A debilitating illness often ignored, one in ten women experiences the chronic pain of endometriosis, but for many the symptoms are dismissed. Endometriosis is a disease of adolescents and reproductive-aged women characterised by the presence of endometrial tissue outside the uterine cavity and commonly associated with chronic pelvic pain and infertility.
Endometriosis is an inflammatory chronic pain condition caused by uterine tissue growing outside of the uterus that afflicts at least 11 per cent of women (and people assigned female at birth) worldwide. This condition results in a substantial burden to these women, and society at large.
A major issue is that diagnosis of endometriosis is often delayed because surgery is needed to histologically confirm the diagnosis. This delay increases symptom intensity, the risk of central and peripheral sensitisation and the costs of the disease for the patient and their nation.
Current conservative treatments of presumed endometriosis are pain management and birth control. Both methods are flawed and can be entirely ineffective for the reduction of patient suffering or improving ability to work, and neither addresses the severe infertility issues or higher risk of certain cancers.
Symptoms of Endometriosis: Painful periods, agony during sexual intercourse, discomfort during bowel movements and urination, excessive bleeding, infertility, nausea, bloating and digestion problems that intensifies during menstruation.
Diagnosing endometriosis may take time: Many women suffer through years of painful menstrual periods before they can get an answer about what is causing them: a common and often undiagnosed condition called endometriosis. In some cases, diagnosis of endometriosis is delayed because teenagers and adult women assume that their symptoms are a normal part of menstruation.
Those who do seek help are sometimes dismissed as overreacting to normal menstrual symptoms. In other cases, the condition may be mistaken for other disorders, such as pelvic inflammatory disease or irritable bowel syndrome. A study by the World Endometriosis Research Foundation found that among women ages 18 to 45, there was an average delay of seven years between the first symptoms and the time of diagnosis. Most cases are diagnosed when women are in their 30s or 40s.
Getting relief from endometriosis: While there is no known cure for endometriosis, the good news is that medications, surgery, and lifestyle changes can help you find relief and manage the condition. Your doctor might recommend one or more treatments to help relieve pain and other symptoms. These include:
- Nonsteroidal anti-inflammatory (NSAID) medications. These may be either prescription or over-the-counter formulations, including ibuprofen (Advil, Motrin) and naproxen (Aleve), which are used to relieve pain.
- Hormone therapies: Because endometriosis is driven by hormones, adjusting the hormone levels in your body can sometimes help to reduce pain. Hormone medications are prescribed in different forms, from pills, vaginal rings, and intrauterine devices to injections and nasal sprays. The goal is to modify or halt the monthly egg-releasing cycle that generates much of the pain and other symptoms linked with endometriosis.
- Acupuncture: This is an alternative medicine treatment, which uses small needles applied at specific sites on the body to relieve chronic pain.
- Pelvic floor physical therapy: This practice addresses problems with the pelvic floor, a bowl-shaped group of muscles inside the pelvis that supports the bladder, bowel, rectum, and uterus. Pelvic pain sometimes occurs when muscles of the pelvic floor are too tight, causing muscle irritation and muscular pain, known as myofascial pain. To treat myofascial pain, a specially trained physical therapist uses her hands to perform external and internal manipulations of the pelvic floor muscles. Relaxing contracted and shortened muscles can help alleviate pain in the pelvic floor, just as it would in other muscles in the body.
- Cognitive behavioural therapy: Another way to help manage pain is cognitive behavioural therapy (CBT). Although few studies have looked at the effects of CBT on endometriosis symptoms, it has been used to successfully manage other conditions that cause chronic pain. CBT is based on the idea that healthier thought patterns can help reduce pain and disability, and help people cope with pain more effectively.
- Stress management: Experiencing chronic pain can cause stress, which may heighten sensitivity to pain, creating a vicious cycle. Because stress can make pain worse, stress management is a vital component of endometriosis management.
- Lifestyle improvements: Maintaining a regular exercise programme, a healthy sleep schedule, and a healthful, balanced diet can help you better cope with and manage stress related to your endometriosis.
- Surgery: Your doctor may recommend surgery to remove or destroy abnormal tissue growth, to help improve your quality of life or your chances of getting pregnant. Some studies have shown that removing growths of abnormal tissue and scar tissue caused by mild to moderate endometriosis can increase the likelihood of getting pregnant.
You are the first one who realises that something is going wrong with your body system, so speak out. Help is on hand. First, speak to your general practitioner – they can refer you to a gynaecologist. It may help to write down your symptoms. If you have severe endometriosis, you may be referred to an endometriosis centre with specialist nurses, surgeons, and teams of other specialists to look after you.
Support is also available. There is a national charity which works to increase the understanding of the condition through campaigning, awareness-raising initiatives and research. It offers a wide range of advice and support through a helpline, information leaflets and support groups. The Royal College of Obstetricians and Gynaecologists (RCOG) is also dedicated to raising awareness of the condition among general practitioners, other healthcare professionals and the public to ensure women receive the best possible care.
(The writer is an obstetrics and gynaecologist surgeon. She is also a senior counsellor of Army Wives Welfare Association)
