Women’s Health with Minoos Hosseinzadeh, M.D. Endometriosis Part I: Identifying Symptoms and Assessing the Impact on Fertility

Endometriosis is a condition where the lining of the uterus or endometrium, which is only supposed to be found in the uterus, is found outside of the uterine cavity. When found outside the uterus, this tissue behaves in much the same way as the lining of the uterus in that it responds to hormones such as estrogen and progesterone by growing and then breaking down and bleeding. Over time, this repetitive monthly bleeding can generate excessive scar tissue formation, which can subsequently produce pain and lead to infertility. Rarely, endometriosis can be found in the lungs, scars and the belly button, but more commonly, endometriosis establishes itself at the following locations within the pelvic cavity:

• Ovaries
• Fallopian tubes
• Posterior cul-de-sac, also known as the space directly behind the uterus
• Bowel and rectum
• Bladder

Candidates Most at Risk for Developing Endometriosis: Incidence Rates
Endometriosis is a common disease among reproductive-aged women. The exact incidence of this disorder is unknown, but it is found in roughly 7-10% of women of childbearing age. Patients identified as having infertility also present with endometriosis 30-45% of the time. Similarly, 40-50% of women who experience pelvic pain also have endometriosis. Although the exact etiology for endometriosis is unknown, it is more common if a first degree relative, such as a mother or sister, has the disease.

Recognizing Common Symptoms of Endometriosis: When to See a Doctor
Although patients with endometriosis can present with a number of symptoms, the most common is pelvic pain. Typically, the pain initiates around the time of the menses and is cyclical. Patients may also complain of pain with intercourse, pain with bowel movements or during urination. For some, abnormal uterine bleeding in the form of menstrual spotting before or after the period may occur. It is important for women to understand the following key points:

• The amount of pain does not correlate with the severity of the disease -Patients can experience severe pain yet present with minimal endometriosis or vice versa.
• Patients may have endometriosis but remain asymptomatic -Not all cases of endometriosis produce pain or bleeding.
• Endometriosis can present with infertility -It's important to consult a reproductive endocrinologist who can identify any link between the two.
• Early diagnosis makes a difference -It's imperative to make a diagnosis as early as possible, especially in adolescents whose reproductive future is at stake.
• The symptoms of endometriosis could also be signs of other problems -To be sure, consult a physician for a complete evaluation.

In the next issue, the diagnosis of endometriosis will be explored. To protect fertility, early diagnosis is especially important and there are several telltale signs that enable a reproductive endocrinologist to make an educated decision about the presence of endometriosis and bring patients one step closer to finding treatment.

OC Life Readers: Email questions to Women’s Health with Dr. Minoos at DrMinoos@OCPCmagazine.com. ____________________________________________________________________________

Dr. Minoos Hosseinzadeh is a nationally recognized specialist in reproductive endocrinology at the largest and most-established locally-based fertility center in Orange County, Calif., Coastal Fertility Medical Center (http://www.coastalfertility.com). Double-board certified in Obstetrics and Gynecology and Reproductive Endocrinology & Infertility, she is also a member of the American Society of Reproductive Medicine, Society for Reproductive Endocrinology and Infertility, American College of Obstetrics and Gynecology and the Royal College of Physicians and Surgeons. She has presented at several national and international fertility meetings and authored numerous papers on hormone replacement therapy and age-related female infertility.