Implantation is a process in which a developing embryo, moving as a blastocyst through a uterus, makes contact with the uterine wall and remains attached to it until birth. The lining of the uterus (endometrium) prepares for the developing blastocyst to attach to it via many internal changes. Without these changes implantation will not occur, and the embryo sloughs off during menstruation. Such implantation is unique to mammals, but not all mammals exhibit it. Furthermore, of those mammals that exhibit implantation, the process differs in many respects between those mammals in which the females have estrous cycles, and those mammals in which the femals have menstrual cycles. Females in the different species of primates, including humans, have menstrual cycles, and thus similar processes of implantation.

Researchers Geoffrey Sher and Jeffrey Fisch gave Viagra, also known as sildenafil, to women undergoing fertility treatment to test whether the medication could improve fertility and pregnancy rates. The researchers proposed that Viagra, typically indicated to treat erectile dysfunction in men, would help women with a history of failed past fertility treatments by thickening their endometrial lining, which is the layer of tissue in the uterus where an embryo implants during pregnancy. Sher and Fisch gave the women Viagra during in vitro fertilization, or IVF, an assisted reproductive technology. They summarized their findings in the article “Effect of Vaginal Sildenafil on the Outcome of In Vitro Fertilization (IVF) After Multiple IVF Failures Attributed to Poor Endometrial Development,” published in Fertility and Sterility in 2002. Although they noted additional research was needed, Sher and Fisch concluded that the prescribed combination treatment of Viagra and IVF resulted in an increased thickening of the endometrium lining which enabled the embryo to implant and result in a pregnancy.

Arnaud Fauconnier and Charles Chapron published “Endometriosis and Pelvic Pain: Epidemiological Evidence of the Relationship and Implications,” henceforth “Endometriosis and Pelvic Pain,” in the journal Human Reproduction Update in 2005. In that article, the researchers studied the relationship between pelvic pain and endometriosis. Endometriosis is the growth of endometrium, or tissue that normally lines the inside of the uterus, outside of the uterus. The authors review medical studies in order to determine how much evidence exists that endometriosis causes chronic pelvic pain symptoms. Then, the authors describe specific relationships between different types of endometriotic lesions and pain symptoms. By establishing specific relationships between pain and endometriosis, “Endometriosis and Pelvic Pain” helped healthcare professionals diagnose and treat pelvic pain related to endometriosis.

Dysmenorrhea refers to painful menstrual bleeding and often includes symptoms such as cramps in the lower abdominal region, pain radiating down to the thighs, nausea and vomiting, diarrhea, fatigue, and headaches. There are two types of dysmenorrhea, called primary and secondary dysmenorrhea, which develop in different ways. In cases of primary dysmenorrhea, people experience painful cramps before and during most of their menstrual cycles, which does not happen as a result of a different underlying condition and is mostly due to hormone imbalances. On the other hand, secondary dysmenorrhea is a symptom of an underlying condition that cause problems with the reproductive organs such as endometriosis. According to the American College of Obstetricians and Gynecologists, researchers have reported that dysmenorrhea impacts up to fifty to ninety percent of women, remaining one of the most common reasons why women miss days of school and work as of 2021, and contributing to decreased quality of life.

Endometriosis is a medical condition that involves abnormal growths of tissue resembling the endometrium, which is the tissue that lines the inside of the uterus. Those growths, called endometrial lesions, typically form outside the uterus, but can spread to other reproductive organs such as ovaries and fallopian tubes. Endometrial lesions swell and bleed during menstruation, which can cause painful and heavy menstruation, as well as infertility. As of 2021, there is no cure for endometriosis, although medical therapies such as birth control pills and GnRH analogues can treat the painful symptoms of endometriosis. More than eleven percent of women between the ages fifteen and forty-four in the US have endometriosis, which can often decrease a woman’s quality of life due to painful symptoms and impair her reproductive potential.

NovaSure is a device for endometrial ablation, which is a procedure that removes the endometrium, that the US Food and Drug Administration, or FDA, approved for use on 28 September 2001. Endometrium is the tissue that lines the uterus. NovaSure destroys the endometrium by sending electric beams at the endometrium. Hologic, a medical technology company concerned with women’s health, developed NovaSure to treat menorrhagia, or heavy bleeding during menstruation. Menorrhagia is a common symptom of endometriosis. Endometriosis is the growth of the endometrium outside of the uterus. While NovaSure is not a treatment that doctors use to directly treat endometriosis, the procedure may help alleviate heavy bleeding during menstruation, which may improve a patient’s quality of life as heavy menstrual bleeding is often associated with high levels of anxiety and low levels of confidence.

In the early 1920s, researchers Edgar Allen and Edward Adelbert Doisy conducted an experiment that demonstrated that ovarian follicles, which produce eggs in mammals, also contain and produce what they called the primary ovarian hormone, later renamed estrogen. In their experiment, Doisy and Allen extracted estrogen from the ovarian follicles of hogs and proved that they had isolated estrogen by using a measurement later renamed the Allen-Doisy test. Allen and Doisy’s 1923 experiment to isolate estrogen showed it was made within the ovaries and also established a method for isolating the sex hormone. That method provided a basis for future research on hormones. Later researchers showed that estrogen functions in the menstrual cycles of primates by signaling for the tissue lining the uterus (endometrium) to thicken in preparation for possible implantation of a fertilized egg.

In the early twentieth century US, Jean Paul Pratt and Edgar Allen conducted clinical experiments on women who had abnormal menstrual cycles. During the clinical tests, researchers injected the hormone estrogen into their patients to alleviate their menstrual ailments, which ranged from irregular cycles to natural menopause. The hormone estrogen plays a prominent role in the menstrual cycle by signaling the tissue lining the uterus (endometrium) to thicken in preparation for possible pregnancy. In their clinical tests, Pratt and Allen showed that injecting estrogen into female human subjects restored their normal menstrual cycle, removed symptoms such as hot flashes, and caused uterine tissue to grow. The clinical tests conducted by Pratt and Allen provided experimental evidence and justification for the injection of isolated estrogen in women to alleviate, for a short amount of time, different menstrual problems, and it contributed to later hormone therapy research.

In 2010, Albert L. Hsu, Izebella Khchikyan, and Pamela Stratton published “Invasive and Non-invasive Methods for the Diagnosis of Endometriosis,” henceforth “Methods for the Diagnosis of Endometriosis,” in Clinical Obstetrics and Gynecology. In the article, the authors describe how specific types of endometriotic lesions appear in the body and evaluate five methods for diagnosing endometriosis. Endometriosis is the growth of endometrium, the tissue that normally lines the inside of the uterus, outside of the uterus. The authors state that although endometriosis impacts many women, the condition is difficult to identify. They identify laparoscopy, an invasive surgical procedure, as the most accurate diagnostic method. By analyzing the effectiveness of available diagnostic methods, the authors help physicians diagnose endometriosis and increase the quality of life for affected women.

Leuprolide acetate, or leuprorelin, is a manufactured drug that has been prescribed as a treatment for endometriosis, a medical condition in which body tissue that typically lines the uterus grows outside of the uterus, since 1989. Leuprorelin is a modified version of a gonadotropin-releasing hormone, a type of hormone that helps regulate the female menstrual cycle. The drug inhibits the production of estrogen, a female sex hormone that enables endometrial gland growth. After two weeks of injections, leuprorelin stops the production of estrogen, and without estrogen, endometrial glands become inactive. That decreases the growth of uterine tissue outside of the uterus, which helps decrease the pain associated with endometriosis. Although physicians commonly prescribe leuprorelin as of 2019, women with endometriosis have reported adverse side effects and health complications.