By Joann Paley Galst, Ph.D., Chair, AFA Mental Health Advisory Council
Endometriosis is a disease caused when tissue lining the uterus migrates and grows outside of the uterus, for example, on the outer walls of the uterus, the ovaries, or the fallopian tubes. When the hormone changes occurring during a normal menstrual cycle cause the tissue of the uterine lining to thicken in preparation for embryo implantation, these same hormones also cause the endometrial tissue outside of the uterus to grow. Yet, these extraneous tissues are not expelled from the body with a menstrual cycle and can cause damage in the form of adhesions to the ovaries or fallopian tubes, sometimes making getting pregnancy more difficult. It is unknown, at present, what causes endometriosis.
Some women experiencing endometriosis have no symptoms at all. Others may experience lower abdominal pain, pain during intercourse or at ovulation, low back pain, irregular or heavy menstrual bleeding, blood in the urine, or diarrhea and/or constipation if the endometriosis invades the intestines. Endometriosis is often difficult to diagnose without a laparoscopic exam and, if a woman is not experiencing pain, may not be recognized as a problem until the woman tries to get pregnant. During a laparoscopic exam, if a physician finds endometrial tissue, he/she may remove any scar tissue observed. Medications, including birth control pills, may be recommended to control the hormonal shifts that cause the endometrial tissue to grow. If a woman wishes to become pregnant, IVF may be recommended after a period of attempts on her and her partner’s own, although ovarian stimulant drugs can actually worsen endometriosis, so be sure to consult your physician to determine your best course of action.
Emotional Impact of Endometriosis.
Endometriosis can also cause emotional pain in several ways:
First, since endometriosis can be difficult to diagnose, you may not be taken seriously if you experience pelvic pain and the pain may be incorrectly diagnosed as psychological, i.e., “all in your head.” This indifference to a woman’s pain can hurt.
Second, if you first become aware of your endometriosis when you have difficulty conceiving, you will likely be shocked and saddened by this diagnosis, feeling as though your body has let you down. This can create feelings of inadequacy or feeling like less of a woman. If these feelings have emerged for you, it will be important for you to remember what really makes you a woman – i.e., your sensitivity, your particularly sensibilities and values, and your heart.
Although you may be experiencing difficulty on your journey to parenthood, you have not hit the end of the road. Good treatment may bring you just what your heart desires. If you feel a need for support, joining an AFA support group or telephone coaching group or consulting with a mental health professional familiar with infertility and its treatment can help you cope using strategies that have been associated with better psychological adjustment such as active coping and positive reinterpretation. While endometriosis can have psychological ramifications, and those suffering may benefit from psychotherapy to learn effective coping techniques, rest assured that there is no indication that it is psychologically caused.
Joann Paley Galst, Ph.D. is Co-director of Support Services and Chair of the Mental Health Advisory Council of the American Fertility Association. . She is a psychologist in New York City specializing in reproductive health issues including infertility and pregnancy loss and a past chair of the Mental Health Professional Group of the American Society for Reproductive Medicine. She has written extensively in the fertility field and is a co-author with Judith Horowitz and Nanette Elster of Ethical Dilemmas in Fertility Counseling. She can be reached at 212-759-2783 or , http:www.wmhcnyc.org/galst/