Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Endometriosis definition and facts
- What is endometriosis?
- What are the stages of endometriosis?
- What are the signs and symptoms endometriosis?
- Does endometriosis increase a woman's risk of getting cancer?
- What causes endometriosis?
- Does endometriosis cause infertility?
- Does diet affect endometriosis?
- Is there a test to diagnose endometriosis?
- What is the treatment for endometriosis?
- What medications treat endometriosis?
- Can surgery cure endometriosis?
- Who gets endometriosis?
- Which specialties of doctors treat endometriosis?
- What is the prognosis for a woman with endometriosis?
- Can endometriosis be prevented?
- Endometriosis FAQs
- Find a local Obstetrician-Gynecologist in your town
Does endometriosis cause infertility?
Endometriosis is more common in infertile women, as opposed to those who have conceived a pregnancy. However, many women with confirmed endometriosis are able to conceive without difficulty, particularly if the disease is mild or moderate. It is estimated that up to 70% of women with mild or moderate endometriosis will conceive within three years without any specific treatment.
The reasons for a decrease in fertility when endometriosis is present are not completely understood. It is likely that both anatomical and hormonal factors are contributory to diminished fertility. The presence of endometriosis may incite significant scar (adhesion) formation within the pelvis which can distort normal anatomical structures. Alternatively, endometriosis may affect fertility through the production of inflammatory substances that have a negative effect on ovulation, fertilization of the egg, and/or implantation of the embryo. Infertility associated with endometriosis is more common in women with anatomically severe forms of the disease.
Treatment options for infertility associated with endometriosis are varied, but most doctors believe that surgery is superior to medical treatment for endometriosis. When appropriate, assisted reproductive technology may also be used as an adjunct or an alternative to surgical therapy.
Does diet affect endometriosis?
There are no well-established data that show that dietary modifications can either prevent or reduce the symptoms of endometriosis. One study showed that a high consumption of green vegetables and fruit was associated with a lower risk of developing endometriosis, while a higher intake of red meats was associated with a higher risk. No association was seen with alcohol, milk, or coffee consumption. Further studies are needed to determine whether diet plays a role in the development of endometriosis.
Is there a test to diagnose endometriosis?
Endometriosis is most commonly treated by obstetrician-gynecologists (OB-GYNs).
Endometriosis can be suspected based on symptoms of pelvic pain and findings during physical examinations. Occasionally, during a rectovaginal exam (one finger in the vagina and one finger in the rectum), the doctor can feel nodules (endometrial implants) behind the uterus and along the ligaments that attach to the pelvic wall. At other times, no nodules are felt, but the examination itself causes unusual pain or discomfort.
Unfortunately, neither the symptoms nor the physical examinations can be relied upon to conclusively establish the diagnosis of endometriosis. Imaging studies, such as ultrasound, can be helpful in ruling out other pelvic diseases and may suggest the presence of endometriosis in the vaginal and bladder areas, but they cannot reliably diagnose endometriosis. For an accurate diagnosis, a direct visual inspection inside of the pelvis and abdomen, as well as tissue biopsy of the implants are necessary.
As a result, the only definitive method for diagnosing endometriosis is surgical. This requires either laparoscopy or laparotomy (opening the abdomen using a large incision).
Laparoscopy is the most common surgical procedure most commonly employees used for the diagnosis of endometriosis. This is a minor surgical procedure performed under general anesthesia, or in some cases under local anesthesia. It is usually performed as an out-patient procedure (the patient does not stay in the facility overnight). Laparoscopy is performed by first inflating the abdominal cavity with carbon dioxide through a small incision in the navel. A thin, tubular viewing instrument (laparoscope) is then inserted into the inflated abdominal cavity to inspect the abdomen and pelvis. Endometrial implants can then be directly seen.
During laparoscopy, biopsies (removal of tiny tissue samples for examination under a microscope) can also be performed in order to obtain a tissue diagnosis. Sometimes random biopsies obtained during laparoscopy will show microscopic endometriosis, even though no implants are visualized.
Pelvic ultrasound and laparoscopy are also important in excluding malignancies (such as ovarian cancer) which can cause many of the same symptoms that mimic endometriosis symptoms.
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