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Dr. Jones: So you're having trouble getting pregnant. It's been six months and you really want to have a baby, but you know that fertility therapy can be very expensive and involved. Is there another way? And what's the difference between taking different kinds of ways to getting your baby? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care, and this is "Making Babies" on The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health," with Dr. Kirtly Jones, on The Scope.

Dr. Jones: Most of us want children and we'd like to have children in a timely manner. But if you're not getting pregnant in the time that you want, we always have said, "Well, go to your doctor or your family doctor, and then if you're not getting pregnant, come to see a specialist." But are there ways that you can actually enhance your own fertility without intervening with medications or interventions, at least for the start?

Today on The Scope studio, we are talking with Dr. Joseph Stanford, professor in the Department of Family and Preventative Medicine. And Dr. Stanford has a special interest in natural, procreative technology. And we're going to be talking about that, how to make yourself as fertile as you can be using natural methods. Thank you for joining us, Joe.

Dr. Stanford: Thank you, it's a pleasure.

Dr. Jones: So can you tell me about what is natural restorative or reproductive medicine? I'm a reproductive endocrinologist and everything that I do is not very natural. I do some really big hormones, and we do some really big procedures, and we do help people get really pregnant. But maybe there's something on the way to coming to me that actually might be very successful. So go with it.

Dr. Stanford: So natural procreative technology actually has a spectrum of things. The entry level is for couples to understand their fertility better, to understand what factors improve it, what factors are detrimental. And make lifestyle changes and also understand when the best times are for having sex.

Dr. Jones: Okay. What things make it better? What makes your fertility better?

Dr. Stanford: Adequate sleep, good diet. These are things you probably tell patients just as much. Moderate amount of exercise and weight that is not too high or too low, especially for women but also for men.

Dr. Stanford: Okay. And what things make things worse? All those converses meaning, an unhealthy lifestyle, not getting enough sleep, alcohol, and cigarettes smoke and unhealthy weight for men and women?

Dr. Stanford: Right, other drugs, marijuana, all those things.

Dr. Jones: Right. And then not enough sex?

Dr. Stanford: Well, not appropriately timed sex. That's one of the myths, is that you have to have sex either every day or every other day. But for couples with infertility, it's often the case that the fertile window is narrower for the woman. It may be three days instead of five or seven. It may be one or two days, the days that are functionally most likely for conception to happen. Couples can learn to track that and know when those days are with fertility awareness or natural family planning as one component of the natural procreative of technology.

Dr. Jones: Okay. So, education about things which enhance your fertility in your own body and timing and appropriate frequency of intercourse. And then you mentioned that was one. So what's two?

Dr. Stanford: So number two for natural procreative technology is really very similar in some ways to a medical . . . We do a full medical history exam for the woman and the man. We're trying to identify underlying factors that may be inhibiting fertility. I think we could both agree that a healthy woman, healthy man, healthy couple that didn't have any health issues, part of their healthiness would be being able to reproduce when they're in their reproductive age range.

So if there is not fertility at a normal level, something organically, physically is wrong. And usually, in our research with looking at this with couples, there are usually multiple underlying contributing factors. So what we're trying to do is identify all of those contributing factors and make them better to the extent we can. Some of them are lifestyle issues, some of them are medical issues. It may be thyroid, it may be polycystic ovary syndrome, it may be an endometriosis it may be a varicocele. It may be other things affecting semen quality. So we were trying to identify all of those things and find whatever we know that we have in our toolkit currently to correct and restore the possibility of natural conception.

Dr. Jones: So let's take endometriosis for an example. In my world, if we think someone has endometriosis and maybe we can feel it. Maybe someone's had a look inside their tummy, and they saw it, we feel an abnormal ovarian cyst and we can tell on ultrasound it's endometriosis. In my world, we operate on that and say, "Now we've restored your pelvis, at least for a little while, to its better fertility so go for it."

Dr. Stanford: I would I would applaud that. I think that the only definitive treatment we currently have for endometriosis is good surgery. And when I say good surgery, I mean surgery that's not just removing it but also minimizing the risk of subsequent adhesions. So adhesion-free surgery. I don't personally do surgery, but I have a short list of surgeons that I trust to refer to for patients that need that. So I think surgery can be part of the restorative process. And in endometriosis, it's what we currently know we have for that. I hope down the road, we'll find some other ways to reverse endometriosis or prevent it without surgery, but we're a ways away from that.

Dr. Jones: So for guys, if we have a gentleman who comes to us at the Utah Center for Reproductive Medicine and he has maybe half the numbers of sperm that he should or less. He has less than 20 million sperm per CC, and they don't look right, we move right away to . . . maybe we'll look for a varicocele, but we might do inseminations or might move to IVF. What do you do for guys to enhance their fertility? Do you go back to the lifestyle and the health issues?

Dr. Stanford: Definitely start there because that's kind of the foundation and it's a rare man that doesn't have some lifestyle issue, right? We definitely start there, but there are also some limited trials, some of the supplements that have been done for antioxidant and other types of supplements. And I think, in many cases, it's worth the trial of those with a follow-up semen analysis to see which way things are going, paying attention to the fact that semen analyses have a natural fluctuation as well.

Dr. Jones: So here's the problem that I face often here in Utah. And that is, and it can happen anywhere, and that is a young couple, they're 25. They've been trying six months. They haven't become pregnant. They want to be pregnant yesterday. And they want to immediately jump to my toolbox. And I don't even want to open . . . I don't even go looking for my tool box yet because they haven't tried long enough and hard enough for. . . And if I tell them I think they should try for another year using, actually, things that you're recommending, sometimes they walk out of my door and walk into my partner's door. So maybe if I send them to you, you'll keep them in your arms until you decide they need to come back to me?

Dr. Stanford: I would certainly do my best. And I think we have a reasonable track record. One of the things we find from studies of infertility treatment is that there's a high dropout rate from all types of fertility treatment. IUI, IVF, also the natural procreative technology, we all struggle with the keeping the couples engaged enough to say, "You really can succeed if you give it the full try." And couples often give up before we think they should, medically.

But, having said that, I do think that what I do is a lot different than just saying, "Okay. Try for another year," or, "Learn how to time it, and then try for another year." We're actively managing the cycle. What I mean by that is we track it with the woman's fertility tracking, charting biomarkers. We're looking at the mucus score. We quantitate the quality of the cervical fluid or cervical mucus production. We look at the bleeding pattern, including little bits of spotting making us nervous. We look at that. I usually just do a single [inaudible 00:08:21] hormone level seven days after ovulation.

So we're looking at these parameters and their timing of intercourse to look at 12 optimized cycles, not just trying for a year, but let's get 12 cycles where we can document that the cycle looks optimized for conception, based on the woman's charting, based on the timing of intercourse, based on the hormone levels.

Dr. Jones: So after that, what do you do if it's been 12 cycles and they haven't conceived, and you haven't either found a reason, or you found a reason, but they still haven't conceived. Where do they go from there? Do they get to decide about where the next steps are?

Dr. Stanford: They certainly always get to decide, but my recommendation to them at that point is, "We've done a full course of treatment, I can't promise you anything further. If you want to keep going, because that's what you want to do, I'll support that, but I'm not recommending that in the sense that we have done a full course of treatment. And you can look at other options, whether that's other fertility treatment or adoption or accepting your childlessness with saying you've done what you wanted to do." So those are always the couple's choices. So, for me, a full course of treatment is those 12 optimized cycles after having corrected all the underlying issues that we can.

Dr. Jones: Right. Well, I think most of us who do this want people to have the family that they want and we don't want any kind of therapy dragging on for too long because the clock is ticking, especially for women. But in the fertility business, I would say, I think it's important not to intervene with the big guns too soon, but not to avoid the big guns, meaning in-vitro fertilization, if it's something that's a choice for them.

And I think that what you've done, I've seen many of your patients over the years be pretty happy and successful with doing their own fertility once you've ruled out . . . you wouldn't . . . Somebody with no sperm, no eggs or no tubes, you would probably send them on pretty quickly.

Dr. Stanford: Right. If they don't have a possibility for natural conception because their both tubes are blocked, I'll certainly advise them of that upfront. This approach, I think, is a viable approach for the vast majority of sub-fertile or infertile couples, but there are a few that have absolute reasons that they can't conceive naturally.

Dr. Jones: Right. So I think both of us want the same thing in the end. I don't want to over-treat young couples that might get pregnant on their own with either specially adapted cycles to look at their own peak natural fertility or just time. And you probably don't want people jumping into high-tech fertility before it's time for them as well.

Dr. Stanford: Definitely, I agree with that. And I think that one of the things that are a little different about the restorative approach is we, ourselves, are also trying to take a longer view. Not just getting them pregnant, and I know that you would agree with this too, we want a healthy baby. We want a full-term life, ideally singleton baby. In other words, not twins when we can avoid that because of the risk. Not because we don't like twins, but because they just have more risks to the mom and babies. And we want that baby to grow up healthy, and we want the mother to be healthy later in her life. So I think the idea is to look at the overall health picture and not just, "Do you get pregnant next month?"

Dr. Jones: Great. Okay. Well, so for people who are attempting to get pregnant and are still young, of course, 45-year-olds might get a different approach, our goal is to do the right thing at the right time. And both of us are planning on doing that. And call us if you need us and thanks for joining us on The Scope.

Dr. Stanford: Thank you.

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Dr. Jones: How do you plan when and how many children to have? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care and this is "Making Babies or Not," on "The Scope."

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on "The Scope."

Dr. Jones: Most of us want children and most of us want to have them when the time is right. However, how much are we really willing to do to accomplish this goal of family? Some people prefer to take a more natural approach and some a more technical approach. Natural family planning provides contraceptive methods and a fertility method for creating a family of the right size at the right time.

Today in "The Scope" studio, I'll be talking with Dr. Joseph Stanford, professor in the Department of Family and Preventative Medicine. Dr. Stanford has a special interest in natural family planning and in natural procreative technology. Dr. Stanford and I have spent our careers in helping people have the children they want, but we take different approaches and we're going to talk about that today. Welcome, Dr. Stanford.

Dr. Stanford: Thank you, great to be here.

Dr. Jones: So let's just throw it out there, what is family planning to you?

Dr. Stanford: Family planning, to me, means couples being able to choose how many children to have, and when and how to have them.

Dr. Jones: I agree with that 100%. So there is a large domain of knowledge and practice around natural family planning.

Dr. Stanford: There's some considerable science and there's also . . . my interest is a lot of things we're still learning, but yes, there's a considerable body of science behind it.

Dr. Jones: Okay. So tell me a little bit about your counseling couples or your practice of natural family planning. What does that mean?

Dr. Stanford: So natural family planning means couples understanding when the woman is ovulating, when the days are that intercourse would result in pregnancy, and then making choices to either have intercourse or abstain. Or we can talk about the various choices they might make around that time to decide to either try to get pregnant or not.

Dr. Jones: So how well does it work?

Dr. Stanford: If a couple understands the days that they may get pregnant and does not have intercourse on those days, it's highly effective for avoiding pregnancy. The controversy about effectiveness comes when couples take chances or say, "Well, maybe I'll see what happens." That's where the gray areas and the controversy come for effectiveness.

Dr. Jones: Right. Well, so, for me, I would say I take a more technical approach. I certainly was raised as a reproductive endocrinology with the science of contraception in terms of birth control pills, birth control hormones, IUDs and shots, because my training told me that people are the least predictable about their behavior when they're thinking about sex and that the difference between what they intend to do and what they really do is kind of big. We know that people want to take their birth control pills and they . . . 10% of them screw up and they don't take them right. Well, what about the natural family planning? You must be looking at a very unique group of people who are motivated, highly motivated.

Dr. Stanford: Yes and no. I would say that successful users in natural family planning are highly motivated for a variety of reasons and find a way to make that work, and find it beneficial to their relationship over time. So in that sense, yes, they're highly motivated. I would also say that they, on average, tend to have a little bit different view about when they want to have children. I think natural family planning users, on average, probably have a few more, one or two more children than the contraceptive users, and that's because of their worldview of how many children they want and what methods they want to employ to get there.

Dr. Jones: So I think the people who provide this service may have a unique worldview. That would be you versus what mine might be, and the people who come to practice this method reliably and successfully may have a little bit of a different worldview, so I think . . .

Dr. Stanford: But I would also say there's a spectrum of reasons people use natural family planning or what we might call fertility awareness methods. Some are coming at it from a religious point of view, some are coming at it from an ecological point of view, they don't want hormones, some are coming at it from a point of view of not wanting to have a barrier or they like that idea of understanding their bodies. So there's a spectrum. It's not a monolithic group that use natural family planning.

Dr. Jones: Right, and I understand that, having grown up sort of in the granola culture, that a lot of women didn't want to put anything in their body or take anything unnatural and preferred -- they were well-educated women -- to make their own personal choices, and I can see that that might be very useful for them if they practice it reliably through a lifetime of contraception.

Kids who might be sexually active, when they're still not reliably ovulating or women postpartum, or women in their 40s, are there special tools that you have to use for women who aren't reliably ovulating?

Dr. Stanford: Let's talk about the women in their 40s or women who are not reliably ovulating. Those are cases where I think we do need more research, but I do think we have adequate tools to make it work for those who want to make it work. Is it always the easiest thing? No, sometimes it requires a little more patience. It can work for that group. I hope we have better ways in the future to make it work a little more smoothly or easily.

The teenager, that's another question of motivation and the whole social context of . . . . I believe that teenagers should all be educated in their sexuality, including their fertility and their fertility cycles. Whether or not that means we rely on that as the only way of them not getting pregnant, I would think you need to look at social context and social norms, and other issues. And in some social context for some teenage populations and families, they may think contraception's part of that, but I think that for all teenagers, they should understand their fertility.

Dr. Jones: Right. I thought that if they had sex, they were reflex ovulators like cats, meaning, yes, grown-up women ovulate on a schedule and teenagers only ovulate when they have sex because it seems like it only takes once, at least that's what they've told me.

Dr. Stanford: Well, you know, that's an interesting question that I actually think we need a little more research on, but it's not true that . . . there's no evidence, let's put it that way, that women can go from no mature follicle to ovulating based on one intercourse.

Dr. Jones: Even I know that. Well, so I take it . . . I come at contraception from a perspective of wanting to have a very low failure rate with almost no input.

Dr. Stanford: Right.

Dr. Jones: So for those of us who are interested in what we call long-acting, reversible contraception, or highly effective reversible contraception, we want something that's highly effective and reversible, and you don't have to think about it, that has some side effects, though. It has some downside and women, the tradeoff for highly effective and reversible is some side effects, but I guess . . . what is the failure rate if you follow the rules? Did we talk about that?

Dr. Stanford: Yeah, 1% to 2%.

Dr. Jones: One to two percent, that's pretty good, per year?

Dr. Stanford: er year.

Dr. Jones: Per year.

Dr. Stanford: So I would say that is a fundamental difference in philosophy. Natural family planning is, in some ways, the complete opposite of long-acting, reversible effective contraception in the sense that the goal is to have as little user input as possible, make it completely independent of the user.

Dr. Jones: Right.

Dr. Stanford: Natural family planning is the radical opposite of that. The user, and not just the woman, but the woman and the man together, need to cooperate and understand what's going on and cooperate to make that happen for both of their intentions. So it is a radically user-dependent method, which I think some people see as a weakness, but it is also a strength.

Dr. Jones: I think it is for strength and what I really want is for women to have their choices.

Dr. Stanford: Right.

Dr. Jones: And for couples to have their choices.

Dr. Stanford: Right.

Dr. Jones: And I think that's important to both of us, and whether you choose a very technical approach to your personal contraception, or you want a, what I call radically . . .

Dr. Stanford: User-dependent . . .

Dr. Jones: . . . user-dependent method, meaning your control and your body

Dr. Stanford: Right.

Dr. Jones: We want to have both people to be successful.

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Interviewer: Birth control pills are not adequate treatment for polycystic ovarian syndrome. So what should you do to treat it? That's next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: There's sometimes a misunderstanding that birth control pills are an adequate treatment for polycystic ovarian syndrome, but they actually can make it worse. So what should you do? Dr. Joseph Stanford is with University of Utah Healthcare. What do you know about treating this syndrome? What can we learn?

Dr. Stanford: So we know a lot more about the underlying causes of the syndrome now. There's underlying insulin resistance so we want to treat that to get at the underlying condition, underlying disease and not just mask it with a birth control pill, which actually worsens insulin resistance.

Interviewer: Does it really? Okay. So what are some of the things that a woman can do to help manage that?

Dr. Stanford: So we start with diet and exercise. Don't we always start with that? But it is really critical, in this condition especially. Women with polycystic ovarian syndrome sometimes have a lot of trouble losing weight. They may be overweight. And so there may be medications as well as the diet and exercise to help with that to some degree. But still, the cornerstone is diet or healthy weight.

Also, a diet that is what we call a "low-glycemic index diet." And that's a diet that does not raise blood sugar suddenly. So obviously minimize the added sugar, we want to minimize simple sugars, and also minimize simple starches. We want a diet that will give you a low, steady blood sugar. So that's complex carbohydrates and proteins and fats. Good amounts of good fats. So that's a diet called a low-glycemic index diet used for diabetics. Also, it works very well with polycystic ovarian syndrome.

Interviewer: And if a woman does this diet well, first of all, are there medications that go along with it?

Dr. Stanford: There are medications that can be used along with it and some women need them and some may not.

Interviewer: Okay. So some diet is enough.

Dr. Stanford: For some, yes.

Interviewer: And then you do the diet. The cysts go away. The symptoms go away. Do you have to stay with that diet then for the rest of your life?

Dr. Stanford: Yes.

Interviewer: You do? Okay. Isn't that the way it always is as well?

Dr. Stanford: If you meet with a dietician and get your diet adjusted to something you enjoy but is also healthy, that's the goal really for long-term maintenance.

Interviewer: Are physicians still using birth control pills pretty commonly to treat this condition?

Dr. Stanford: Yes, I would say they are, especially when it's just dealing with the irregular periods that are part of the condition. And they do make the periods regular. The problem is they don't treat the other underlying issues.

Interviewer: And if you don't treat those underlying issues, those other ones, what other issues could arise as a result?

Dr. Stanford: Some women could still have problems with infertility later on. She could also be at higher risk for diabetes, gestational diabetes or regular diabetes later in her life.

Interviewer: Do those cysts go to scar the ovaries at any point? Or once you kind of get back on that diet, they just kind of go away?

Dr. Stanford: These are small cysts and they don't cause scarring. With management of the disease with diet, exercise, and maybe medications, those cysts can get smaller or fewer of them. They won't go away entirely. In fact, a certain small level cyst is normal to have. It's the excessive small cysts that cause the polycystic ovarian syndrome.

Interviewer: So it sounds like the first thing you should do is just pretend like you have diabetes and eat accordingly.

Dr. Stanford: That could work. If you have questions about that, it doesn't hurt to meet once or twice with a dietician and really get it figured out.

Interviewer: All right. Are there other diet considerations?

Dr. Stanford: Yes. There's a good study recently that showed that women who eat more of their calories at breakfast and a lot fewer at dinner sort of the opposite of what most Americans do right? No breakfast and a big dinner. But if you turn that around and eat a bigger breakfast and a very small dinner, that actually reduces your insulin secretion and your testosterone for women with PCOS. So that sort of switch around on the diet can be really helpful.

Interviewer: It's amazing. So some of these small, little changes really can make that much of a difference.

Dr. Stanford: It makes a big difference.

Interviewer: Wow, that just is incredible to me. What about exercise?

Dr. Stanford: Exercise is critical. Isn't it critical for anything? But it's definitely critical for this condition. And that doesn't have to be running marathons. Just regular aerobic exercise. Walking every day, 20 minutes, can do wonders. So just a consistent level of exercise.

Interviewer: So it sounds like this condition arises out of poor diet and not exercising enough.

Dr. Stanford: Women that have this condition have some underlying genetic issues that make them more susceptible to that. So some women could get away with a poor diet and not exercising, and women with PCOS basically can't get away with it because they have an underlying condition that's exacerbated by the way they're living. It's not something to blame the women. Our society kind of pushes us in one direction and we have to push back and push into a more healthy direction.

Interviewer: Gotcha. What about supplements?

Dr. Stanford: So there actually is one supplement that's been shown to really help in this condition. It's called inositol. I-N-O-S-I-T-O-L. That is related to the B vitamins and you can look that up. It's been shown in randomized trials to actually improve the PCOS biochemical anomalies.

Interviewer: What's the takeaway from this conversation?

Dr. Stanford: The takeaway is that women with PCOS can get to be normally healthy. They just have to pay more attention to it than someone who doesn't have it. And maybe in the long run that's a good thing. It'll help you live your whole life healthy.

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Interviewer: Polycystic Ovarian Syndrome causes irregular periods, unwanted hair growth, sometimes weight gain and infertility, but it's very treatable with lifestyle and medication. We'll examine the condition and what you can do if you think you have it coming up next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Polycystic Ovarian Syndrome is a common but under-recognized disease. It is very treatable and we're going to learn more about it from Dr. Joseph Stanford. He's with the University of Utah Healthcare. First of all, what is Polycystic Ovarian Syndrome?

Dr. Stanford: Well, the main features of the syndrome really don't have anything to do with the ovaries: irregular periods, unwanted hair growth on the face or other parts of the body and then there are multiple small cysts on the ovaries and that's where the name comes from. Women only have to have two of those three to have the condition.

Interviewer: Oh, okay. When does it usually come on in a woman's life? Could it come on young, old, anytime?

Dr. Stanford: Usually young So women who have it will usually develop it in the teen years.

Interviewer: And is it literally at one point all of a sudden you start getting some hair growth?

Dr. Stanford: It could be more gradual. I wouldn't say it's sudden overnight.

Interviewer: Okay. And typically, where do you find that hair growth?

Dr. Stanford: On the face. So women who have to pluck and remove hair on the face and sometimes other parts like the chest or belly that's unwanted hair growth.

Interviewer: How common is it? How many women get this?

Dr. Stanford: So Polycystic Ovarian Syndrome as a whole is about 10% of women and that would be similar numbers for the unwanted hair growth. There can be other causes of that as well. It's not the only cause.

Interviewer: All right. And why is it unrecognized?

Dr. Stanford: I think women, if they've heard anything about it, they think about cysts on the ovaries. And that's, like I said before, not the main feature of the condition. It's one of the three pieces and not one that women know about unless they've had an ultrasound or something like that. The public is not generally aware that this syndrome involves these other problems, severe irregular menstrual flows, irregular periods and unwanted hair growth.

Interviewer: And what causes it?

Dr. Stanford: So what we know now is that it has a lot to do with insulin resistance. Sort kind of like a pre-diabetic condition where women don't use insulin quite as well and the ovaries don't respond to insulin quite as well and that causes hormonal imbalances like the excess male hormones that cause hair growth and the irregular periods.

Interviewer: And why is it bad?

Dr. Stanford: Certainly it can cause problems with the unwanted hair growth and it can make it harder for women to lose weight or make them gain weight that they don't want to. In the long run, it can give them a higher risk of diabetes and other complications that come from diabetes like heart disease.

Interviewer: Are there any other effects other than the symptoms that could be negative on a woman's body?

Dr. Stanford: Certainly, it can cause infertility for women who are at the point they want to get pregnant. This can be an issue. So it's definitely something to pay attention to and treat for better health.

Interviewer: And what are some of the treatments?

Dr. Stanford: Briefly, I'd say treatments include diet and medications.

Interviewer: Oh, okay. And does it go completely away?

Dr. Stanford: It can be managed to where it's pretty much not a problem.

Interviewer: All right. And what about the cysts? Do they just go away as well?

Dr. Stanford: They often get better as well.

Interviewer: Without surgery?

Dr. Stanford: Right.

Interviewer: Oh, well that's probably a relief for a lot of women.

Dr. Stanford: Right.

Dr. Stanford: Surgery usually is not necessary.

Interviewer: Okay. Outstanding. So are there any final thoughts you have? Is there a question I forgot to ask or anything you feel compelled to say?

Dr. Stanford: I would just say for women who have irregular periods or unwanted hair growth should get it checked out and not just think, "That's the way I am. I have to deal with it." And we're here to answer any questions. Happy to be of help.

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Interviewer: If you're missing time from school or work or relationships because of severe pelvic pains, it could be endometriosis. We'll examine that next on the Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use, for a happier and healthier life. You're listening to The Scope.

Interviewer: Fatigue, excessive pain during periods or intercourse or with bowel movements or urination, excessive bleeding and infertility. These are some of the symptoms of endometriosis. And 10% of women have this condition and some don't even realize it. Our goal for this podcast is to raise awareness to this condition and help you figure out if you might have it. Dr. Joseph Stanford is with University of Utah Health Care. Are there some other symptoms, did I miss anything?

Dr. Stanford: Those were the main symptoms. You covered it well.

Interviewer: So, why don't women realize they have this condition? I find that kind of surprising at that thought.

Dr. Stanford: A lot of women think that having pains with periods is normal or just something they have to deal with or they may go to the doctor that says, "Well, we'll see how it goes. Let me put you on the pill and see how you feel." And they don't really look into what might be the underlying issue.

Interviewer: Is this pain just during periods or is it all the times during the month?

Dr. Stanford: The biggest pain is during periods but sometimes it will get so severe that it's at other times of the month as well.

Interviewer: All right. I was reading some stories about women who have been diagnosed with the condition and I notice kind of that theme that you mentioned that sometimes doctors don't necessarily recognize the condition. Is that common?

Dr. Stanford: It's often they may not recognize it or they may just feel like, "Let's try something simple," and then try to deal with the symptoms because the only way for sure diagnose endometriosis is a surgery. So, it's understandable that sometimes doctors would be reluctant to mention that possibility.

Interviewer: Yeah, I got you. And some of these stories that I was reading also kind of led me to believe that women who know they have it, at some level, knew they have it because it's excruciating. Is that pretty accurate as well?

Dr. Stanford: Often, but I would say there's a spectrum of symptoms. Some women have milder symptoms, and they may still have the conditions.

Interviewer: So, those milder symptoms, how do you know what's normal and . . . because pain threshold, that's a very personal thing.

Dr. Stanford: I would just say pain with periods that interferes with your life, that's not normal.

Interviewer: So, many women have these terrible symptoms before they get diagnosed and treated. What causes endometriosis?

Dr. Stanford: There are a lot of theories about it, a lot of research going on, but at this point, we really don't know for sure what the causes are.

Interviewer: Do you know if it's a lifestyle issue, is it something that a woman's doing or not?

Dr. Stanford: I wouldn't say it's a lifestyle issue, there may be some environmental exposures, there may be some genetic factors.

Interviewer: Okay, all right. So, what exactly is going on? We've talked a lot about the symptoms, what is it? What's happening?

Dr. Stanford: What's happening is that tissues that are normally on the inside of the uterus called the endometrium, that tissue gets on the outside of the uterus or another part of the pelvis or other parts of the body where it's not supposed to be and it causes problems, inflammation, pain, problems.

Interviewer: I think you mentioned the only way to deal with that at this point is surgery?

Dr. Stanford: The only definitive way to get rid of it is surgery. There may be medicines to reduce the symptoms, yes.

Interviewer: All right. I understand that sometimes these conditions can be misdiagnosed as irritable bowl syndrome or IBS. Is that common?

Dr. Stanford: That would be common. That's a disease that could be confused with it, yes because irritable bowel syndrome would have some of the same symptoms.

Interviewer: Yes. How would you differentiate between the two if you're a woman.

Dr. Stanford: Well, if the symptoms are particularly around the menstrual period, the menstrual flow and if the symptoms are with intercourse, you definitely should be thinking more about endometriosis.

Interviewer: All right. So, other than the misery and compromising quality of life, are there other reasons that a woman should be treated for this condition.

Dr. Stanford: Yes, in the long run, it can reduce fertility if she is wanting to have children. Also, there's some indication that it may be linked to some future cancer risks.

Interviewer: Is there anything I left out, anything that you feel compelled to say, anything that you feel a woman should know about?

Dr. Stanford: Yes. Most women with endometriosis could go for many years before they get it diagnosed and I would say that if you're having symptoms, it's better to get looked at sooner than wait.

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