Black Women and Endometriosis

According to the Massachusetts General Hospital Fertility Center, between 30% and 50% of women who experience infertility have endometriosis. Some women may have more than one possible cause of infertility. Doctors and researchers believe that the endometrial implants may change the immune system and the chemical and hormonal makeup in the fluid that surrounds the organs in the abdominal cavity. This could interfere with or prevent the release of eggs from the ovaries (ovulation). Some women with endometriosis do not ovulate at all. Endo can also form cysts in the ovaries which can keep eggs from maturing and becoming viable. 

Treatment for endo that can preserve or increase fertility may include surgery to remove only the endo implantations (conservative surgery) or fertility treatments ranging from in vitro fertilization (IVF) to stimulating the ovaries to produce eggs.

Endometriosis can be suspected based on symptoms of pelvic pain and findings during physical examinations in the doctor's office. Occasionally during a gynecologic exam, 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.

However, neither the symptoms nor the physical examinations can be relied upon to conclusively establish your 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 still cannot definitively 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.

Laparoscopy is the most common surgical procedure for the diagnosis of endometriosis. Laparoscopy is a minor surgical procedure done under general anesthesia or in some cases under local anesthesia. It is usually performed as an out-patient procedure, and you will go home the same day.

Endometriosis can be treated with medications or surgery. The goals of endometriosis treatment may include pain relief and enhancement of fertility.

No one knows for sure what causes this disease, but experts have a number of theories:

• Since endometriosis runs in families, it may be carried in the genes, or some families may have traits that make them more likely to get it.
• Endometrial tissue may move from the uterus to other body parts through the circulatory or lymphatic system. Endometrial tissue may back up into the abdomen through the fallopian tubes during a woman's monthly period; this is usually referred to as “retrograde menstruation.”
• If you have problems with your immune system, it may fail to find and destroy endometrial tissue growing outside of the uterus. Recent research shows that immune system disorders and certain cancers are more common in women with endometriosis.
• The hormone estrogen appears to promote the growth of endometriosis. Researchers are looking at whether it is a disease of the endocrine system.
• New research shows a link between dioxin exposure and susceptibility to endometriosis. Dioxin is the name given to a group of 200+ chemicals that are formed as by-products of industrial manufacturing. Dioxins are powerful hormone-disrupting chemicals (EDCs). More research is needed to find out whether man-made chemicals cause endometriosis. For more information on EDCs, please visit our page on Environmental Justice.