Endometriosis—which occurs when tissue that’s supposed to be lining the uterus winds up outside it—can be mild or severe, with symptoms or without.
Some women with the disease will have no trouble getting pregnant. But for others the disease will cause fertility problems, and they will need proper treatment to conceive.
For most of her life, Natalie Coulder associated her period with pain.
Even in her late teens, her cramps seemed more severe than those her friends complained about during “that time of the month.” In fact, her pain would sideline her completely, forcing her to stay inside every 28 days.
Still, it wasn’t until she and her husband were trying—and failing—to get pregnant that Natalie began to question her own body and the pain she felt with menstruation. “My mother and my grandmother both had been diagnosed with endometriosis. I knew that I probably had it, but [until this time] I didn’t think a whole lot about what that might mean,” she says. “After all, they had children.”
She even had difficulty convincing her doctor to take the problem seriously. “I was told I was young and it would happen, so I should just relax,” she says.
After numerous failed attempts, Natalie got pregnant, but she had a miscarriage in her tenth week. Despite her youth, she struggled to conceive again, and constant back pain joined heavy monthly cramping on her list of complaints. “I knew something was seriously wrong,” says Natalie, who finally consulted a different doctor. He agreed the problem was probably endometriosis, and after proper treatment, Natalie and her husband got pregnant again. This time the pregnancy was healthy, and the couple welcomed a healthy little girl, Eliana.“It means, ‘God has answered me,’” Natalie says.
Endometriosis is the presence of endometrial tissue, which is the lining of the uterus, outside of where it belongs, explains Linda Sung, MD, an ob/gyn with the Reproductive Specialists of New York, and clinical assistant professor of ob/gyn at the State University of New York at Stony Brook. As we all learned back in junior high health class, cells lining the uterus are shed during menstruation—unless, of course, a woman is pregnant. However, for a surprisingly large number of women—10 to 15 percent of reproductive-age women who menstruate, according to the American College of Obstetricians and Gynecologists (ACOG)—similar cells grow outside the uterus and continue to respond to hormonal cues, often causing pain and fertility problems. Endometriosis is a non-cancerous condition that affects over 5.5 million women in North America alone—making up between 2 to 10 percent of women of reproductive age.
While endometriosis can affect almost any part of the body, in most cases the tissue adheres to other pelvic structures, including the ovaries and fallopian tubes. Less commonly, lesions can also occur on the bladder, bowels, and rectum. In rare cases, endometriosis has even been found in cesarean section and laparoscopy scars, and in the lungs, spine, and brain.
“Endometriosis is a disease process, not well understood by many doctors,” says Kenneth Gelman, MD, a reproductive medicine specialist for Memorial Healthcare Systems in Hollywood, Florida. The medical community has yet to pinpoint a cause, although most agree a combination of genetic, biological, immunologic, and environmental factors are probably involved. According to Dr. Gelman, many subscribe to the theory of retrograde menstruation—that some of a woman’s menstrual tissue doesn’t flow out during her period, but flows back through the fallopian tubes into other areas of the body. Then it attaches itself and grows, forming endometrial implants
The Many Faces of Endo
Endometriosis is an “equal opportunity condition,” affecting no single group of women more than any other. Genetics is the only known risk factor. “Endometriosis is six to seven times more prevalent among first-degree relatives [such as daughters and sisters] of affected women than the general population,” says Lisa King, M.D., a reproductive endocrinologist in private practice at The Women’s Place and clinical instructor of ob/gyn at the University of Texas Southwestern Medical Center at Dallas. In fact, since many women only experience mild pain, or no pain at all, the genetic link may be the only “heads up” until attempts at getting pregnant fail.