The Potential Fertility Problem that More Than 5 Million American Women Have

April Daniels Hussar,SELF magazine

Does the phrase "killer cramps" ring a bell? It might just mean Aunt Flo is on her way, but it could also mean something more serious is going on. March is NationalEndometriosis Awareness Month -- and if you just read that and said, "Huh?" then we're glad we caught you.

Normally, when you have your period, you shed the lining of your uterus, called the endometrium, explains Dr. Jamie Grifo, Program Director at NYU Fertility Center. Sometimes, however, these endometrial cells can be found outside of your uterus, and on places like your fallopian tubes and the outside of your ovaries, though it's not certain how they get there, says Grifo.

This misplaced tissue still sheds during your period, which causes local inflammation and scarring in your pelvis -- which in turn can cause symptoms like unusual pelvic pain and pain during sex, though, Dr. Grifo says, symptoms really vary from person to person. "Some patients have a lot of the disease and hardly any symptoms; some patients have a lot of symptoms and hardly any disease."

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According to the U.S. Department of Health and Human Services (HHS), more than 5 million women in the U.S. have endometriosis, and it can affect any woman, no matter how young, as soon as she menstruates. If untreated, endometriosis can lead to infertility, but it doesn't always -- HHS reports that about 30 percent to 40 percent of women with endometriosis are infertile, making it one of the top three causes of female infertility.

"It's not clear exactly how endometriosis prevents a woman from getting pregnant," says Dr. Grifo. "It probably damages tubes; there are hormonal and endocrine things that occur; there's evidence that it can interfere with sperm and maybe fertilization." No one really knows, says Dr. Grifo -- but what is known "is when you treat it, patients who were infertile before become more fertile."

If surgery, in which doctors burn or laser the endometriosis and either cut through or remove the scar tissue, doesn't work, then, says Dr. Grifo, it can be bypassed completely with in vitro fertilization. "There's a lot of hope," says Dr. Grifo. "Those patients do very well."

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Also, says Dr. Grifo, "There are plenty of women who get pregnant with endometriosis and we don't even know about it."

If you are struggling with infertility, Dr. Alice Domar, the Director of Mind/Body Services at Boston IVF, assistant professor of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School and the author of Conquering Infertility: Dr. Alice Domar's Mind/Body Guide to Enhancing Fertility and Coping With Infertility, shares some advice: "Talk about it, get support."

"People are often ashamed and don't want to share that they're struggling with infertility," says Domar. "It can be very emotionally isolating, but my advice to women is to get support and reach out for the emotional help that you need. Educating and letting your loved ones know what you need from them can help everyone to better understand what you're going through."

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If you're not trying to conceive, taking birth control pills is the first line of treatment for endometriosis, says Dr. Grifo. Hormonal suppressive therapy is another effective treatment, he says.

Untreated, endometriosis can also possibly lead to tumors that could develop into certain types of ovarian cancer, SELF has reported. That's one more reason why it's vital to keep up with your annual gyno visits, and make sure you tell your doctor about any symptoms you might be having.

"If you have symptoms, they should not go undiagnosed," says Dr. Grifo. "Go see a doctor, get an ultrasound and then you have to make a decision. How bad are the symptoms? Can you live with them?"

Domar adds, "The number one thing is to not wait too long to get help. The sooner you see a specialist, the more likely you are to get pregnant, and seeing a specialist can give you some answers you're looking for, which may help you to cope. If you have endometriosis, knowing that you can successfully be treated with medication or surgery may help you feel more hopeful about the situation."

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