In endometriosis, tissue similar to the endometrium grows outside the uterus and causes chronic inflammation. It can affect fertility through adhesions, changes in the tubes and ovaries, and an inflammatory environment that impairs implantation. Treatment depends on severity and ranges from anti-inflammatories and hormonal therapy to laparoscopic surgery and, in some cases, IVF directly.
Endometriosis affects 10% of women of reproductive age, but it is badly underdiagnosed: on average, 7 years go by between the first symptoms and the diagnosis.
Very heavy or prolonged bleeding (going through more than 1 pad an hour for hours at a time, or flow lasting more than 8 days) is another red flag that can point to endometriosis, as well as to fibroids, polyps or a clotting disorder.
Severe pelvic pain, especially during your period or during sex, is the cardinal symptom of endometriosis. The book lists it as a red flag that calls for an appointment no matter how long you have been trying. Book with a gynecologist, document your symptoms (dates, intensity, patterns) and bring your previous results and cycle charts.
If you already have a diagnosis of endometriosis, or significant pelvic pain or pain during sex, the book says to see a specialist right away rather than waiting the standard 12 or 6 months of trying.
Endometriosis can also come together with another diagnosis. The book's example is endometriosis plus reduced ovarian reserve: that doesn't automatically mean a more serious case, but it can change the strategy, so ask your specialist how much each factor weighs.
A related condition, adenomyosis, is endometriosis within the uterine muscle. The book groups it under uterine factor, among the changes that make implantation harder.
Diagnostic laparoscopy is minimally invasive surgery under general anesthesia that allows endometriosis and adhesions to be seen and treated. It isn't a routine test: it is indicated when there is strong clinical suspicion.
The book also mentions growing evidence for NAC (N-acetylcysteine) in women with endometriosis, used under medical guidance in specific cases, and suggests about 180 days of supplementation before trying when endometriosis is present. Which path fits depends on severity, and that is a decision to make with your specialist.
When choosing your doctor, the book suggests asking directly: “Do you have experience with my specific type of case?” Endometriosis is one of the examples it gives.
Endometriosis is diagnosis number 2 in Chapter 33 of Map to the Positive, in Station IV (Signs). Around it, the station gives you the 13 red flags that should not wait, how to choose a doctor with experience in your type of case, what diagnostic laparoscopy and the other advanced tests show, and the full treatment ladder.
Take 30 days. If it does not give you more clarity than everything you have read for free so far, ask for a refund and you get every cent back. We cannot promise you a pregnancy. We can promise you will not be guessing.
References: World Endometriosis Research Foundation guidelines (2022).