My mother had several miscarriages, and my sister has endometriosis. I’ve always had painful periods and irregular menstrual cycles. I’m 28 years old and definitely want to have kids in the future, but I’m wondering whether I should be concerned about my fertility, given my family history. Should I be getting tested now in case I also have endometriosis? What kind of testing is involved, and if it turns out I have endometriosis, how might it affect my fertility?

Written by our medical expert Dr. Stephen Hudson, Director of the Victoria Fertility Centre in British Columbia, Canada. 

Thank you for your questions, which need to be broken down in order to respond appropriately.

First of all, the fact that you have painful and irregular periods demands attention. There may be a number of reasons for this, and you really need to be evaluated by an OBGYN (gynecologist). Irregular painful periods may be caused by a variety of conditions, some of which may impact on your future fertility, if left unaddressed.

Your family history is also relevant. Endometriosis is caused by the implantation of endometrial cells outside of the uterus. It is very common and is found to occur in up to 40 % of women with subfertility (women who experience fertility problems). There appear to be multiple factors at play. There is no doubt that endometriosis is more common in families (there is a very high prevalence in identical twins). It is an inflammatory condition which also likely has immune system relevance. That means that apart from causing scarring and damage to the pelvic organs thereby affecting fertility, endometriosis may also create a hostile environment for the implanting and developing embryo, thereby influencing pregnancy outcome.

The fact that your mum had recurrent miscarriages and your sister has endometriosis increases the chances that you too, may be at higher risk for reproductive/gynecological problems. Recurrent miscarriage – which is what happened in your mother’s case – is a complicated condition requiring expert medical evaluation. It can be linked to coagulation, genetic, immune, hormonal, uterine, inflammatory and tubal irregularities, so finding and treating the cause of recurrent miscarriage can be a challenge.

As yet, it appears you have not yet tried to conceive, so we don’t know whether you will have reproductive problems. But given your history I would suggest the following:

  1. That you get more details regarding your Mum’s pregnancy losses (how early were they, what testing was done, etc.).
  2. That you keep a temperature chart and menstrual calendar to determine if you are ovulating. Such a record would be helpful for your physician in planning your work up and treatment.
  3. That you speak with your doctor about arranging a clinical examination and pelvic ultrasound, as well as some blood tests to check your hormone levels, and blood count. Hormone abnormalities can cause irregular periods.
  4. Occasionally irregular bleeding can be caused by infection and cervical problems, so you should ask your physician to do a Pap smear and cultures.
  5. Endometriosis typically can be associated with painful periods, premenstrual spotting and painful intercourse. If, after clinical assessment, endometriosis is suspected, your gynecologist may recommend a procedure called a laparoscopy (looking inside your abdomen with a telescope and camera).
  6. Irregular bleeding and painful periods may also be caused by polyps and fibroids, so your doctor may recommend a hysteroscopy (a look inside your uterus with a telescope and camera), if a pelvic ultrasound indicates that this is necessary.

If endometriosis is left untreated it certainly may progress and affect your future fertility. So I do believe it is very important you seek expert medical advice. I hope this information helps.

To read more about endometriosis, click here.

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