Infertility is a silent condition. Like many diagnoses, this is confusing, expensive, and heart-wrenching. However, unlike other conditions where you “have” something you don't want, infertility is characterized by “not having” something you wanted.
As an obstetrician-gynecologist for more than 30 years, Dr. Caroline Peterson has seen countless women live under the silent, suffocating burden of infertility. And she has helped many just like her clarify their feelings, find peace of mind, and welcome new family members.
But over the years, Dr. Peterson has seen a particularly elusive problem complicate matters for women facing infertility: endometriosis.
“And for almost 50% of women with infertility, that's the root cause,” Dr. Peterson says.
What 4 million women have in common
Dr. Peterson understands the concerns and questions that women often have when they come to our office. In fact, Dr. Peterson treats more endometriosis patients than any other patient in this part of the country.
Across the United States, an estimated 4.1 million women, ranging in age from their late teens to their 40s, have endometriosis.
And for most of these 4.1 million women, their unique experiences share a common thread: feeling overlooked while living with severe pain.
Endometriosis is essentially a condition in which uterine tissue has become malformed. In other words, tissue normally found in the lining of the uterus (endometrium) appears (or is implanted) elsewhere. It can reach the ovaries, fallopian tubes, and even the lining of the lungs and heart. Experts still don't know the cause.
However, if implanted in the pelvic cavity (which contains the bladder, colon, and reproductive organs), it can cause severe pelvic pain and infertility.
Effect on fertility
When endometrial tissue is implanted into the fallopian tubes, they become scarred. And the worse the scar, the harder it is for eggs and sperm to pass through. There are four stages of endometriosis, four of which are the most severe.
However, even stage 1 endometriosis can lead to infertility. Scarring not only causes problems for eggs and sperm, but implantation of endometrial tissue also becomes a target for a woman's immune system.
“Even if you're a stage 1, 2, or 3 woman, your body is busy fighting this other disease,” Dr. Peterson says. “When a woman's body and immune system are this compromised, it becomes difficult to conceive.”
However, once diagnosed and treated, many women are able to “conceive naturally.”
Dr. Peterson says there are two main ways to diagnose and treat endometriosis.
- Laparoscopy: A minimally invasive surgery that uses a thin, lighted tube with a camera (laparoscope) to check the organs around the abdomen. Dr. Peterson says this is the “gold standard for diagnosis.”
If endometriosis is found, it can be painlessly removed with a surgical laser, especially in the first three stages. If it's stage 4, “we'll laser remove it for improvement.” You get results,” says Dr. Peterson. “And we often go to infertility specialists for assisted reproductive technology.”
- clinical evaluation: Your doctor will evaluate your symptoms and lifestyle factors to determine whether you may have endometriosis. Dr. Peterson points out that “several medical associations have recognized this as acceptable for diagnosis.”
Treatment often requires hormones and additional medications.
However, Dr. Peterson acknowledges that there are vulnerabilities in the clinical evaluation. Because endometriosis is difficult to diagnose without seeing it and is often not considered as a cause of symptoms in the early stages, women can face even more challenges along with infertility during clinical evaluation.
As if infertility wasn't that difficult
Endometriosis is too small to be detected by scans such as MRI, CT scan, or ultrasound. And possible symptoms include severe pelvic pain, especially during sexual intercourse and menstrual cycles. Bladder and bowel problems. Whether it's fatigue or depression, women often struggle to find help when they seek it.
Dr. Peterson says that among women with endometriosis,
- 58% reported seeing three or more doctors before receiving a diagnosis.
- 63% They reported that at least one doctor told them there was nothing wrong.
- nearly 60% They reported not being taken seriously by their doctors.
In addition to the physical and emotional pain, women with endometriosis must overcome the emotional strain of feeling overlooked and distrusted while being at a loss as to where to turn for help. is common. And that can quickly lead you to stop looking for answers.
“No one wants to be told that what they feel and experience every day is nothing,” says Dr. Peterson. “It can be disempowering for a person.”
All this leads to a delay in diagnosis. In fact, for women with endometriosis, diagnosis can delay her by two to six years. In some cases, it can take up to 10 years. Delays also include misdiagnosis.
“Due to symptoms, 70% of women with endometriosis end up being diagnosed and treated with irritable bowel syndrome when they actually have endometriosis,” Dr. Peterson said. talk.
What's needed, Dr. Peterson points out, is improved ways to quickly diagnose endometriosis. And they're calling for more patient-centered resources to “tell young women that something could be wrong.”
Helping women heal and feel heard
Dr. Peterson has shown how effective this approach is in improving the health of patients. She and her nurse, Sarah King, created a survey and resulting questionnaire for new patients who come to her seeking answers.
Patients answer five questions to help Dr. Peterson and colleagues understand a patient's likelihood of endometriosis. Doing so can also give voice to the experiences of women with symptoms, opening the door to productive conversations about women's health early on.
“We're not going to wait for people to recover from infertility. We're going to work with a survey. And after two years of research, we're not going to wait until people recover from infertility. We found that 100% of the women tested actually had endometriosis, which was confirmed by laparoscopy.”
Since then, successful diagnosis and treatment have led to more women getting answers and regaining their confidence.
And in many cases, they welcome the “something they wanted” that they have been waiting for.
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