Ever wonder why it seems like your period is worse than your friends’ or family members’? Why is it so much easier for others to deal with that time of the month? Does your period make you miss out on school, sports, career, relationships or social events? You could be living with endometriosis. Learn more about the condition from our friends at The Endometriosis Foundation of America.
Endometriosis is a progressive chronic pain condition that usually gets worse over time. If treated early, however, endometriosis symptoms can be managed.
This means that often the pain can be managed and the growth can be slowed down. How this is done (if it can be done) varies patient to patient since endometriosis expresses itself quite differently in every body. There is no cure for endometriosis, but there are a number of ways one can treat their symptoms and reduce their daily pain.
There are several treatment paths for endometriosis, both surgical and non-surgical options. It will be important for your doctor to explain the pros and cons of all options. An informed decision should be made, with your doctor’s guidance, based on your personal situation.
This type of treatment is considered to be the gold standard of endometriosis treatment. It most often will provide long-term relief from symptoms, help correct pelvic abnormalities, and may even improve fertility. This procedure can be used to diagnose and treat the disease. Endometriosis acts like an iceberg, where the disease is both above the surface and in the tissue below. Excision surgery removes the disease both above and below the surface. This is why it is considered the gold standard treatment for endometriosis.
Ablation/ cauterization/ fulguration/ vaporization
While it may be an option, these types of treatments have been found to be ineffective for long-term management of endometriosis. These treatments only remove the tissue on the surface, but neglect the tissue growing beneath. Additionally, issue is removed through a burning technique, which may end up building more scar tissue on the affected area, leading to more pain.
Hysterectomies have been shown to work very well for some women, while causing more issues for others. Since endometriosis begins in the female reproductive system removing the uterus seems like a logical approach and some have found relief from this process. However, endometriosis thrives off estrogen, a hormone produced by the ovaries, and since the disease can travel, removal of the uterus is not a guaranteed fix. If you simply remove the uterus and do not excise the remaining endometrial tissue from other areas, the patient may continue to have pain.
(Ablation, cauterization, fulguration, vaporization and hysterectomy are not recommended treatments by the Endometriosis Foundation of America.)
Endometriosis lesions respond to hormones such as estrogen. Hormone therapies have been developed to stop estrogen secretion, suppress menstruation, and mimic menopause.
GnRH-A (Gonadotropin Releasing Hormone Agonists) is a group of drugs that are modified versions of gonadotropin-releasing hormone. Gonadotropin-releasing hormone is a naturally occurring hormone that aids in the control of the menstrual cycle. GnRH-A is to be used with add-back medications. Add-back medications help to reduce/prevent side effects. It is taken at the same time as the GnRH-A. If your doctor does not mention add-back medication, you should ask about it. There are several types of GnRH-A drugs- Lupron®, Zoladex®, Synarel® and Suprefact®. You should talk to your doctor about which type is best for you.
Aromatase Inhibitors (AIs) are a relatively new group of drugs for the treatment of endometriosis, but has been used to treat post-menopausal women with breast cancer for over a decade. It suppresses estrogen levels in the ovaries as well as fat tissues and possibly even within the endometriosis implants. AIs are to be used with add-back medications. There are several types of AIs- Anastrozole® and Letrozole®
Progestin Therapy artificially creates the progesterone hormone. Progestin will help to shrink endometriosis lesions and reduce pain. There are 3 types of progestin therapy- oral, injection, and intrauterine device (IUD).
Birth control can help to provide symptom relief from endometriosis. Compared to other treatments, oral contraceptives are relatively inexpensive and can be taken safely for years. There are two types of oral contraceptives – continuous/extended oral contraceptives and cyclic oral contraceptives. Continuous/extended oral contraceptives have an extended number of active pills or no inactive pills. Cyclic oral contraceptives have a certain number of active and inactive pills.
Painkillers such as aspirin, Tylenol, and narcotic pain medications like Codeine, Vicodin and Percocet can help to reduce pain and symptoms, but do not remove or treat the disease.
Diet and Nutrition
Healthy nutrition has been found to have a strong connection with endometriosis. Many patients with endometriosis have food allergies like gluten and lactose. Avoiding certain foods, increasing intake of fruits and vegetables, and exercising, may lead to an improvement in hormonal balance and deficiencies. In some patients, symptoms of endometriosis may be reduced as well. There are a number of blogs and books with information on how to eat properly to reduce your endometriosis. While many women have found this approach effective it is important to keep in mind that a diet change is not a medical solution.
Alternative therapies are typically non-traditional methods. They can include the use of herbal medicines, acupuncture, exercise, transcutaneous electrical nerve stimulation (TENS), shiatsu, biofeedback, homeopathic therapy, osteopathy, and naturopathy.
It is important to remember that there is no cure for endometriosis, and that everyone’s treatment plan looks different. What may work for one woman may not work for the other, so it is important to pay close attention to your symptoms and what does or does not exacerbate them.
Living with a chronic pain condition can be overwhelming, but please remember that you are not alone. You can find support groups online and maybe even in your hometown. A quick Facebook or Twitter search of “endometriosis” will connect you to an entire online community who will understand your daily struggles, frustrations, and concerns. Each patient must find what works best for her when learning to live with endometriosis. Finding the right specialist and taking time to listen to and rest your body are a great place to start!
Artwork by endo warrior Jenny Oh