How it’s tested
If you have endometriosis, you’ll bleed during your period like other women do. But you may also be bleeding internally from the implants outside your uterus. Internal bleeding is physically painful, and can lead to scar tissue in your pelvis. Scar tissue can block or harm your fallopian tubes, and pockets of old blood in your body can form cysts. Both scar tissue and cysts can reduce your blood flow, harming your ability to generate multiple healthy eggs. It can even lead to your store of eggs being reduced prematurely.
In addition, although we don’t entirely know why, a fertilized egg seems to have a harder time implanting in your uterus if you have endometriosis. Usually when an egg can’t implant easily, we find abnormalities in your uterus that explain the problem (like an abnormal shape, thin uterus lining, etc). Although these abnormalities can be found in women with endometriosis, it’s just as common for women with endometriosis to have a perfectly normal uterus. Unfortunately, it seems that egg implantation suffers anyway.
Finally, the painful periods and scarring can make sex hurt quite a bit. You may feel like avoiding intimacy. And as with any pain, your emotional well-being can suffer a lot.
The only way to truly diagnose endometriosis is through a laparoscopy. That’s an invasive surgical procedure.
Usually, if your doctor thinks you may have endometriosis, he or she won’t recommend having a laparoscopy if the only reason is to diagnose you. That might seem strange, but in most circumstances, knowing that you have endometriosis doesn’t help the doctor very much with your fertility. So it may not be worth putting you through such an invasive procedure.
Now, there are always exceptions. You should discuss the benefits and disadvantages of surgery with your doctor. Also, although surgery is unlikely to improve your fertility, it’s possible to opt for surgery just to reduce your endometriosis-related pain. That might be a perfectly appropriate reason to undergo the surgery, and it’s something you can definitely discuss with your doctor.
Without a laparoscopy, there are red flags we look for that suggest you might have endometriosis:
- You have a mom or sister with the disease
- You have really painful cramps before your period
- You feel pain when your vagina is being penetrated really deeply (this is called “deep dyspareunia” and can sometimes happen during sexual intercourse, depending on the position and force of the penetration)
- Your transvaginal ultrasound shows blood-filled cysts on one or both ovaries – usually between one and four centimeters in size, and persistent from week to week and month to month
- Your HSG or sonohystogram shows that one or both of your fallopian tubes seem to be blocked
- Your blood tests may be positive for CA125 or Interleukin 6
- Your endometrial biopsy test may show the presence of the marker Beta-3 integrin
We’ve love to able to diagnose endometriosis with a simple blood test, biopsy or ultrasound, but unfortunately we can’t. Our choices are either to do an invasive laparoscopy surgery, or use these indirect signs and symptoms to build our diagnosis.
How it’s treated (before trying)
Remember how estrogen may stimulate your endometriosis? The longer your condition is left untreated, the more it experiences estrogen spikes from your menstrual cycle. All those spikes increase your chance of internal bleeding and scar tissue.
That’s why a continuous low-dose birth-control pill is often suggested. Not only does the continuous pill lower your estrogen levels, it also flattens those menstrual estrogen spikes by simply stopping your periods.
We can also lower your estrogen and stop your periods with similar treatments, like Lupron Depot injections. These injections may be more effective than the birth control pill, they can cause more intense side effects, like hot flashes and depression.
Uh, how can I get pregnant if I’m on the pill?
You’re right: you can’t get pregnant while you’re being treated for endometriosis using the pill. The pill is more like a fertility pre-treatment, in hopes of boosting your reproductive health when you do start trying.
Neat fact: pregnancy and breast feeding are actually the ideal treatment for endometriosis: you won’t have your period while you’re pregnant, and your estrogen levels drop severely when you breastfeed. You may have heard stories about couples who struggled with their first pregnancy, only to discover that future pregnancies came more easily. These stories might match an underlying diagnosis of endometriosis!
How to treat endometriosis while trying
When you have endometriosis but you’re actively trying to get pregnant, the best treatment targets each separate area of female fertility: your eggs, your tubes and your uterus.
First, it’s good to take pre-treatment supplements to maximize your egg quality and stimulate your ovaries. We can dramatically increase the number of eggs available for IVF-based fertility.
At the time of IVF, the eggs themselves may be lower quality. In that case, some doctors will suggest using ICSI to ensure fertilization (instead of relying on the more natural fertilization that IVF uses).
Some doctors do an endometrial biopsy to analyze it further. This is controversial, as it doesn’t really work as well as we would like. That said, some tests include Harvey Kliman’s Endometrial Function Test, the “E-tegrity Assay” for beta-3 integrin, and a genetic profile looking for the ideal window of implantation.
Second, we’ll want to treat your fallopian tubes. You may attempt an HSG or even tubal cannulation to increase your chances of nice open tubes, and as a couple you can try intrauterine inseminations to maximize the number of sperm being delivered to the ends of your fallopian tubes.
That said, you can also bypass the fallopian tubes altogether with IVF. In fact, bypassing your tubes may actually be necessary: because endometriosis can be associated with serious tubal disease like hydrosalpinx, your doctor may need to block or remove part of your fallopian tube before IVF.
Finally, to prepare your uterus, your doctor may recommend a sonohystogram or hysteroscopy before your treatments start. This allows your doctor to discover and treat any polyp or septum early on.
The egg’s implantation in your uterus can be maximized through pre-treatment with Lupron or the birth-control pill, as we mentioned earlier. A pre-treatment endometrial biopsy can also help: not only is it informative, but it can also have a therapeutic effect on your fertility! In fact, a biopsy during your last pre-treatment cycle can improve or even double pregnancy rates in your first treated cycle.