Endometriosis: Its Everywhere, But in Small Amounts

No one really knows what causes endometriosis. The prevailing theory is that it is caused by menstrual blood that backs up through the tubes during one’s period. This blood also contains the shedding glands from the lining of the uterus (the endometrium). It’s these glands that start the problem. In some women, for unknown reasons, these glands stick and continue to grow in areas like the ovary (most common area), the tubes and other areas in the pelvis near the bladder and rectum. These growing glands, only in some cases, can cause scarring and inflammation that lead to tubal blockage and pain. Ten percent of women have endometriosis.
So when most people hear this for the first time they worry that they have it, and it’s their cause of infertility. Rest assured this is usually not the case. First, of the 10% of people who have it, the vast majority of them don’t have enough of it to cause any problem at all. They may have a spot the size of a dime in their ovary or in those other places, but its not enough to cause any of the problems listed above, including infertility. Second, there is a lot written about the ability of even a small amount of endometriosis to cause problems with ovulation, fertilization, embryo quality and implantation. There are not enough facts in the literature to support any of this, and most doctors today believe the only way endometriosis causes infertility is by causing scar tissue that interferes with tubal function. Some doctors like to perform a laparoscopy on every infertility patient, using the excuse that 10% of women have endometriosis, so we need find it and annihilate it. This is over operating, and fruitless. Other tests can be performed to look for endo, including an ultrasound and hysterogram. If these two tests are nomal, a laparoscopy may be indicated in only a small percentage of cases. A typical indication for laparoscopy will be discussed in the next entry.