Abortion does not cause endometriosis

By Heather Guidone and Lone Hummelshoj

Claims have recently emerged that abortions cause endometriosis, wrongfully confusing the disease with endometritis.

FACT: abortions do not cause endometriosis.

FACT: endometritis and endometriosis are two completely different illnesses. One occurs inside the uterus, the other occurs outside the uterus, and these two diseases are not related.

Background

Elizabeth Bruce speaking at the Democratic National Convention, 5 September 2012

Endometriosis received a surprising mention at the Democratic National Convention yesterday when Elizabeth Ann “Libby” Bruce took the stage to share her experiences with the disease.

In her remarks Ms Bruce revealed that she received care for endometriosis at Planned Parenthood after many doctors dismissed her symptoms, maintaining that:

without Planned Parenthood, my pain would have continued, and I might not have my daughter today.

Opponents of Planned Parenthood swiftly took to social media outlets in response, tweeting claims that abortion increases the risk of endometriosis. The ensuing debates on the matter revealed that many people are confused about endometriosis and endometritis, erroneously believing the two conditions to be one and the same – and linked to elective abortion.  They are not.

Firstly, we wish to thank Ms Bruce for having the guts to stand up and talk about her endometriosis and fertility issues in public.

Secondly, we wish to set the record straight about endometriosis, endometritis, miscarriages, and abortion.

Endometriosis

Endometriosis is a disease in which tissue similar to the lining of the uterus (endometrium) is found elsewhere in the body (ie. outside of the uterus) typically in the abdominal cavity.

This tissue causes nodules and inflammation, which results in scar tissue and adhesions [1].

Symptoms are wide-ranging, and often start in adolescence, but may be under-appreciated and/or under-recognised by the medical and lay communities alike leading to a considerable delay in diagnosis and commencement of treatment.

Endometriosis can be very painful, and is the most common cause of infertility in women (approximately 30-40% of women with endometriosis deal with sub-fertility issues).

Endometriosis affects an estimated 176 million women worldwide [2].

Endometritis

Endometritis, on the other hand, is an inflammation or irritation of the lining inside the uterus (the endometrium).

Endometritis is caused by infections such as chlamydia, gonorrhea, tuberculosis, or mixtures of normal vaginal bacteria.

Endometritis is more likely to occur after miscarriage or childbirth, especially after a long labor or c-section [3].

A medical procedure that involves entering the uterus through the cervix will increase the risk of developing endometritis. This includes a D&C, hysteroscopy, and placement of an intrauterine device (IUD) [3].

Endometritis can occur at the same time as other pelvic infections such as acute salpingitis, acute cervicitis, and many sexually transmitted infections (STIs) [3].

In most cases endometritis can be treated with antibiotics [3].  In fact, unlike endometriosis, which has no known cure, nearly 90% of women treated for endometritis within an approved regimen note improvement in 48-72 hours.  Also, unlike endometriosis, in the PID Evaluation & Clinical Health (PEACH) study, endometritis was not found to be associated with subsequent pregnancy-related complications, chronic pelvic pain, or infertility [4].

Treating endometriosis

Endometriosis can seldom be cured. Whereas there are treatments for endometriosis those, which are drug-based, can have serious side effects, and surgery has to be performed by a surgeon skilled in excising the disease thoroughly.

The challenge of finding, or being able to afford, adequate care for endometriosis is an issue for millions of women with the disease.

Governments that wish to prioritise women’s health issues should be applauded – not condemned.

Miscarriage and abortion is not the same thing – and neither cause endometriosis

Now that we have cleared up that endometriosis and endometritis are not the same disease and are treated differently, let’s also get it straight that miscarriage and abortion are not the same thing either.

A miscarriage is spontaneous pregnancy failure before 14 weeks and such a distressing loss in early pregnancy can affect a woman’s physical and mental health.

Many women with endometriosis, unfortunately, miscarry their unborn child in early pregnancy due to factors still relatively unknown. All we know, so far, is that sub-fertile women with endometriosis and pelvic pain suffer twice the rate of miscarriages compared with fertile women (42.1% vs. 22.4%) [5].  Why these miscarriages happen is still being researched.

An abortion is a medical or surgical procedure to electively end a pregnancy.

Elective abortion may be linked to infection and this is not in dispute (any surgical procedure carries a risk of such). Worldwide, rates of infection in first trimester surgical abortion vary from 0.1%-4.7%. This incidence included a large number of cases of mild endometritis or “genital tract infection” treated without confirmatory testing on an outpatient basis [6].

Abortion does not cause endometriosis

The dispute, however, is not whether elective abortion holds a risk of infection, but rather, to clarify that endometriosis is not linked to abortion. In fact, it has been shown that:

women with endometriosis had fewer prior pregnancies, elective abortions, and ectopic pregnancies compared to women seeking care for infertility, who did not have endometriosis [7].

and

…a reduced risk of endometriosis in women [who] reported a history of induced abortion has been reported [8].

Facts should set agendas – not politics

To claim that abortions cause endometriosis for political gain is not only inaccurate but also an insult to all women.

We urge medical writers, journalists, bloggers, etc, to please check their interesting facts before making claims in relation to endometriosis (or any other disease for that matter) before publication.

Once in the published domain, unsubstantiated claims may cause hurt, distress, confusion, (unrealistic) hope, (unnecessary) anxiety, and may perpetuate myths which in turn result in needless delay in research and treatment development.

• Please be responsible when publishing about diseases.
• Please don’t add to the plethora of mis-information which, regretfully, is already “out there” about endometriosis. Misinformation will hurt the millions of women who battle the disease every single day.
• Please use established organisations to verify information before publishing. We’re very happy and willing to work with and assist you. Collaboration is as key to us as it is to you when we work together to unlock mysteries such as endometriosis.

Thanks!

Global organisations fighting for women with endometriosis

The organisations we represent are all apolitical.

The work of the ERC, WES, and WERF is all about improving the quality of life and treatments for an estimated 176 million women worldwide [2], who have to deal with the effects and cost of endometriosis.

Our shared goal is to:

• raise awareness of endometriosis to ensure early diagnosis and consequent timely treatment to avoid future damage to each woman’s reproductive health;
• provide factual information empowering women with endometriosis to make informed choices about their treatment options; and
• raise funds for research into disease mechanisms to enable the development of treatments without side effects and – one day – a cure.

 More information

→ Facts about endometriosis
→ Facts about endometritis
→ Facts about the work of Planned Parenthood
→ Donate to research into endometriosis

 References

1. Kennedy S, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Human Reprod 2005;20(10):2698-2704.
2. Adamson GD, et al. Creating solutions in endometriosis: global collaboration through the World Endometriosis Research Foundation. J of Endometriosis 2010;2(1):3-6.
3. Endometritis. US National Library of Medicine. Last accessed 6 September 2012.
4. Rivlin ME, et al. Endometritis. Medscape. Last accessed 6 September 2012.
5. Manipalviratn S, et al. Data presented at the 2007 Annual Meeting of the American Society for Reproductive Medicine), Washington DC, USA.
6. Lichtenberg ES, et al.  Abortion complications: Prevention and management. In: Paul M, Lichtenberg ES, Borgatta L. Grimes DA, Stubblefield PG (eds). A Clinician’s Guide to Medical and Surgical Abortion. New York: Churchill Livingstone, 1999:197-216.
7. Matalliotakis IM, et al. Epidemiological characteristics in women with and without endometriosis in the Yale series. Arch Gynecol Obstet 2008;277(5):389-93.
8. Parazzini, F, et al. Previous abortions and risk of pelvic endometriosis. Hum Reprod 1998;13(11): 3283-3284.

The author

Heather Guidone and Lone Hummelshoj are internationally recognised advocates for women with endometriosis and known authorities on the facts of the disease. Ms Guidone is Vice President/Director of Operations of the Endometriosis Research Center (ERC). Ms Hummelshoj is the Editor-in-chief of Endometriosis.org, Secretary General of the World Endometriosis Society (WES), and the Chief Executive of the World Endometriosis Research Foundation (WERF).