More difficult? Likely so. Impossible? Absolutely not! OBGYN and fertility expert Dr. Gleaton explains everything you need to know when trying to conceive with endometriosis.

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By OBGYN and fertility expert Dr. Kenosha Gleaton

For most of us, many negative emotions surface when thinking of the word “puberty,” from marked acne to mood swings—and most notable our monthly cycle. Unfortunately, these early menstrual cycles are often marked by crampy pelvic pain, nausea, and vomiting. And while most of these cycle related symptoms eventually improve, sometimes they don't. And what if symptoms worsen and bring more pain with normal activities like sex, bowel movements, and urination? 

Overview of endometriosis

Endometriosis is a condition in which the tissue that lines the uterus (the endometrium) is found outside the uterus. This endometrial lining, also known as implants, can be found in various places including the bladder, rectum, ovaries, and fallopian tubes. Endometriosis is actually more common than most people realize and occurs in nearly one in 10 women of reproductive age. Although it often occurs in the 20s, it is most often diagnosed in women in their 30s and 40s.

Endometriosis is actually more common than most people realize and occurs in nearly one in 10 women of reproductive age

Symptoms of endometriosis

Although every woman is different, the most common symptoms of endometriosis include: 

  • Painful periods, including pelvic pain and cramping
  • Lower abdominal or low back pain
  • Sharp, deep pain during ovulation, sexual intercourse, bowel movements, or urination
  • Shooting pains (sciatica) during menstruation
  • Heavy menstrual periods
  • Bleeding in between periods
  • Indigestion, diarrhea, constipation, or nausea
  • Infertility

The four stages of endometriosis

Because of the varying degrees of endometriosis, a staging system has been developed to help both doctors and patients quantify the extent and severity of this condition:

  • Stage 1 or minimal: few small implants 
  • Stage 2 or mild: more implants than in stage 1, often deeper
  • Stage 3 or moderate: many deep implants, scarring, adhesions
  • Stage 4 or severe: widespread implants, cysts on ovaries, thick scarring
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Tracking ovulation when you have endometriosis

When trying to conceive (TTC) in the setting of endometriosis, it's important to identify your fertile window, your LH surge, and subsequent ovulation by using ovulation predictor tests (OPKs). Charting ovulation allows you to confidently identify when you're most likely to conceive. This is of utmost importance for endometriosis patients since each cycle can expose the reproductive organs to further damage. Endometriosis can affect the tubes and ovaries and tends to progressively worsen over time, especially if untreated. 

Getting pregnant with endometriosis

Every woman's journey to conception is different, unique, and sometimes unpredictable. 

Thus, there is no defined timeline for how long it will take to get pregnant —with or without endometriosis. However, we do know that endometriosis, even in the mid stages, can lead to infertility. If you’ve been trying to conceive for longer than one year if under 35, and more than six months if over 35, discuss the next steps with your OBGYN. 

Pregnancy risks associated with endometriosis

Several pregnancy complications are associated with endometriosis including:

  • Miscarriage: Several studies have evaulated a link between endometriosis and miscarriage and found that there is up to an 80% increased miscarriage risk with endometriosis.
  • Preterm labor: In 2017, a metaanalysis of over 50,000 pregnant women showed that endometriosis patients are 1.5 more likely to have preterm deliveries before 37 weeks.

Ways to manage endometriosis

Endometriosis is best managed by identifying current goals, mainly whether a woman is trying to conceive or not. If not trying to get pregnant, it is generally recommended to suppress or reduce cycles. Fewer cycles means fewer endometrial implants, scarring, and damage to pelvic structures. 

When TTC, we recommend using ovulation predictor tests to quickly identify the LH surge and subsequent ovulation. During this preconception period, symptoms can be managed by over-the-counter (OTC) antiinflammatories, and herbal supplements including green tea, camomille, and omega 3 fatty acids. Unfortunately, sometimes these OTC agents are simply not enough. If pain is uncontrolled with OTC agents, ask your OBGYN about whether a prescription medication or surgical procedure is appropriate for you. 

Become your own health advocate

Endometriosis represents a complex medical condition that often requires a variety of treatments to optimize outcomes. If you're suffering from endometriosis, or its symptoms, speak with your OBGYN regarding a plan for diagnosis and treatment. Most importantly, don’t suffer silently. Listen to your body and become your own health advocate. Following these steps will give you the optimal chance for achieving a successful pregnancy, when the time is right.

Most importantly, don’t suffer silently. Listen to your body and become your own health advocate.

 

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