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Blog | Alto Pharmacy

 Stress doesn’t simply spill into our personal lives, it affects the body in many ways. And it isn’t only short-term ailments like tension headaches or muscle pain to be mindful of — ongoing stress can take a heavy toll on your long-term heart health. In recent years, numerous research studies have found that stress can increase a person’s risk for heart disease, the leading cause of death in the United States.

Understanding the Stress-Heart Health Connection

While many people know that high blood pressure, high cholesterol, genetics, and smoking are all key heart disease risk factors, stress isn’t always included in conversations about heart health. As you prioritize a heart-healthy lifestyle, regularly evaluate your stress levels, taking steps to reduce stress and manage it positively when it does arise.

Here’s more on the stress-heart health connection, including coping strategies that will benefit your heart as much as your mind.

Stress triggers physiological changes in the body that can influence heart health. It all starts in the brain. When you encounter a stressful trigger, the amygdala — a portion of the brain responsible for emotional processing — communicates that you are in distress, activating your nervous system.

As part of this process, the stress hormones adrenaline and cortisol are released, which can temporarily increase blood pressure and insulin resistance. Sometimes the body’s experience of stress also leads to inflammation in the arteries. Over time this can affect the function of your blood vessels, potentially resulting in atherosclerosis, or the accumulation of plaque in the walls of your arteries.

Less directly, stress has a ripple effect on lifestyle factors related to heart health. Everyone responds to stress in different ways. For some, exercise might be a positive outlet during challenging times. But for others, stress makes it difficult to fit in consistent exercise. (The American Heart Association recommends 150 minutes of moderate-intensity aerobic activity per week.) And stress frequently goes hand in hand with unhealthy behaviors like smoking and heavy alcohol consumption or other substance use.

There is also the link between stress and sleep, another less discussed heart health risk factor. The overactive nervous system created by chronic stress — and its continuous output of hormones — can create a vicious cycle of anxiety-fueled insomnia and insomnia-fueled anxiety.

Stress presents differently from one person to another. If you are experiencing any of the following symptoms, talk to your doctor about stress management techniques and other resources.

Stress relief doesn’t have to be a big endeavor. Look for small opportunities, like the following, to engage the body and mind in your daily or weekly routine. (Your heart will thank you!)

Exercise is fundamental to heart-healthy living, and it also happens to be a powerful source of stress relief.

Like the stress-heart health connection itself, the soothing effects of physical activity are grounded in hormones. Exercise is known to lower your levels of adrenaline and cortisol while stimulating production of endorphins, the body’s feel-good chemicals.

Longer blocks of regular exercise are important for your long-term heart health, but in moments of high pressure you’ll feel some stress-relieving benefits from even a quick burst of movement.

As you get moving, find ways to calm the mind. Many practices fall under the umbrella of mindfulness, the cultivation of present moment awareness and shift away from reactivity. Try meditation, yoga, tai chi, walking, or even bringing a bit more attention to your morning coffee or cup of tea.

With so many options for living more mindfully, focus on finding the habits and routines that work for you, and which fit easily into your day.

Deep breathing, a proven tactic for lowering stress hormone levels, is an accessible entry point. You may also benefit from the following resources:

Insight Timer, which offers a variety of free guided meditations

What’s Up?, which uses a cognitive behavioral therapy (CBT) approach to managing stress and negative thoughts

Healthy stress management isn’t just about using positive coping mechanisms in the moment. You may be able to stop stress before it happens — without getting too far into the future, of course.

Researchers have linked workplace stress, which many U.S. adults experience, to negative heart health. One Swedish study connected a poor experience of a manager to the risk of heart attack.

There are tangible ways to make the demands of a job or responsibilities at home feel more manageable (saying no when it’s necessary for starters). Stress management is personal, so consider what you need and don’t be afraid to ask for it.

At Alto, we make it as simple as possible to manage your risk for heart health issues and follow the treatment plan your doctor recommends. We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly.

Reach out any time through in-app messaging or by phone at 1-800-874-5881.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

Allergies, the immune system’s response to foreign substances, can take numerous forms, from hay fever and allergic asthma to food allergies, medication allergies, and more. For those with allergic contact dermatitis — also referred to as allergic eczema — contact with an allergen causes skin inflammation and a rash.

Common Treatments for Allergic Rashes

While allergic contact dermatitis can be uncomfortable, painful, or itchy, a healthcare provider can help you identify the underlying trigger and manage symptoms. Read on for more about the condition.

Allergic contact dermatitis occurs when exposure to an allergen causes a skin rash. The condition can take different forms, and skin may appear red, swollen, blistering, flaky, or scaling. Many people experience pain or itchiness. There may also be a burning or stinging sensation. 

Common allergens that trigger allergic contact dermatitis include:

Poison ivy, poison oak, poison sumac, and other plants

Certain metals used to make jewelry such as nickel

Certain medications including antibiotics

Preservatives used in cosmetic products and household products

Symptoms typically take 24-48 hours to develop, though they may appear within minutes or hours of exposure in some cases. You may be more susceptible to the condition if you have sensitive skin or chronic skin issues that aren’t caused by allergies.

It takes time to develop an allergy, and you likely will not have a reaction to an allergen after a single exposure. Many people become more sensitive to an allergen with each subsequent exposure.

If you develop contact dermatitis several times and are unsure of the trigger, keep a diary of potential factors to identify the allergen.

In rare cases, allergic contact dermatitis overlaps with anaphylaxis, a severe and potentially life-threatening reaction that swells the airways and blocks breathing. This reaction may occur within seconds or minutes of exposure to an allergen.

The signs and symptoms of anaphylaxis include:

Respiratory symptoms including wheezing and a persistent cough

In addition, anaphylaxis is frequently accompanied by hypotension, or low blood pressure, defined as blood pressure under 90/60 mm/Hg or a 30% reduction from your baseline blood pressure.

Anaphylaxis must be treated with epinephrine, a hormone and medication used in emergency treatment. Many people with severe allergies carry injectable epinephrine in a pen. If you experience anaphylaxis and do not have epinephrine, go to an emergency room as soon as possible. If you do not have someone to accompany you to the emergency room, call 911 first.

Allergic contact dermatitis vs irritant contact dermatitis

Allergic contact dermatitis is one of two main types of contact dermatitis. Irritant contact dermatitis is a rash that develops quickly in response to a chemical substance, or irritant, including harsh soaps and detergents, hair dyes, certain household products, and acids. 

Symptoms of irritant contact dermatitis are similar to those of allergic contact dermatitis, however the reaction forms more quickly and is often more painful than itchy.

If it is possible to avoid an allergen or irritant, you may be able to identify the trigger of your contact dermatitis and prevent a reaction. If this is not possible, additional steps are often required for an official diagnosis.

If your doctor believes that you may have allergic contact dermatitis, patch testing may be used to identify the underlying cause. During a patch test, you’ll wear adhesive patches containing common allergens known to trigger reactions. Your provider will check your skin after 48 hours and again after an additional 48-96 hours to check for a reaction.

If your doctor is unable to confirm a diagnosis of allergic contact dermatitis after patch testing, they may order a biopsy — a procedure that removes a small sample of your skin — to determine if another condition is responsible for symptoms.

There is not a similar test to diagnose irritant contact dermatitis, but a doctor may be able to identify the triggering irritant based on the chemicals you regularly come into contact with.

Read When to See a Healthcare Specialist for Allergy Treatment

A variety of treatment options may be used to help you manage allergic or irritant contact dermatitis. Individual treatment plans depend on the severity of symptoms.

As a first step, wash irritated skin with mild soap and water after exposure to an allergen to remove traces of it. In mild cases, this may be sufficient to address symptoms.

If symptoms persist, your doctor may recommend one or more of the following treatments:

Moisturizing creams to hydrate and repair irritated skin

Over-the-counter corticosteroid-based creams to ease itching and inflammation

Colloidal oatmeal-based products to ease itching and inflammation

Calamine lotion to ease itching and discomfort

Over-the-counter oral antihistamines such as Benadryl® or Zyrtec®

Oral steroids such as prednisone to relieve symptoms that don’t respond to over-the-counter medication

Additional immunosuppressive medications including JAK inhibitors — which block immune responses to prevent inflammation — and off-label systemic medications including cyclosporine and methotrexate may be used in severe cases that require multiple rounds of oral steroids.

With effective treatment, symptoms of allergic contact dermatitis are typically resolved within two to three weeks. However, to prevent future reactions, it’s important to identify the underlying cause of your symptoms so that you can avoid it.

Managing allergic rashes is easier with a reliable pharmacy partner by your side. Our pharmacists can answer any questions you may have about treatment, and we offer free, same-day delivery and medication management tools like reminders and auto refills in our app.

To learn more, reach out any time through secure in-app messaging or by phone at 1-800-874-5881.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

The thyroid may be small, but it plays a significant role in your overall health and wellness. This butterfly-shaped gland at the base of your throat produces and regulates hormones that influence your metabolism and energy level, cholesterol, heart rate, body temperature, and more.

How to Manage an Overactive Thyroid

Balanced thyroid hormones allow your body’s many systems to properly function, and issues with the thyroid can impact many aspects of your health. There are two main types of thyroid imbalances that may occur: hyperthyroidism and hypothyroidism.

Hyperthyroidism occurs when the thyroid produces too much thyroid hormone, accelerating the metabolism beyond normal.

Hypothyroidism occurs when an underactive thyroid leads to lower-than-normal levels of thyroid hormone.

Without treatment, both hyperthyroidism and hypothyroidism can lead to more serious complications. Below, we explain how to manage these disorders and maintain a balanced thyroid.

Several conditions or health factors may lead to overproduction of thyroid hormone. Graves’ disease, an autoimmune disorder in which antibodies overly stimulate the thyroid, is the leading cause of hyperthyroidism, accounting for 85% of all cases.

The development of thyroid nodules, which are typically benign lumps or growths in the thyroid that produce more hormones than needed

Thyroiditis, or thyroid inflammation, which most commonly occurs after pregnancy due to an underlying autoimmune disease or unknown cause

Excess consumption of iodine — a mineral critical to the production of thyroid hormone — through diet or medications

There are also several known factors that may increase your risk of developing the condition, including:

Health conditions including pernicious anemia, type 1 diabetes, and primary adrenal insufficiency (also known as Addison’s disease)

Hyperthyroidism is associated with a wide range of signs and symptoms such as the following:

Unintentional weight loss even with increased food intake

Enlarged thyroid gland at the base of your neck

Symptoms of hyperthyroidism may be subtle for some individuals. In addition, many common symptoms overlap with those of other health conditions. If you have any concerns about your thyroid health, consult with your provider for an evaluation.

Hyperthyroidism is associated with irregular menstrual cycles, which can lead to difficulty conceiving. Many people initially learn of a hyperthyroidism diagnosis after experiencing fertility challenges. The treatment options described in more detail below can help restore hormone levels and ovulation.

The thyroid affects so many areas of your health and wellness, and untreated hypothyroidism can lead to other health issues such as the following.

An underactive thyroid can increase levels of LDL cholesterol, leading to a greater risk of heart disease and heart failure.

Hypothyroidism is also linked to depression.

An underactive thyroid can affect ovulation, or the release of a mature egg from the ovaries during a menstrual cycle. Treatment for hypothyroidism may address fertility issues by restoring hormone levels and ovulation.

In the long term, untreated hypothyroidism can damage the peripheral nerves, which carry information from your brain and spinal cord to other parts of your body. This can lead to pain, numbness, and tingling.

There are several ways to diagnose hyperthyroidism, including a physical exam, blood tests, and imaging tests.

Your healthcare provider may check your thyroid, eyes, heart, hands, and skin during a physical exam to confirm a diagnosis of hyperthyroidism.

Your provider may recommend thyroid function testing, which consists of measuring your thyroid hormone levels via blood samples. Hyperthyroidism is characterized by elevated levels of the thyroid hormones triiodothyronine (T3) and thyroxine (T4) and lower-than-normal levels of thyroid-stimulating hormone (TSH).

Your provider may also use one or more imaging tests to more closely examine your thyroid, including a radioactive iodine uptake (RAIU) test, a thyroid scan, and a thyroid ultrasound.

There are a variety of treatment options for hyperthyroidism. Your provider will make individualized recommendations based on the cause of your hyperthyroidism and your overall health history.

The following types of medications are commonly used in the treatment of hyperthyroidism.

Anti-thyroid medications including methimazole (Tapazole®) and propylthiouracil (PTU) reduce symptoms by preventing over-production of thyroid hormones. These medications are typically taken for at least a year, though symptoms may improve within weeks or months.

Radioactive iodine is an oral medication that targets overactive thyroid cells, causing the thyroid to shrink and lowering hormone levels within a few weeks. This treatment approach permanently affects thyroid function, so symptoms of hyperthyroidism will not reappear. In most cases, the use of thyroid hormone medications is necessary after this treatment to maintain balanced hormone levels.

Beta blockers can control associated symptoms such as a rapid heartbeat, nervousness, or tremors. These medications cause the heart to beat more slowly and less forcefully. They will not change hormone levels and are typically used in tandem with anti-thyroid medications or radioactive iodine therapy. Commonly prescribed beta blockers include atenolol (Tenormin®), bisoprolol (Zebeta®), metoprolol tartrate (Lopressor®), metoprolol succinate (Toprol-XL®), acebutolol (Sectral®), and propranolol (Inderal®).

Some cases of hyperthyroidism require removal of part or all of the thyroid gland in a procedure known as a thyroidectomy. While this is effective at treating hyperthyroidism, it can result in hypothyroidism, which requires ongoing use of thyroid supplements.

Iodine consumption can contribute to the development of hyperthyroidism or worsen symptoms. Managing hyperthyroidism often includes monitoring iodine intake.

If your provider recommends following a low-iodine diet, try to avoid or limit your intake of seafood and seaweed, which have the highest iodine content of all foods. Other high-iodine foods to consume in moderation include milk and dairy products, egg yolk, and iodized salt.

Never make significant changes to your diet without first consulting your provider or a nutritionist.

The most common cause of hypothyroidism is an autoimmune disorder called Hashimoto's thyroiditis.

Other significant contributing factors include:

Thyroid surgery, which can affect hormone production

Radiation therapy to treat cancer, if targeting the head or neck

Anyone can develop hypothyroidism, but several known factors may increase your risk, including:

Sex - the condition occurs more frequently in women than in men

Age - the condition occurs more frequently in those over 60

Having another autoimmune disorder such as type 1 diabetes or celiac disease

Symptoms of hypothyroidism often develop gradually, over the course of many years. These are among the most common and significant:

If you have symptoms of hypothyroidism, your doctor will likely use a thyroid stimulating hormone (TSH) test to confirm a diagnosis. This simple blood test measures the levels of thyroid hormones in your blood.

One challenge of diagnosing hypothyroidism is that symptoms frequently overlap with those of other health issues.

Hypothyroidism is manageable. Treatment allows you to control symptoms such as elevated LDL cholesterol levels and weight gain, preventing potential health complications.

The main goal of treatment is to increase your thyroid levels. Levothyroxine (Levo-T®, Synthroid®, Tirosint®), a synthetic thyroid hormone taken orally, is often the starting point.

Another synthetic thyroid hormone, liothyronine (Cytomel®), may also help treat low thyroid levels.

There are formulations that combine levothyroxine and liothyronine.

The majority of individuals with hypothyroidism need to take medication every day on an ongoing basis, though some mild cases are resolved with short-term treatment.

How to Manage an Overactive or Underactive Thyroid

The Alto product and engineering team has long been focused on initiatives that improve our unit profitability. Now that we’ve laid a strong foundation, we've started to think about our next big bets: How do we expand our services beyond delivering prescriptions? How do we test new value-add offerings quickly and iteratively? That’s where the incubation team comes in.

Meet the Innovation Team Building Alto's Next Big Bets

The Alto product and engineering team has long been focused on initiatives that improve our unit profitability. Now that we’ve laid a strong foundation, we've started to think about our next big bets: How do we expand our services beyond delivering prescriptions? How do we test new value-add offerings quickly and iteratively? That’s where the innovation team comes in.

Newly launched in 2022, the team is small and scrappy by design. We’re a product manager, two engineers, a part-time designer, and a part-time manager with a single mission: to launch at least two significant new business experiments per year. If an experiment is successful, we’ll scale it into a full workstream before handing it off to a stand-alone product team.

We started with over-the-counter (OTC) medications. OTCs, or medications you can buy without a prescription, like Advil, are high-margin products that users are accustomed to purchasing at traditional, brick-and-mortar pharmacies. The goal of this experiment was to assess how much interest users have in adding OTCs to their order while checking out in the Alto app. We set a target conversion rate and offered OTCs only from our San Jose pharmacy, which is less busy than our San Francisco pharmacy but close enough to engineers in San Francisco for in-person troubleshooting.

Our initial hypothesis: if we present users with a small selection of OTCs targeted to their needs (based on the prescriptions in their cart), they’ll be more likely to convert. With support from our pharmacy partners, we carefully curated a recommendation algorithm that would suggest nine OTCs based on the medications already in the user’s cart.

In the interest of lean experimentation, we wanted a scrappy technical solution that could be implemented quickly while meeting our high user experience standards and minimizing operational risk. We settled on the following architecture:

We prioritized creating a clean API for Alto’s customer-facing app and using as much of our current infrastructure as possible. Although OTCs are distinct from prescriptions, we decided to reuse our existing prescription model rather than build a new one from scratch. This allowed us to leverage existing systems and operational workflows, reducing engineering time and risk of regression.

Behind the API, we opted to store our OTC formulary and associated metadata in in-memory data structures:

ADVIL = SkuId.new(sku: '...', sku_type: '...').freeze
CLARITIN = SkuId.new(sku: '...', sku_type: '...').freeze
FISH_OIL = SkuId.new(sku: '...', sku_type: '...').freeze
...
METADATA_BY_SKU_ID = {
  ADVIL.hash_code => {
    image_url: '...',
    name: 'Advil Ibuprofen 200mg Coated Tablets',
    quantity_description: '100 tablets',
    product_description: 'Easy to swallow powerful pain reliever for headaches, joint and muscle pain.',
  },
  CLARITIN.hash_code => {
    image_url: '...',
    name: 'Claritin 24 Hour Allergy Tablets',
    quantity_description: '30 tablets',
    product_description: 'Non-drowsy, 24 hour relief of symptoms due to allergies: sneezing, runny nose, itchy and watery eyes.',
  },
  FISH_OIL.hash_code => {
    image_url: '...',
    name: 'Fish Oil 500mg Softgels',
    quantity_description: '130 softgels',
    product_description: 'Dietary supplement with EPA and DHA omega-3 fatty acids to support heart health and maintain normal triglyceride levels.',
  },
  ...
}.freeze

This gave us a nice balance of speed and flexibility. We knew that we could optimize once we had established our OTC offering and gained an understanding of how it would evolve within Alto.

The results of phase 1 were a bit disappointing, but very interesting: the conversion rate of users who checked out with an OTC was just under our target. However, nearly half of all users who saw the experience would scroll down to peruse all nine OTCs that were offered.

Based on this positive sign of engagement, we hypothesized that perhaps we just weren’t showing the right OTC products to the user. For phase 2, we decided to scrap the limited recommendations and allow users to explore an entire catalog of OTCs.

Phase 2 required categorizing our list of OTCs into buckets such as “Top Sellers,” “Covid Care,” and “Allergy & Asthma.” We built a new fetch_categorized endpoint to return our OTC catalog structured by category, adding search functionality into the client so that users could quickly filter for a specific product. This search field was also heavily tracked with analytics events to help us learn which products to add to our catalog in the future.

This new experience immediately outperformed phase 1. After a few performance improvements (speeding up our catalog and product image load times), we eventually hit our target conversion rate — even managing to surpass it on some weeks!

Our eventing did show that a significant number of users with multiple prescriptions or smaller screens were not even seeing the OTCs in Cart, as they were pushed below the fold. We tried experimenting with alternate spots to show our catalog:

1. An interstitial that shows after Cart and before Checkout - this didn’t perform any better than the control and was quickly scrapped.

2. A single carousel at the top of Cart - this out-performed the control but at the cost of our guardrail metric. With a decrease in the overall checkout rate, we decided to stick with the control for now.

This phase of UI experimentation validated that our users wanted an offering of categorized OTCs. However, our initial technical solution wouldn’t scale as we rolled out to more of our pharmacies. The following questions led us to this conclusion.

How might we support changes to our OTC catalog on a per-pharmacy basis?

Given factors such as inventory, geography-related price sensitivities, and experimentation, we wanted to make sure that we could tweak the OTC experience for users getting deliveries from a specific pharmacy.

In the status quo implementation, that would have likely meant adding an additional layer to our data structures like so:

SKUS_BY_PHARMACY_AND_CATEGORY = {
  SF_PHARMACY_ID => [
    AddOnOtcCategoryType::TopSellers => [
      IHEALTH,
      FLONASE,
      ASPIRIN,
      ...
    ],
    ...
  ],
  ...
}

We weren’t worried about memory space limits given our relatively small number of pharmacies and OTC catalog. We were concerned, however, that each modification would require an engineer to go in and make code changes, get PR approval, and wait for a full deploy for the update to go live. This would be a bad use of engineering time, and our CI/CD process would become a bottleneck to otherwise quick modifications.

How might we add and remove OTCs from our catalog?

Similarly, we knew that adding and removing OTCs from our catalog would also be a somewhat regular workflow. There are some other considerations when adding a new OTC (Is it in our product database? Do we need any new procurement/inventory workflows to make sure it gets stocked in our pharmacies? Do we have a nice image to render in the app?), but we wanted to automate the technical side as much as possible — or at least be able to automate it.

The natural next step was to move our OTC catalog into the database.

Alto’s OTC Database Schema. Some columns excluded for brevity.

Now, rather than grabbing from in-memory data structures, we are efficiently querying the database for the OTC catalog of a user’s specific pharmacy, preloading all of the associated models needed for our API response.

OtcCategory
  .includes(otc_category_products: { otc_product: :otc_product_metadata })
  .where(otc_category_products: { pharmacy_id: pharmacy_id })
  .where(otc_product_metadata: { pharmacy_id: pharmacy_id })


At the time of writing, an engineer is still required to go in and make the changes at the database level. However, we plan to build an admin dashboard so that designated pharmacy partners can tweak our OTC catalog without the help of an engineer.

We’re excited about our next iteration, which will allow users to add OTCs to their upcoming deliveries at any point, not only when checking out. It will likely be live by the time you read this.

Once that’s released, we will continue to learn, iterate, and pay down technical debt — more specifically, maturing the OTC data model in our backend and eliminating the need for them masquerade as prescriptions.

Looking even further ahead, the innovation team has more exciting and impactful projects on our roadmap. We can’t wait to share what’s in store!

Endometriosis is a condition in which tissue that should only grow in the uterus implants and grows elsewhere. It can cause significant pain in some cases and is often a factor in female infertility.

Various forms of pain relief and fertility treatment can help address endometriosis symptoms and related health complications. Here’s what to know about the condition’s causes, symptoms, and treatment options.

Endometriosis: A Leading and Treatable Cause of Female Infertility

Endometriosis is a condition in which tissue that should only grow in the uterus implants and grows elsewhere. It can cause significant pain in some cases and is often a factor in female infertility.

Various forms of pain relief and fertility treatment can help address endometriosis symptoms and related health complications. Here’s what to know about the condition’s causes, symptoms, and treatment options.

The endometrium is the tissue that typically lines the lining of the uterus. Endometriosis occurs when this type of tissue grows outside of the uterus, most commonly in the ovaries, fallopian tubes, and lining of the pelvic cavity. It may also grow in the intestines, rectum, bladder, vagina, cervix, or vulva. In extremely rare cases, it may be found outside of the pelvic area.

Just like endometrial tissue that grows normally in the uterine lining, the abnormal tissue that characterizes endometriosis thickens and bleeds during each menstrual cycle. However, whereas normal endometrial tissue is shed with the cycle, the abnormal tissue cannot leave the body. This can lead to inflammation and scarring of the surrounding tissue, as well as adhesions that bind the pelvic organs to one another.

In cases of endometriosis where tissue grows in the ovaries, the condition may lead to the development of cysts in the ovaries.

There is a spectrum of severity of endometriosis cases, defined by the amount of excess tissue and resulting cysts, scar tissue, or adhesions. The level of pain, which varies by individual, does not always correlate to the stage or severity of the condition. Pain typically peaks during a menstrual period.

The specific causes of endometriosis have not been identified, but the medical community believes that the following factors may contribute to its development:

Retrograde or reverse menstruation, in which endometrial tissue flows backwards through the fallopian tubes and into the abdomen during a menstrual cycle

Transformation of the cells that line the inside of the abdomen into endometrial-like tissue as the result of hormone or immune factors

Transformation of embryonic cells into endometrial-like tissue during puberty as the result of hormone factors

Attachment of endometrial cells to an incision during surgical procedures such as a hysterectomy or c-section

Transport of endometrial cells to other parts of the body via blood vessels or lymphatic fluid

Issues with the immune system that keep the body from destroying abnormal endometrial tissue

In addition, the following risk factors are often linked to endometriosis:

Getting your first menstrual cycle at an early age

Having an abnormally short menstrual cycle (e.g., less than 21 days)

Abnormally heavy menstrual periods lasting beyond seven days

Other health conditions that prevent the flow of menstrual blood during a menstrual period

There is also evidence that endometriosis may have a genetic component. You may have a higher risk of developing it if you have a mother, sister, or aunt with the condition.

Common symptoms of endometriosis include:

Pain, especially severe menstrual cramps in the abdomen or lower back

Painful urination or bowel movements during menstrual periods

Gastrointestinal issues including diarrhea, constipation, and nausea

Endometriosis can look very different from one individual to another, with varying experiences of symptoms. In some cases, the condition may not be accompanied by any noticeable symptoms.

How endometriosis affects female fertility

Endometriosis is a leading cause of female infertility, as abnormal growth of endometrial tissue can block the fallopian tubes, preventing the fertilization of an egg. It accounts for 24-50% of all female infertility cases, and one-third to one-half of individuals with the condition experience difficulty conceiving.

In mild or moderate cases of endometriosis, surgery to remove adhesions, cysts, and scar tissue is all that is needed to restore fertility. In other cases, additional procedures or fertility treatment may be required.

Getting an accurate diagnosis is critical to effectively treating the condition. However, the diagnosis process can be lengthy, with multiple steps, as symptoms frequently overlap with those of ovarian cysts, pelvic inflammatory disease, and irritable bowel syndrome (IBS).

An evaluation for endometriosis begins with a conversation about your health history. Several tests may be used during the diagnostic process, including the following.

A transvaginal or abdominal ultrasound, which provides images of your reproductive organs to help your doctor identify cysts potentially related to endometriosis

A laparoscopy, a procedure that inserts a small camera through the abdomen with the goal of directly identifying endometrial tissue outside of the uterus. This is the only procedure that can definitively confirm a diagnosis of endometriosis.

Severe pain from endometriosis can affect daily activities, and there are a variety of pain relief options, including both medications and surgery. Your doctor will likely try non-surgical interventions as a starting point and recommend procedures if the condition does not respond to initial treatment.

The following treatments may be used to treat discomfort caused by endometriosis or related health issues:

Over-the-counter pain medication such as ibuprofen

Supplemental hormones including the male hormone androgen, which can regulate hormonal production or minimize fluctuation to prevent abnormal tissue growth

Hormonal birth control including pills, patches, and vaginal rings, which prevent abnormal tissue growth by decreasing fertility

Gonadotropin-releasing hormone (GnRH) agonists, which block the production of estrogen to prevent menstruation

If symptoms do not improve after the treatments above, your doctor may recommend surgery. In addition to its usage during the diagnosis process, a laparoscopy can remove abnormal endometrial-like tissue. 

A hysterectomy, which removes the uterus and cervix, is typically reserved for severe cases. The procedure permanently affects your fertility, and you will not be able to become pregnant after the procedure. It’s important to consult your doctor about your options as well as your reproductive goals before moving forward.

In vitro fertilization (IVF) — a process in which eggs and sperm are fertilized and then placed into the uterus with the potential outcome of a pregnancy — can help individuals experiencing endometriosis-related infertility conceive.

Blog

Understanding the Stress-Heart Health Connection

Common Treatments for Allergic Rashes

How to Manage an Overactive or Underactive Thyroid

Meet the Innovation Team Building Alto's Next Big Bets

Endometriosis: A Leading and Treatable Cause of Female Infertility

Understanding the Diabetes-Heart Health Connection

How to Improve Indoor Air Quality at Home

How Alto Lowers the Cost of Fertility Treatment Through Better Medication Management

Get to know Jake Moffatt, Engineering Manager on the Alto Assistant Team

Osteoporosis, Explained

How We’re Making It Easier (and More Fun!) to Give Teammates Feedback

How Polycystic Ovary Syndrome (PCOS) Affects Fertility

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