Endometriosis occurs when tissue that normally lines the inside of the uterus (endometrium) grows and attaches to organs outside of the uterus, usually the ovaries and fallopian tubes. In advanced cases, endometriosis causes scarring of these reproductive organs and can block the tubes and mechanically interfere with ovulation.
Two chronic conditions may result from the presence of this disease: infertility and/or pelvic pain.
Endometriosis can be managed surgically, medically or a combination of both.
Surgery involves removing the endometrial tissue on affected areas in the pelvis. This surgery is usually performed via laparoscopy. Subsequent pregnancy rates and relief of pain will vary depending on the extent of disease.
Since endometriosis is stimulated by estrogen, medical therapy has been used to suppress this hormonal stimulation. A particular approach temporarily places a woman into a ‘medical’ menopause. This may assist in relief of pain and subsequent fertility depending on the particular condition. In a large percentage of these patients, an important implantation protein, integrin, is not present in the endometrium and this will decrease conception. Several months of estrogen suppression has been shown to treat this problem and improve pregnancy rates.
PCOS affects 5 – 10% of women in their reproductive years. Treatment options for PCOS include weight loss, medications to treat insulin resistance, and/or medications to stimulate ovulation.
Even modest weight loss can restore ovulation and improve overall health. Treating insulin resistance not only restores ovulation but also decreases the chance of early miscarriage, and the chance of developing diabetes in pregnancy.
If pregnancy is desired, there are several types of medications (oral or injections) to stimulate ovulation.