Staying Clear About Reproductive Health
“Have you ever experienced painful periods and/or heavy bleeding?”
Eight months after I started trying to get pregnant without success, I saw a Reproductive Endocrinologist. I had already been through some tests, but I was particularly concerned about the midcycle bleeding I experienced each month.
I would ovulate and then within a week and a half, I would bleed for a few days. A week or so after that, I would get my period. Every year when I saw my GYN, I brought up the bleeding, but she said it was common.
The bleeding did not happen all the time, but two months after I started trying to get pregnant, I experienced midcycle bleeding every month. I mentioned it to the two GYNs that I saw, but no one had an answer beyond breakthrough bleeding.
I felt that the bleeding was a sign of a serious fertility problem, but no one took my concerns seriously.
I was certain that I was not getting pregnant because of some internal issue affecting my reproductive system.
When I finally saw an RE and explained my symptoms, he immediately told me three causes of irregular bleeding, one of which was endometriosis. He followed this by asking about my period history.
I got my period for the first time when I was 12. After a few years of regular periods, menstruation became very heavy. I also experienced painful cramps to the point where I would frequently vomit from the pain. I used to lie on the couch with a heating pad over my pelvis, in tears from the pain.
Apparently none of this is normal. Pain is relative, of course, but teenage girls do not spend a lot of time discussing the details of their periods, so I had no idea that what I was experiencing was abnormal.
My doctor explained to me that the pain I experienced in my teenage years was likely caused by endometrial tissue, which normally grows in the uterus.
Endometriosis is when that tissue, for whatever reason, grows outside of the uterus.
Problem is, the endometrial tissue behaves like it would in the uterus no matter where it is. It gets thick to prepare for implantation of an embryo and then breaks down and bleeds like a regular menstrual cycle.
He told me that if I did have endometriosis as he suspected, the pain I experienced was the result of cysts, scar tissue or adhesions that formed where the tissue was trapped. Also, the doctor told me that this disease could be the reason for my infertility because endometriosis could block the fallopian tubes or damage the sperm and egg.
And that mid-cycle spotting? Apparently it is normal—for women with endometriosis. No one is entirely sure why, but some doctors believe that hormones cause the breakthrough bleeding.
By the time I saw the fertility doctor, I was 31. I had been on birth control for years, which made my periods much less painful. The hormones in the pill regulated my cycle and prevented the endometriosis from getting any worse.
In 2012, I had laparoscopic surgery, which is the only way to diagnose endometriosis. My surgery lasted for three hours. The doctors found and excised 9 or 10 spots of endometriosis. Fortunately, none were covering my fallopian tubes and I had no scar tissue or adhesions to worry about. Out of four stages, I was diagnosed with Stage II, or mild endometriosis.
According to the Mayo Clinic, I am one of the ⅓ to ½ of all women suffering from endometriosis who have trouble getting pregnant. I am also typical of a woman with endometriosis in that many women with the disease go a decade before being diagnosed.
In December of 2013, I finally got pregnant with my first daughter. When she was born the following August, I started breastfeeding. Between fertility treatments, pregnancy and a year of nursing, I rarely got a period for about three years. Since the endometriosis was cleared out during my surgery, I had no endometrial tissue lingering in my pelvis to affect my future fertility.
Endometriosis is a disease I never heard about until I could not get pregnant. I had all of the classic symptoms: heavy periods, extreme menstrual pain, even a misdiagnosis of irritable bowel syndrome at one point. However, I could not get a doctor to take me seriously until I took it upon myself to see a specialist.
According to the Centers for Disease Control and Prevention (CDC), 10% of American women (around 6.1 million) between 15 and 44 face infertility.
There are a myriad of infertility causes, from hormonal imbalances to PCOS. These are rarely discovered until couples start trying to conceive. During my experience, I often wished that all women were screened at age 21 to assess their fertility so they could be prepared for whatever problems they may face.
Women need to be educated about the signs and symptoms of reproductive diseases like endometriosis.
When I first tried to get pregnant, I read Toni Weschler’s “Taking Charge of Your Fertility” cover to cover. It taught me everything that I had missed or glossed over in sex ed classes. It taught me how to chart my cycle, how to maximize my chances of getting pregnant and which four conditions are most known to affect fertility. Surprise, surprise, the first one listed is endometriosis.
I plan to give “Taking Charge of Your Fertility” to my daughters when they hit puberty. They already have a higher chance of having endometriosis because of my diagnosis, but I want them to be better prepared than I was.
I was fortunate my endometriosis did not return after the surgery. I was actually able to get pregnant with my second daughter completely on my own the first time we tried. Today, I am on the pill to prevent my periods from becoming heavy and painful again. While I know that endometriosis may come back someday, I also am now aware of the symptoms and know how the disease can be treated.
Knowledge, after all, is power.