Silent Endometriosis

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There are many usual signs and symptoms of Endometriosis.  If you suffer from this disease, you know them all too well.  If you’ve not heard of them, please read about them here.  One of our readers, Tanya, let us know that she suffers from “Silent Endometriosis.”  What’s that?  She has an official Endometriosis diagnosis, but only some of the symptoms associated with Endometriosis.  Some women with Silent Endo don’t have any Endo symptoms (this is known as asymptomatic Endometriosis). Does that make her any less of an Endo sufferer? No, not at all.  She suffers from the same invasive disease as the rest of us.  Just in a different way.

A whole slew of questions were raised, which we’ll look into:
  1. Why do some women present with classic symptoms like crippling pain and some don’t?
  2. And, given that silent endometriosis exists, this makes me wonder if the overall incidents of endometriosis is higher than is usually quoted. How many women have this and have no idea?
  3. Since the symptoms don’t present as normal in silent endometriosis, what are some of the other signs that women possibly facing this condition can look out for?
  4. Why do some women who are riddled with endometriosis have no pain, and others with very little endometriosis have excruciating pain?

Let the research begin!

Symptoms of Silent Endometriosis

Dr. Jeffrey Braverman wrote in October 2013 about his surprise at how many women facing problems with fertility go undiagnosed with Endometriosis, simply because they do not have pelvic or period pain.  A red flat for Silent Endo may be a prior history of miscarriages or failed IVF attempts.  He says many women with Silent Endometriosis suffer from unexplained elevated FSH (follicle stimulating hormone) levels, low AMH (anti-mullerian hormone) levels, unexpected low egg numbers, poor egg quality, or recurrent miscarriages.  These symptoms alone may be an indicator of Silent Endometriosis.  His office also finds many women with Silent Endo suffer from immune related issues, such as pelvic inflammation and elevated NK activity (NK cells are immune cells known as Natural Killer cells, and when elevated may show a heightened autoimmune response).  Dr. Tamer Seckin, one of the leading Endometriosis experts in the country, later blogged about Dr. Braverman’s efforts to shed light on infertility and Silent Endometriosis.

Dr. Braverman again addressed these topics in 2014 with the Endometriosis Foundation of America.  You can read the transcript and watch the video here.  He stresses again that most women that they see end up having Silent Endometriosis, but the first signs of the diagnosis is infertility, recurrent miscarriages, or pregnancy complications; NOT pain.  And that many are able to conceive after having their Endometriosis surgically removed.

On the flip side, a study published in 1987 in the British Medical Journal found no direct link between Endometriosis and infertility.  Women with Endometriosis were treated prior to attempts to conceive; however, they “did not return to normal fertility, though all other causes of infertility were excluded.”  They therefore questioned the disease’s role or contributions to infertility.

A study published in 2015 in the Journal of Psychosomatic Obstetrics & Gynecology found that women who suffer Endometriosis pain, as opposed to those without painful symptoms, have a poorer quality of life and mental state of being.  Is it saying that asymptomatic Endo sufferers don’t suffer? No.  It simply points out that pelvic pain can make a drastic difference, as well as recommends the possibility of psychological intervention for those in pain.  I’m sure anyone living with Silent Endometriosis must feel some sort of anxiety or grief at this invasive disease in their body, even if they may not feel physical pain.

As if this wasn’t enough to process, there is a case published in 2015 of a woman who had a lump in her belly button.  Sound familiar?  We have previously written about belly button Endometriosis (click here) where the bump bled, caused pain, grew, etc., especially during periods.  Well, this gal had no symptoms of Endometriosis, but had developed a bump inside her belly button which she carried around for 18 months before having it surgically removed.   Her little bump never bled or changed during her periods.  She had no prior diagnosis of Endometriosis.  Her doctors thought it was a keloid scar or maybe a fibroid in her skin.  So they cut it out and sent it off for biopsy: and it came back as umbilical Endometriosis.  She was referred to a gynecologist for treatment.  And the study doesn’t follow-up with her progress…

The medical community does not know why some women suffer with Endometriosis pain, while others may not know they have it.  It’s been suggested that those with Silent Endometriosis simply have a higher pain tolerance than others.  Although I know you women are strong and badass, I don’t know if I buy this theory.

Tanya’s Story & Symptoms of Silent Endometriosis

I asked Tanya if she could share with us her symptoms and diagnosis of Silent Endometriosis. Graciously, she agreed:

“1. I have had right side pain in the area of my ovary since my early 20s (I’m 38 now). I’d been to several doctors and they did ultrasounds, etc. and ultimately said it was nothing. The pain was not based on my cycle like most Endo pain is — it was pretty much always there. After I got the lap, I found out I had Endo on my right ovary, so that’s what that pain was all along.

“2. I frequently got what I thought were UTIs, but when I would get tested they always told me it wasn’t a UTI. I also had to pee all the time, and I had trouble fully emptying my bladder. The biggest concentration of my Endo was on my bladder.

“3. I had bright red spotting up to a week before my period. My fertility doctors always passed it off as low progesterone (without actually testing my progesterone). But really it turned out that I had Endo on my cervix and that’s what was causing my bleeding.

“4. Infertility. Also, poor egg quality and low ovarian reserve, despite my AMH and FSH (tests for ovarian reserve and egg quality) being normal.

“But I had none of the classic symptoms. I am lucky I found out. My half sister also had Silent Endometriosis and went through IVF and infertility, so it was in the back of my mind for a while. However, I asked two different fertility specialists and my OB if they thought I might have Endo, and they all said absolutely not. I think because I didn’t have the classic symptoms. I finally went to a reproductive immunologist who specializes in Silent Endo and within 5 minutes of speaking to me for the first time he diagnosed me with probable Endo. I got the lap with his surgeon a couple of weeks later and they found Stage 3 Endo.

“So that is my story. I hope this helps. I really appreciate you researching this. Like I said, I was lucky I found out. I really had to fight to get a diagnosis. It makes me sad that many infertile women are likely suffering with this and have no idea.”

Diagnosing Silent Endometriosis

It may very well be that the only signs and symptoms of Silent Endometriosis are likely fertility issues and an official diagnosis is obtained by chance.  Most women learn of their Silent Endo while undergoing some sort of unrelated abdominal surgery.

If you would like to see a video of what Endometriosis implants look inside of a woman diagnosed with Silent Endometriosis, click here.  Warning : you’ll be looking at a person’s insides!  But, it looks just like normal Endometriosis implants.  That’s because, in fact, it IS.  The symptoms are different; that’s all.  Just look at Tanya.  She had some symptoms, and she wasn’t diagnosed for quite some time.  Her implants, although not causing her extreme pain, did disrupt her body enough to create noticeable issues for her.  And, remember, some women have no symptoms.  I’m sure many go their entire lives never suspecting…

In 2002, a study followed-up with women who were previously diagnosed with Silent Endometriosis.  Between 1986 and 1989, 39 women had surgeries to have their tubes tied (aka a tubal ligation).  During those surgeries, Endometriosis implants were observed, removed, biopsied, and they were official diagnosed with the disease.  They’d never had any prior complaints usually associated with this disease.  Most were diagnosed with “minimal Endometriosis,” which may be considered Stage I or Stage II Endo.  In 2001, the authors followed-up with these women to see how they had been feeling over the years.  Only 6% had reported any type of pelvic pain since their diagnosis.  The study concludes that there is very little risk that women with asymptomatic Endometriosis will ever develop or have worsening symptoms.

How Many Women Suffer from Silent Endometriosis?

A study published in 1991 evaluated 86 women, all of whom said they did not have any symptoms of Endometriosis.  All 86 underwent laparoscopic surgeries, and low and behold almost half of them did, in fact, have Endometriosis!  A whopping 45.3% of the women had “definitive evidence” of Endometriosis.

A 2010 study suggests that 20-25% of women with Endometriosis are asymptomatic (meaning they don’t have any symptoms).  Assuming these estimates are accurate,  and that 176 million women worldwide have Endometriosis…25% would mean that 44 million women have mild to no Endo symptoms! Think you’re alone in your Silent Endometriosis?  Think again! Millions of women are right there with you.

But this begs the question: how many women have it and don’t know it?  To quote the Mr. Owl of the old Tootsie Pop commercials, “The world may never know.”  We can only continue to educate each other, the masses, and the medical community of the potential signs of Silent Endometriosis.

Stages of Endometriosis and Levels of Pain

Going back to that 1991 study which examined 86 women for Endometriosis, 32.5% were diagnosed with Stage I, 9.3% had Stage II, 1.1% had Stage III, and 2.3% suffered from Stage IV Endometriosis.  And none of these women had suffered from any pain or other typical symptoms of Endometriosis.

It has often been said that the Stage of Endometriosis does not dictate the pain level, only the level of infiltration of the disease.  Someone diagnosed with Stage I Endometriosis (the least invasive Stage), may have the WORST pain; and someone with Stage IV (the most invasive Stage), may have minimal pain.

But why? It’s a conundrum.  Nobody knows. Perhaps one day they will better understand not only the cause of our disease and the course it takes, but also the differences in pain levels, Stage levels, and ultimately…a cure.

Treating Silent Endometriosis

Since most women suffering with Silent Endometriosis don’t suffer any pain, the treatments I’ve run across only discuss surgically removing the implants.  Some studies actually mentioned not treating it, even surgically, since there are no symptoms to be treated.  Sometimes the risks outweigh the benefits (anesthesia, adhesions, recovery, etc.).

However, alterations to diet and lifestyle may help keep the growths of Endo at bay whether you have Silent or regular Endometriosis – anything we can do to help our bodies fight the growth and recurrence of the implants should be done. Right? Right.

My Last Two Cents

I feel like I’ve raised more questions than answers, but am once again very grateful to our readers for bringing this topic to light.  I had no idea that Silent Endometriosis was a thing!  Not only am I flabbergasted by the sheer volume of women who may have it and not know it, but am heartbroken with the lack of attention and information available on this subject.  I hope this little blog entry brings peace and answers to some…

Yours, Lisa

Resources:

Braverman IVF & Reproductive Immunology – (Blog, Oct 2013) Silent Endometriosis a Significant Cause of “Unexplained” Embryo/Egg Quality Issues in Young Women

Dr. Seckin Endometriosis Care and Surgery – (Blog, April 2014) Endometriosis and Infertility

Endometriosis Foundation of America – (Video, 2014) Jeffrey Braverman, M.D.; Outsmarting Endometriosis

Fertility & Sterility – (Abstract, Oct. 2002) A Long-Term Follow-Up Study of Women with Asymptomatic Endometriosis Diagnosed Incidentally at Sterilization

Human Fertilisation & Embryology Authority – description of NK cells

Oxford Journals – (Article, March 2015) An Unusual Case of Asymptomatic Spontaneous Umbilical Endometriosis Treated with Skin-Sparing Excision

Taylor & Francis Online – (Abstract, Aug. 2015) Impact of Endometriosis on Quality of Life and Mental Health : Pelvic Pain Makes the Difference

U.S. National Library of Medicine – (Article, Aug. 2010) Endometriosis and Infertility

U.S. National Library of Medicine – (Abstract, July 1991) Prevalence of Endometriosis in Asymptomatic Women

U.S. National Library of Medicine – (Article, May 1987) Successful Treatment of Asymptomatic Endometriosis : Does it Benefit Infertile Women

http://humanrep.oxfordjournals.org/content/11/suppl_3/103.full.pdf

https://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Practice_Guidelines/Educational_Bulletins/endometriosis_and_infertility(1).pdf

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

6 thoughts on “Silent Endometriosis

  1. I had a lipersocopic tubal ligation after having 2 children. I’ve never had bad periods or problems conceiving. after my procedure the doctor told me I have stage 4 endometriosis. hoping I stay symptom free. Thank you for your extensive research on the topic.

    Like

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