DEAR DOCTOR K:
I have endometriosis. Could this affect my fertility?
Endometriosis can affect fertility — but not in every case. Let me explain.
Endometrial tissue is the inner lining of the uterus. Normally, that’s the only place in the body where it grows.
However, with endometriosis, the same type of tissue also grows where it shouldn’t — in places outside the uterus. It may grow in or on the ovaries or fallopian tubes, or in the pelvis or lower abdomen. Endometriosis doesn’t always cause symptoms. But when it does, it can result in severe pain and discomfort.
Whether or not endometriosis affects your fertility depends on its severity and location. It’s more likely to interfere with your fertility if endometrial tissue covers or grows into your ovaries, or if it blocks your fallopian tubes.
There are many available treatment options. Even without treatment, most women with mild endometriosis eventually can become pregnant.
For mild pelvic or abdominal pain, you can try a nonprescription pain medication — ibuprofen (Advil, Motrin), for example, or naproxen (Aleve). If this doesn’t help, your doctor may prescribe a prescription-strength pain reliever.
Stronger medications that contain a mild narcotic, such as codeine, are available, but they carry the risk of drug dependence and addiction.
Other treatments relieve pain by controlling levels of female hormones that encourage inflammation within patches of endometriosis. This can worsen pain and discomfort. The treatments of this type include birth control pills (because of their effects on the levels of sex hormones, not because they prevent pregnancy). Other treatments of this type include medicines called gonadotropin-releasing hormone agonists (yes, it’s a mouthful), progestins and a medicine called danazol (Danocrine).
Surgery is another option if medicines fail. Some procedures may be done laparoscopically, through small incisions. Using specialized surgical instruments, the doctor destroys small areas of extra endometrial tissue growing outside the uterus. The doctor may burn the tissue away, trim it away, or use a laser to vaporize it. (See illustration.) Many women who have laparoscopic surgery to improve their fertility become pregnant.
For more extensive endometriosis, you may need traditional abdominal surgery. This is done through a larger incision.
A last-resort treatment is a hysterectomy. This involves removing your uterus, ovaries and fallopian tubes — and any endometrial tissue that comes with them. It is performed only in women with severe disabling pain who no longer want to become pregnant.
Fortunately, symptoms of endometriosis usually go away after menopause. I don’t think we know for sure that the treatments I mention above will improve fertility — your specific question. However, let me repeat that most women with mild endometriosis do not have problems with fertility.