Doubling over with pain during your period? Sometimes, it's way more than just a serious case of cramps. For approximately 176 million women globally, it's endometriosis, a painful disease in which tissue that normally lines the inside of the uterus grows outside of the uterus. And unfortunately, endometriosis is one of the leading causes of infertility and one of the more difficult ones to treat, says Shahin Ghadir, M.D., reproductive endocrinologist at Southern California Reproductive Center
What is Endometriosis?
During a normal menstrual cycle, the lining of your uterus thickens and then sheds when a fertilized egg doesn't attach, resulting in your period. But when this lining starts to grow outside of the uterus—like on your ovaries or inside the pelvic cavity—it becomes inflamed, grows, and essentially has nowhere to go, says Ghadir. The result is severe pelvic pain, usually during your period, along with significant scarring to the surrounding tissue. It may also lead to large cysts on your ovaries called endometriums, which are filled with endometrial fluid. And sadly, doctors still aren't sure what causes the disease, though they know estrogen plays a role.
Spotting and Treating the Symptoms
It takes years for most women to be diagnosed with this mysterious disease, says Ghadir. Unfortunately, that's because the only definitive way to diagnose it is with a surgical biopsy of the tissue. Still, Ghadir urges women to tell their doctor if they have any of the symptoms: chronic pelvic pain, severe menstrual cramps, spotting before your period, painful bowel movements or urination (especially during your period), and discomfort or pain during sex (especially during deep penetration).
Your doctor may suggest a few less invasive treatments before ordering a biopsy. Surprisingly, the first line of defence is usually birth control. Taking birth control pills to stabilize your hormones can help, but an even better option is continuous birth control, like Lybrel, which lets you skip your period for a longer period of time. As your hormones level out, it tends to alleviate the symptoms, explains Ghadir. The next treatment option would be an injected medication taken either once a month or once every three months. The shot, called Lupron, puts you into a premature, reversible menopause by lowering your estrogen levels so that you don't have a normal monthly cycle, says Ghadir. If either of these treatments work, your doctor may give you a tentative diagnosis of endometriosis, though the only way to know for sure is with a biopsy. Sadly, there's still no cure for the disease—but it's often possible to remove some of the lesions and scar tissue through surgery.
The Word on Fertility
Between scar tissue and cysts, this painful disease can wreak havoc on your reproductive future. While medication and surgery can alleviate the symptoms, the only way to preserve your fertility is by freezing your eggs to be used in the future in case your endometriosis gets worse, says Ghadir. He also notes that many women with the disease have better luck with IVF. The good news: Symptoms tend to get better during pregnancy.
Even though there isn't a cure for endometriosis, it's still crucial to know your diagnosis as early as possible. Not only will it help you treat your symptoms, but it may give you more time to think about and preserve your fertility. "If you have endometriosis and are considering children in the future, consider meeting with a reproductive endocrinology specialist sooner—rather than waiting until things are out of control," says Ghadir.
For more info head to Endometriosis Australia.