Dr. Ingrid Prosser answers questions about symptoms and treatments of this common, painful condition as well as how it affects fertility..
If you’ve ever had severe menstrual cramps, pain between periods, or painful intercourse, and you haven’t gone through menopause yet, you might be one of the 1 in 10 women who suffer from endometriosis. The condition affects women during their childbearing years. In addition to pelvic pain and discomfort, it can also affect fertility.
However, there are options for treating endometriosis-associated pain – both treatments that are already FDA approved as well as new treatments being studied right here at VPFW. I’d like to answer a few questions about this common ailment, including how you might qualify for a paid clinical research study that could help more women find relief.
Whether you are interested in participating in the study or not, we encourage anyone who is suffering to consult with their provider about treatment options that help you regain your quality of life.
What can lead to pelvic pain and infertility?
Endometriosis is a common cause of pelvic pain and infertility. If you’re experiencing both, it’s a good indicator you may be suffering from endometriosis. In fact, 30% to 50% of women with endometriosis are unable to get pregnant and carry a baby. This makes endometriosis one of the top three causes of female infertility.
What is endometriosis?
Endometriosis is a chronic gynecological condition that affects 6-10% of women of reproductive age. It is primarily caused by glands which are normally found within the uterus being implanted instead on tissues outside of the uterus such as the ovaries, tissues surrounding pelvic structures, and even organs outside of the pelvis. These endometriosis implants can cause significant inflammation, ovarian cysts, and scarring.
What are the symptoms of endometriosis?
Common symptoms of endometriosis include chronic pelvic pain, painful periods, severe menstrual cramping, painful intercourse, and infertility. In fact, the incidence of endometriosis in women having difficulty achieving pregnancy is 21-40%, and in those with chronic pelvic pain, it’s approximately 70%.
Lesser-known or more uncommon symptoms of endometriosis include increased pain and frequency during urination, inconsistent bowel movement, back pain, chest pain, uterine bleeding and difficulty breathing.
Are there any risk factors for endometriosis?
Yes, risk factors for endometriosis include a family history of the condition. If you have a first degree relative (mother or sister) who has been diagnosed previously, you have an increased risk of developing endometriosis.
How do I know if I have endometriosis?
Endometriosis can often be suspected based on a patient’s symptoms or by findings on imaging, such as pelvic ultrasonography. However, the diagnosis is definitively made by biopsy of endometriosis lesions that are detected during diagnostic surgery.
Typically, the surgery is a laparoscopy – a minimally invasive surgical procedure that allows the surgeon to access the inside of the abdomen and pelvis through small holes, without having to make large incisions. Based on the findings during surgery, the stage of endometriosis can be determined, from Stage 1 (minimal) to Stage 4 (severe). The severity of symptoms does not always correlate with the severity/stage of the disease.
What is Stage 4 endometriosis?
Stage 4 is considered the most severe stage of endometriosis. At this stage, tissue grows in multiple places in a person’s body. The most common symptom of this stage of endometriosis is general pain: pain during sexual activity, bowel movements, and/or while urinating.
Severe menstrual cramping, spotting or bleeding between periods, and difficulty getting pregnant are some of the other common symptoms of Stage 4 endometriosis. Back pain and pelvic pain are also expected.
Can I get pregnant if I have endometriosis?
It can still be possible to have kids with endometriosis, but it will likely be more challenging. Pregnancy rates are higher in women with Stage 1 and 2 disease, and those younger in age.
For women with Stages 3 and 4 endometriosis, or who are older than 35, additional fertility treatments such as IVF may be needed. Stage 4 endometriosis pregnancy success is most likely when surgery is performed to remove scar tissue and/or large endometriotic cysts.
If you have endometriosis or are experiencing symptoms, and are interested in having children someday, it’s a good idea to start discussing your options with your doctor, even before you start trying to conceive. You can bring this up in a preconception visit with your OB/GYN. Reproductive specialists can also help if you have been trying to get pregnant for six months without any success.
If you’re experiencing infertility due to endometriosis, you can learn more about your options in Dr. Draper’s blog post, Fertility Treatment Options: A Comprehensive Guide.
How is endometriosis treated?
Treatment for endometriosis addresses management of endometriosis-related pain and infertility.
Options for treatment include anti-inflammatory medications, oral contraceptives, progestins, intrauterine devices, GnRH agonists such as Lupron, and surgery. Surgical treatment includes minimally invasive procedures to remove implants and scar tissue or sometimes hysterectomy (removal of uterus). The treatment approach depends upon the severity of symptoms, whether infertility is present, and whether the patient has completed childbearing.
Alternative therapies to manage pain-related symptoms, such as acupuncture, yoga, heat therapy, and herbal supplements, can be helpful in individual cases, but have not been proven to be effective treatments in most women.
What happens if endometriosis is left untreated?
Untreated endometriosis does have the potential for progression; therefore, it’s important for patients and their clinicians to develop an ongoing treatment plan. If left untreated long enough, the condition does disappear once the patient reaches menopause. However, many patients choose to be treated to improve their quality of life and/or address infertility before they reach menopause.
Is it possible to participate in a paid clinical study for patients with endometriosis?
Yes! VPFW is partnering with Clinical Research Partners to conduct a paid clinical research study for women with endometriosis to evaluate the safety and efficacy of a treatment for moderate-to-severe pain associated with the condition.
If you qualify, decide to participate, and complete all scheduled visits, you may receive up to $2,050. All study-related visits, tests, care from VPFW providers, and the study drug are provided to the participant at no cost.
You might be eligible for this clinical trial if you are premenopausal, 18-49 years old, have regular menstrual cycles, have moderate to severe pain due to endometriosis during your most recent period and while off your period, are not pregnant or actively trying to become pregnant, and do not have osteoporosis or any bone disease.
Interested in participating?
If you are interested in helping improve your life and the lives of other women by participating in this paid clinical research trial at VPFW’s Koger Center office, please fill out the form below, and we will reach out to you as studies become available.
You can learn more about the endometriosis study here or call Heather at Clinical Research Partners, 804-893-0645, if you have questions about participating. To schedule an appointment with a VPFW provider, you can call us at 804-791-4975 or set an appointment online.