16 Mar Endometriosis Awareness Month
As part of our initiative to raise awareness about different medical conditions that can have an effect on female fertility, in the last few months, we’ve covered ovarian cancer, cervical cancer, and PCOS. But this March, we’re going to focus on endometriosis, in honor of Endometriosis Awareness Month.
Let’s start with a little bit of the history of endometriosis. It was discovered microscopically, back in 1860, by Baron Carl von Rokitansky, but it wasn’t until 1920 that the first metamorphological explanation, and full description, was given by a gynecological surgeon called Thomas Cullen. Yet, to this day, is it unknown why some women get endometriosis, and others do not. The only evidence there is that endometriosis could be caused by relatively low testosterone during fetal development, which is responsible for “programming” the female reproductive development and is associated with other factors such as certain genetic polymorphisms, autoimmune alterations, alterations in the microbiota and increased risk of breast cancer. By contrast, PCOS has been associated with relatively high testosterone in prenatal development.
Then, in the 1960s, doctors started implementing hormone therapies for patients with this condition, which consisted of high-dose testosterone and/or high-dose estrogen therapy. We now know that high levels of estrogen in women, and more specifically of estradiol, can trigger inflammation and cause severe pain in patients with endometriosis. In fact, one of the things medical professionals advise people to do is to switch to a vegetarian diet, as vegetarians normally have 15-20% lower estrogen levels. But if patients are not willing to give up meat, then they can simply try to increase their intake of cruciferous vegetables, such as broccoli, cauliflower, cabbage, Brussels sprouts, etc. For what concerns testosterone, researchers are currently trying to come up with new ways of delivering the effects of higher testosterone, without generating the androgenic side effects (such as facial hair, lowered voice, breast reduction, etc.) to make the treatment more tenable for women.
Continuing with the timeline, in March of 1993, Endometriosis Awareness Month was observed for the very first time, and yellow ribbons were distributed worldwide to demonstrate solidarity with women suffering from endometriosis.
But what exactly is endometriosis? And does it affect that many people? According to the WHO, the definition of endometriosis is: “a disease where tissue similar to the lining of the uterus grows outside the uterus, causing pain and/or infertility”. As for whether it affects the vast majority of women, the answer is no, but it does affect roughly 10% (or 190 million) or reproductive-age women and girls globally. In the EU alone, it affects approximately 14 million women, and is considered one of the most common chronic diseases in fertile women.
Not surprisingly, a large number of the reported cases were first identified in assisted reproduction clinics, during an infertility consultation. Unfortunately, this disease looks very, very differently for each person, thus individual assessment, followed up with a specialized gynecologist, who will prescribe a personalized treatment, is crucial. As most women go years without their condition being properly diagnosed, we cannot emphasize enough the importance of carrying out annual gynecological examinations.
Our advice for younger patients with endometriosis, not currently looking to get pregnant, is to freeze their eggs, preferably before the age of 36, as endometriosis accelerates the diminished ovarian reserve, usually observed between the ages of 35 and 40.
For those with mild cases of endometriosis, who are looking to get pregnant, we recommend artificial insemination, if they know that they have a normal ovarian reserve, healthy fallopian tubes, and their partner’s semen analysis has not shown any abnormalities in the quality of the semen.
On the other hand, we suggest conventional IVF to patients with endometriosis, who have obstructed fallopian tubes or a lower ovarian reserve. But if there’s a record of previous unsuccessful IVF cycles or patients present a very low ovarian reserve, IVF with egg donation could help them increase their chances of a successful pregnancy.
At Reproclinic, we plan on continuing our initiative of educating people around the world about the different conditions that have an adverse effect on fertility, in hope of helping them seek any medical assistance if they need it.