CONDITIONS WE TREAT

Infertility: Causes and Treatment

What is infertility?

In general, infertility is defined as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex. Because fertility in women is known to decline steadily with age, some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex.

Pregnancy is the result of a process that has many steps. To get pregnant:

A woman’s body must release an egg from one of her ovaries
A man’s sperm must join with the egg along the way (fertilize).
The fertilized egg must go through a fallopian tube toward the uterus (womb).
The embryo must attach to the inside of the uterus (implantation).

Infertility may result from a problem with any or several of these steps.

Endometriosis

What is Endometriosis?

Endometriosis (en-doe-me-tree-O-sis) is often a painful disorder in which tissue that normally lines the inside of your uterus (the endometrium), grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis.

With endometriosis, the tissue goes through the same cycle as the uterine lining and therefore bleeds with each menstrual period. Since this tissue has no way out of the body it becomes trapped and can cause scar tissue to form and the pelvic organs to stick together. When endometriosis involves the ovaries, cysts called endometriomas may form.

Common signs and symptoms of endometriosis include:

Painful periods. Also called dysmenorrhea, may occur in the pelvis/abdomen before and during the menstrual period.
Pain with intercourse. This pain may be during or after sex
Pain with bowel movements or urination. These symptoms most often occur during the menstrual period.
Excessive bleeding. Periods may be heavy during the menstrual flow and/or between periods (intermenstrual bleeding).
Infertility. At times endometriosis may first be diagnosed during evaluation for infertility.
Other signs and symptoms. During the menstrual period you may experience fatigue, diarrhea, constipation, bloating and nausea.

The exact cause of endometriosis is not certain and though there are many theories, none have been clinically proven. Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis may temporarily improve with pregnancy and may go away completely with menopause.

Some people are more likely to develop endometriosis. Those at risk are those who:

Have never given birth
Started their period at an early age
Have a menstrual cycle less than 27 days
Bleed heavy with their periods that last longer than seven days
Have higher levels of estrogen in their body or greater lifetime exposure to the estrogen produced by the body
Have a low body mass index
Have one or more relatives with endometriosis • Have disorders of the reproductive tract

There is no known cure for endometriosis and its presentation is progressive. This means that initially your symptoms may be only with your menstrual period but later can occur at other times as well.

Diagnosis:

The diagnosis of endometriosis requires a detailed medical history, pelvic ultrasound or MRI and, the one sure way, is by laparoscopy (an outpatient surgical procedure).

Treatment:

Effective treatments are targeted at helping with the symptoms. They include medications (pain medications, aromatase inhibitors, Gn-RH agonist and antagonist), hormone therapy, and surgery to help manage pain, associated complications and fertility issues.

Ask your provider at Redefined For Her about current options for managing endometriosis.

Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovary Syndrome is a hormonal problem that may cause missed menstrual periods or periods last longer than they should. Often a person with PCOS will have high levels of the male hormones (androgens) and fluid filled sacs in their ovaries (cysts) that represent eggs that have not been released during ovulation. Some women who have this disorder will not have the appearance of cysts on their ovaries.

There is no known cause of PCOS though other women in the family may have a history of this diagnosis. Many women with this condition will also have a problem called insulin resistance that causes their body not to use insulin well. This condition, along with obesity can make symptoms of PCOS worse.

Signs and Symptoms of PCOS include: irregular periods, increased androgen levels that may lead to acne, excess hair growth or loss, abnormal weight gain, and enlarged ovaries (with and without cysts).

11062b_b0b600451b66457f943a1dc2eb8c15fc~mv2.jpeg

Conditions associated with PCOS are infertility, pregnancy induced high blood pressure or diabetes, fatty liver disease, type 2 diabetes, sleep apnea, endometrial cancer, depression and anxiety.

PCOS is diagnosed with a detailed medical history, physical exam, lab tests and pelvic ultrasounds.

Treatment for PCOS involves a healthy diet that will normalize and maintain an optimal body weight, moderate exercise, hormonal therapy, infertility medications, medicines to normalize insulin levels and other therapies for associated conditions.

Uterine Fibroids

Uterine fibroids are noncancerous tumors that women may develop from the muscle of their uterus. One in 5 women will develop fibroids, though they are more prevalent in African American women. They may range in size from a grain of rice to a large melon and may be single or multiple. Many with fibroids do not have symptoms. Fibroids may grow on the surface, within the muscle of the uterus or inside the uterine lining.

The cause of fibroid growth is unknown but their growth is believed to be caused by hormones in the body, biologic growth factors and genetics (they tend to run in families).

Signs and symptoms of fibroids may include: irregular or heavy bleeding, pelvic pressure, frequent urination, constipation, backache, pain with intercourse, painful menstrual periods, leg pain and problems emptying the bladder.

Diagnosis is achieved with a detailed medical history, physical exam, pelvic ultrasound, saline infusion sonogram, hysterosalpingogram, MRI and endometrial biopsy

Treatment for uterine fibroids may be medical or surgical. Medical treatments can be for heavy bleeding, pain management, temporary shrinking of fibroids, hormonal therapy or simply monitoring the growth of the fibroid(s). Surgical treatments may be hysteroscopy, myomectomy (removal of fibroids only), endometrial ablation, fibroid embolization, radiofrequency ablation, focused ultrasound therapy and hysterectomy.

Adenomyosis

Adenomyosis (ad-uh-no-my-O-sis) is when the tissue that, normally lines the inside of the uterus (endometrium), grows into the muscle of the uterus. Since this tissue is the same that lines the uterus, it will thicken, break down and bleed with each menstrual cycle. Over time this may cause the uterus to enlarge, pressure in lower abdomen, uterine tenderness, heavy periods and pelvic pain, with or without period.

The cause of adenomyosis is not known, though there are many theories. The disease resolves after menopause. For women who have severe symptoms related to adenomyosis, hormonal treatments can help. Removal of the uterus (hysterectomy) cures adenomyosis.

CONDITIONS WE TREAT

Infertility: Causes and Treatment

Endometriosis

Polycystic Ovarian Syndrome (PCOS)

Uterine Fibroids

REDEFINED

FOR HER