have a very mild disease that is very difficult to diagnose yet she may have terrible terrible pain. While on the other hand, another woman may have stage IV disease which is incidentally diagnosed while performing Laparoscopy for some other reason.

Is the success rate of IVF in a woman with endometriosis the same as someone without endometriosis?

Unfortunately, no as of multiple factors like poor egg quality and damaged uterine walls, the success rates are lower even in IVF. How much lower will depend on the extent of the damage. Some patients come in after trying various treatments over years despite endometriosis. They think that IVF is the last option and they will take that up only when all roads are closed. Little do they realise that when they finally take it up, doctors already have their backs against the wall. The result of course is multiple failures, higher costs, frustration, misunderstands as to why things are not working out despite IVF, and lastly landing up with donor eggs or surrogacy.

IVF is a fantastic treatment, however, it can help only if you avail of it in time.

What is the role of medical therapy on pain? Does that work in fertility as well? 

There is a very limited role of medical therapy when it comes to fertility management in endometriosis in comparison to pain management. The basis of medical management is stopping the periods for long periods so that the endometriotic tissues are estrogen hormone deprived and thus shrink.

When periods are not happening ovulation does not occur and thus one can’t get pregnant. When the effect of the drug goes away, periods return but so does endometriosis.

This is why medical management is low when treating patients with fertility issues.

The only role and a very good one is when to perform IVF. The doctors collect the eggs first and since after that there is no need for ovulation, we stop the periods for three months with medical management causing shrinking of both endometriosis and adenomyosis. Now when the embryo is put back into the uterus after 3 months, pregnancy rates are much much better.

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