We very often come across cases of women who have had almost painless periods during their teens but feel an increasing pain with age. And in a case of one thing leading to another, the bigger complaint is about not being able to conceive. Predictably, it is one of the biggest causes of infertility: about 40 percent of women who are diagnosed with endometriosis have problems conceiving. Endometriosis also shows up as a secondary phenomenon in women who fail to conceive due to other reasons. Although many theories have been proposed to explain why it is harder for women with endometriosis to conceive, it is not quite clear as to how much endometriosis affects fertility.

Even though there is no easy way to tell whether someone is having a problem of endometriosis or not, the sheer numbers of women diagnosed with this problem is alarming. Endometriosis is known to be affecting the lives of over 25 million women in India, and there are millions more who may be ignorant about the problem, all of whom are in their reproductive age.

What really happens in Endometriosis?
In endometriosis, the endometrial cells that line the inner wall of the womb are found growing on one or more abnormal locations of the woman’s body, mostly in the pelvic cavity such as the ovaries, fallopian tube and the pelvic sidewalls. There are also other not-so-common sites of growth of endometrial-like cells such as the rectal vaginal septum, inside the bladder and the vagina, and very rarely, in the lungs, spine and the brain.
During menstruation, the actual endometrium (the thin layer of the uterine tissue) is the one that is shed and begins to bleed, but in the case diagnosed with endometriosis, the abnormal endometrial tissues from outside the lining of the uterus also begin to bleed. Blood accumulates around the ovaries and eventually forms a dark brown cyst (also called as chocolate cyst). Blood spots may be noticed around the pelvis. In advanced cases, endometriosis can cause scar tissue that may eventually distort a woman’s internal anatomy. Internal organs may even fuse together due to the adhesions, leading to an extremely debilitating condition called “Frozen Pelvis”.
Despite several theories, it’s still not clear what causes endometriosis. One popular cause is attributed to the backward flow of blood during a period, called as “retrograde menstruation.” During the process, menstrual blood, including endometrial cells are thought to escape into the fallopian tubes, even the bladder, intestines and beyond. Once deposited in abnormal internal organs, the endometrial cells are capable of responding to hormones such as progesterone and estrogen in a way that normal endometrial cells do within the uterus.
However, since retrograde menstruation is a very common occurrence among many women, it is unlikely that this is the only cause for endometriosis. Certain infections in the pelvic area, deposition of endometrial cells during a surgical procedure like a c-section or episiotomy are also known to be the likely causes for endometriosis.
Since the problem of endometriosis is not symptom specific, it is quite possible that some women diagnosed of endometriosis are not even aware of the problem. The most common symptom, however, is pelvic pain, often correlating to the woman’s menstrual cycle (there may be increased pain during menstruation), painful sexual intercourse and infertility (since endometriosis affects women in their reproductive years). Having said, there is no correlation between the severity of the symptom and the extent of endometrial deposits in the patient.
By and large, patients and their relatives are found to be ignorant about the disease, often resulting in delayed presentation to the gynaecologists. Early diagnosis offers the best chance for effective treatment. If in cases where the woman’s reproductive organs obstruct menstrual flow, surgery is a considered option.Pregnancy hampers the progress of endometriosis and hence is curative as well for this condition.

Endometriosis and Infertility:
Infertility is one of the leading consequences of endometriosis: to begin with, the prospect of going through a painful intercourse can impede the possibility of conception. Or, scarring or adhesions of the internal tissues and organs in the pelvic region may restrict adequate movement of the egg down the fallopian tube to the uterus. Overproduction of fertilization and implantation causing hormones—prostaglandins—due to endometriosis can cause infertility.
There are certain fertility tests that may be done to come to a diagnosis for endometriosis. A laparoscopic procedure can identify problems like scarring and endometriosis. Treatment can begin following a laparoscopic procedure and quite often, the best chances for a woman with endometriosis to get pregnant are within the first couple of years following treatment.
There are many women with endometriosis who get pregnant without any treatment at all. And there are some others who get pregnant and bear children successfully by adopting simple dietary, lifestyle changes or other complimentary therapies such as homeopathy and ayurveda. So it may be a combination of treatments where everything is intended towards rectifying the hormonal imbalances that may have triggered endometriosis, or setting the structure of the reproductive organs right.
Understandably, management of this disease may be a long-term process. Doctors prescribe medications to halt the progress of the disease. Surgery is recommended only when absolutely necessary. As such, patients are usually unaware of the disease and treatment modalities, despite the hardships they face in balancing between childlessness and severity of the problem.
Young women who want to conceive may require specialized treatments like In Vitro Fertilization. It may be one of the last options for women affected by endometriosis to get pregnant and bear children successfully. This treatment may be better suited to women who are over 35 years of age. It may be appropriate for women with endometriosis who have blocked fallopian tube.
If your answer is YES to any of the above, then you are at the risk of developing endometriosis

Endometriosis – Frequently Asked Questions
1. Why does the presence of Endometriosis cause pelvic pain?
Each month, when a woman gets her period the lining of the uterus (which is called the endometrium) breaks down and is shed as menstrual flow. When a woman has endometriosis, the kind of tissue that makes up the lining of the uterus also shows up in other parts of her body, including the ovaries, the bowels, and the bladder. During her period, this tissue breaks down — but since it is outside the uterus, it can't leave the body during menstruation, and cysts and scar tissue may form as a result. The presence of adhesions in the pelvic area make the pelvic organs rather fixed. Any motion of these organs (e.g., during intercourse), could produce pelvic pain.
2. Do women with more severe menstrual cramps have a greater tendency to acquire Endometriosis?
Although one of the most common characteristics of women with endometriosis is severe menstrual cramps, this appears to be the result of the disease rather than a precursor to it.
3. What are the signs and symptoms?
The following symptoms are common with Endometriosis:
• painful periods
• pain between periods
• lower abdominal pain
• lower back pain
• painful intercourse especially with deep penetration (dyspareunia)
• menstrual irregularity
• infertility
• nausea, vomiting, dizziness and fainting
• pain with bowel movements and/or urination

4. If I put off having children until my 30s or later, do I have a greater chance of getting Endometriosis? Is there any truth to the belief that delayed childbirth can lead to Endometriosis?
It was earlier believed that early childbearing offered protection against endometriosis. Although the incidence of endometriosis is higher in women who delay having their first child, this may be because of the fact that endometriosis causes infertility. It is therefore difficult to distinguish whether the infertility preceded or followed the endometriosis.
5. Does Endometriosis always cause infertility?
No, it doesn't. Probably fewer than 40% of women with endometriosis are infertile. However, women with endometriosis make up a large percentage of infertility patients.
6. Can I have Endometriosis without having any symptoms?
This does occur in some patients. The symptoms of endometriosis are highly variable. For instance, a patient with very extensive endometriosis may be incapacitated with pain or have very few symptoms. The same variability can be seen in mild endometriosis. Therefore, if the classic symptoms and signs and the physical findings of endometriosis are present in a patient, the diagnosis obviously could be straightforward. However, the absence of symptoms or physical findings does not mean that endometriosis is not present. Infertility is, at times, the only symptom.
7. I have pelvic pain all the time. What is the possibility that I have Endometriosis?
Usually, the pain associated with endometriosis is right before or during the menstrual period in the initial stages; however, as the disease progresses, it may occur throughout the cycle. The pain may be acute or chronic. In about half of the patients with severe or extensive endometriosis, the pain is chronic all through the cycle which gets worse right before and during menstruation, and during or shortly after intercourse.
8. Is it true that intercourse during the menstrual cycle increases the risk of Endometriosis?
This has not been proved. It has been suggested that intercourse during menses might increase tubal activity and increase the backflow of the menstrual cycle through the tubes and thus increase the risk of endometriosis. However, there are no statistics to bear this out.
9. Is there a relationship between Endometriosis and the use of tampons?
This is unlikely. Scientifically, there has not been any basis to conclude that the use of tampons increases the risk of developing endometriosis. Also, with regard to other hygienic practices (such as douching after the menstrual period), it has not been shown that this increases the risk of endometriosis.
10. Can Endometriosis be prevented?
There is no current manner of preventing Endometriosis, and it is not a disease which is "contracted" or "caused" by anything the patient did - nor is it contagious. It is, however, highly suspected to be genetic.
11. What is Endometriosis?
Endometriosis occurs when endometriotic tissue is found growing outside the uterine lining (endometrium). Growth of endometiotic tissue may appear in many places in the pelvis, attached to organs such as the ovaries, fallopian tubes, bladder, bowel etc…
Symptoms of Endometriosis:
Pain is often the number one symptom of endometriosis, though severity may vary from person to person. Other symptoms to look out for include:
• Heavy or irregular periods
• Bloating and gastrointestinal problems (in connection with menstruation)
• Fatigue, sleeplessness and depression
• Infertility and recurrent miscarriage
12. What are the treatment options?
In women who want to retain their reproductive potential, surgical treatment tends to be conservative, with the goal of removing endometriotic tissue and preserving the ovaries without damaging normal tissue. Women who do not wish to maintain their reproductive potential, removal of the ovaries and/or hysterectomy may be the option.
13. Pelvic pain during periods is not normal?

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