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Progressively increasing dysmenorrhea (period pains or menstrual cramping) may be a symptom of endometriosis. It is caused by contractions of uterine muscle initiated by prostaglandins released from the endometrial tissue. A puzzling feature of endometriosis is that the degree of pain it causes is not related to the extent of the disease, and some women with extensive disease feel no pain at all. A woman with endometriosis may notice that as the disease progresses her periods become more painful or that the pain begins earlier or lasts longer.
Endometriosis can cause pain during intercourse, a condition known as dyspareunia. The thrusting motion of the penis can produce pain in an ovary bound by scar tissue to the top of the vagina or in a tender nodule of endometriosis. Most women who have endometriosis report no bleeding irregularities. Occasionally, however, the disease is accompanied by vaginal bleeding at irregular intervals or by premenstrual spotting.
How does endometriosis cause infertility? The relationship between mild (early) endometriosis and infertility is controversial. The most recent theories regarding the endometriosis-infertility link focus on the fact that endometriosis may lead to a form of mild inflammation within the pelvis. In some women with mild endometriosis, the levels of certain chemicals called cytokines (released in response to inflammation) are increased in the abdominal cavity, and these hormones may have a negative effect on follicle and egg development, egg-sperm binding and fertilization, normal tubal function, and even implantation.
Sometimes, the endometriosis may be coincidental and unrelated to the fertility problem. In these patients, other factors may be involved in a couple's infertility, such as poor quality sperm or ovulation disorders and the endometriosis is a "red herring". Some women who have the condition are able to conceive, while others may be infertile due to endometriosis or a combination of factors.
When endometriosis is severe, it's easier to understand how it can cause infertility. Endometriosis may inflame surrounding tissue and spur the growth of scar tissue or adhesions. Bands of scar tissue may bind the ovaries, fallopian tubes, and intestines together and thus interfere with the release of eggs from the ovaries or the ability of the tube to pick up the egg. Rarely, severe endometriosis may cause the tubes to become blocked. The presence of chocolate cysts in the ovary may also impair ovulation.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
