Endometriosis and infertility risk

Endometriosis is a condition that has received increasing attention in recent times, in which tissue that should have grown in the uterus is found in other parts of the body. about 10% of women may experience this condition

Endometriosis is a condition in which the tissue that normally lines the uterus (endometrium) grows outside. Endometriosis usually affects the ovaries, fallopian tubes, intestines, rectum, or bladder. Cysts, lesions, or scar tissue grow and cause the surrounding area to thicken.
Some women have little or no discomfort from endometriosis, but others may experience pain in the days leading up to their period, during menstruation, or during sex. Some were in pain the whole time.
If you have endometriosis, the endometrial tissue in the uterus grows outside the uterus and spreads to the fallopian tubes. These ectopic tissues still function like normal endometrial tissues, which means they shed and bleed during the menstrual cycle. However, the blood cannot flow out of the body but is stagnant, causing internal bleeding and inflammation, edema, leading to many other symptoms because they grow outside the uterus.

Endometriosis most often involves the fallopian tubes, ovaries, intestines or pelvic tissues, although very rarely, the endometriosis sometimes spreads to organs outside the pelvis. The surrounding endometriosis tissue can become irritated and painful, forming scar tissue and fluid-filled sacs that make it difficult to get pregnant.
Endometriosis affects about 10% of women in the United States, and about 25% of women with endometriosis have fertility problems.

Currently, the exact cause of endometriosis has not been determined. Accordingly, endometrial tissue is normally eliminated from the body during menstruation. The body excretes tissue through the cervix and vagina, and some tissue can flow back through the fallopian tubes. Sometimes the tissue also moves into the surrounding area of ​​the abdomen.
This usually doesn't cause problems, but many experts believe that in some women, endometrial tissue implants outside the uterus and leads to endometriosis.
Others believe that the immune system is involved in endometriosis. According to this theory, the immune system destroys the abnormal tissue before it attaches to the outside of the uterus. Endometriosis results when the immune system is unable to remove the misplaced tissue.
Another theory is that endometriosis develops from the remnants of a woman's own embryonic tissue. Here are a few factors that are thought to cause endometriosis:
Menstrual Reflux: Menstrual blood containing endometrial cells flows backward through the fallopian tubes. into the pelvic cavity, causing these cells to stick to the pelvic peritoneum and the surfaces of the pelvic organs instead of moving out of the body. Embryonic cell transformation: embryonic cells in the pelvis can transform into endometrial cells during puberty due to the influence of the hormone estrogen Surgery performed: scars form because surgery like a hysterectomy or a cesarean section can cause endometrial cells to stick to it, causing endometriosis. The vascular and lymphatic system can carry endometrial cells throughout the body. Immune system disorder: With this condition, your body cannot recognize and destroy endometrial tissue that grows outside the uterus causing endometriosis.

Some women with endometriosis have no symptoms. Others may have one or more symptoms ranging from mild to severe as follows:
Pain just before menstruation Pain in the pelvis, back or side during menstruation Heavy bleeding during menstruation Painful bowel movements, diarrhea or constipation during periods Pain or frequent urination during periods Painful sex Difficulty getting pregnant Pain during or after sex Menstrual cycles may last longer or bleed heavily Vaginal bleeding or bleeding between periods Blood in stools, urine Infertility In addition, there are some other symptoms, such as fatigue, bloating, nausea, especially during menstruation.

If you have signs of endometriosis, monitor these symptoms daily for several months. Accordingly, it is important to note the problems you have and how they affect your activities, then share the information with your doctor.
Your doctor will evaluate your symptoms, discuss your medical history, and perform a pelvic exam. During the exam, the doctor will check the uterus for cysts, changes in position, unusual pain, and whether certain areas feel thicker than usual. An ultrasound may be done to check for cysts in the ovaries.
If your doctor suspects you have endometriosis, he or she will order a laparoscopy to confirm the diagnosis before you start treatment. This procedure takes about a day:
First, the doctor makes a small incision near the navel under anesthesia and inserts a thin tube with a light (laparoscope). Your abdomen will then be filled with carbon dioxide to make it easier to see your organs before checking the size, location, and amount of the growing endometrium. Your doctor may also need to take a tissue sample for testing. Doctors evaluate endometriosis using a score system based on the number and size of growths found during a colonoscopy. There are 4 classifications:
Minimal (1 to 5 points) Mild (6 to 15 points) Moderate (16 to 40 points) Severe (more than 40 points)

There is currently no cure for endometriosis, but you can choose from several alternative treatments that aim to reduce the impact of your symptoms. The treatment given depends on the severity of the symptoms, as well as the location and size of the tumours.
Age is also a factor as symptoms can get worse as you get older. However, after menopause, symptoms usually subside.

Once the endometriosis you have has been classified as minimal, mild, moderate or severe, your doctor will recommend possible treatments. Your options depend on whether or not you're trying to get pregnant.

Minimal or mild endometriosis
The doctor can remove abnormal growths during the laparoscopy. In this case, a woman has about a 40% chance of getting pregnant for 8 to 9 months after the procedure. Women under 35 with no other fertility problems can skip treatment for six months and try to conceive naturally. If you don't conceive within that time, your doctor may suggest trying an intrauterine insemination (IUI) fertility drug. Women 35 and older may want to consider fertility drugs with IUI or in vitro fertilization (IVF) before the end of 6 months. Combining clomiphene citrate with an IUI provides a 9 to 10% chance of pregnancy in each treatment cycle. Combining gonadotropins (an injection that stimulates ovulation as well as the development of multiple eggs) with IUI increases the chance of pregnancy by 9 to 15% per treatment cycle. Laparoscopic surgery may be helpful if fertility treatment and IUI are unsuccessful.

Moderate or severe endometriosis
You may be offered laparoscopic surgery or laparotomy (surgery through a larger incision in the abdomen). If you're unable to get pregnant three to six months after surgery, your doctor may recommend IVF, especially if you're 35 or older. Your chances of having a baby through IVF are about 42% for women age 34 and younger; 30% for women aged 35 to 37; 21% for women between 38 and 40 years old; 15% for women aged 41 to 42; and 2% for women 43 years of age and older.

Minimal, mild, or moderate endometriosis
You need regular check-ups to monitor your condition, but may not need medical treatment. Endometriosis is likely to go away when you reach menopause, stop ovulating, and stop menstruating. If you have only mild pain before or during your period, an over-the-counter pain reliever may be enough to ease the discomfort. Birth control pills can also relieve symptoms by blocking ovulation, so the endometrium bleeds less and less often (every few months instead of every month). This slows the growth of new cysts and scar tissue, and may stop the progression of endometriosis. Moderate or severe endometriosis
Pain from moderate or severe endometriosis can be treated with medicines called gonadotropin-releasing hormone (GnRH) agonists. These drugs mimic the hormonal changes that take place during menopause by reducing estrogen levels, causing the growth of the endometrium to shrink and making symptoms less severe. On the other hand, GnRH agonists prevent endometriosis from progressing, but they do not cure it. When you stop taking the medicine, the condition may return. GnRH agonists are also expensive and can lead to side effects similar to those caused by menopause, such as hot flashes, vaginal dryness, and loss of bone density.

Your doctor will likely recommend using this treatment for six months or less. However, if low-dose estrogen and progestin are prescribed to minimize side effects, you can continue to take a GnRH agonist for longer than six months.
If symptoms do not improve after drug treatment, your doctor will recommend surgery. Laparoscopy or laparotomy can remove endometrial masses without removing the affected organs. If the condition is very severe, your doctor may recommend surgical removal of affected organs such as the fallopian tubes, ovaries, or uterus. Of course, if your uterus is removed, you won't be able to get pregnant.

All treatments help with endometriosis, but none cure the disease. Even if you opt for hormone therapy or surgery, endometriosis can come back or get worse.
Here are some suggestions for immediate relief from endometriosis pain:
Rest on a comfortable couch or in bed. Take a warm bath. Place a hot water bottle or heating pad on your abdomen. Prevent constipation by adding more fiber to your diet with whole grains, fruits, or vegetables. Practice relaxation exercises like yoga, deep breathing, meditation, and visualization. Ask your doctor about prescription or over-the-counter pain relievers.

You cannot prevent endometriosis although there are many treatments that can help control the symptoms it causes.
Endometriosis is almost a chronic condition and there is no way to prevent it. However, when endometriosis is diagnosed, there are many treatments available to relieve pain and restore fertility. Do not worry too much about the disease because not all cases of endometriosis cause infertility. Most of the discomfort caused by endometriosis is pain during menstruation. In this regard, there are many pain relievers to help you get through these days more easily.
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Reference source: babycenter.com