Treating the pain of endometriosis

Many women suffer through years of painful menstrual periods before they are able to get an answer about what’s causing them: a common and often undiagnosed condition called endometriosis.

What is endometriosis?

Endometriosis is a condition that occurs when tissue much like the tissue that lines a woman’s uterus — called the endometrium — starts to grow in other places inside the body. Most commonly, these growths are within the pelvis, such as on the ovaries, the fallopian tubes, the outer surface of the uterus, or the bladder.

During the menstrual cycle each month, the tissue lining the uterus grows thicker, then breaks down as blood that exits through the vagina. The wayward tissue growths of endometriosis respond to the same hormones as the uterine lining. But instead of draining through the vagina as a menstrual period, blood from tissue growth elsewhere in the body has nowhere to go. It pools around nearby organs and tissues, irritating and inflaming them, and sometimes causing scarring. In addition to pain, endometriosis can cause other symptoms, such as bowel- and bladder-related problems, heavy periods, sexual discomfort, and infertility.

Diagnosing endometriosis may take time

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. The problem of getting an accurate diagnosis and treatment is worse for some minority groups, including people of color and indigenous people, according to the Endometriosis Foundation of America.

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 behavioral therapy. Another option to help manage pain is cognitive behavioral 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 an important component of endometriosis management.
  • Lifestyle improvements. Maintaining a regular exercise program, 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.

Ultimately, it may take time to find the right combination of treatments to ease pain and manage this condition. But working closely with your doctor makes it more likely that you will be able to do so.

Related Information: Help for Endometriosis

Comments:

  1. Alison S.

    Hi. Thank you for your interest and general information about endometriosis. Getting the word out about endometriosis is super important.

    As a person who both suffers from and has studied endometriosis independently (after going through pre-med at UTEP, etc), there are some important developments that get overlooked.

    1. Endometriosis can only be diagnosed through a laparoscopy.
    2. The only effective treatment is to remove the lesions and treat any associated adhesions.
    3. Endometriosis is a mutagenic lesion unrelated to uterine tissue. Most women who have mutagenic endometriosis lesions have a normal uterine lining.
    4. Endometriosis lesions develop their own blood supply and (pain) nerve connections, which is why the disorder is so painful, even with few lesions.
    5. Endometriosis is a serious disorder that can cause disabling pain, bowel adhesions, pelvic floor disorder and infertility.
    6. Endometriosis is associated with a higher risk for reproductive cancers, especially ovarian cancer through endometriomas.

    I was diagnosed with endometriosis when I was 20 because of the disabling pain, including migraines, and anemia related to heavy bleeding. The doctors did “extensive work” on my intestines. Same thing when I was 27 (2013), plus an excision of endometriosis on an ovary. The next year, I had a dermatoid cyst removed. And two years later, in 2016, when I was 30, I had a hysterectomy because endometriosis had impacted my uterus. I had a cancer scare because of a suspected endometrioma recently. I need another surgery due to bowel adhesions and other complications.

    Nothing cures this disease and nothing adequately treats it. I have so many friends who have lost their careers, lives and family to this disease. And many more who have lost hope.

    The experts call it an “enigma,” but this is an inheritable disease that is caused by a genetic, mutagenic disorder that results in abnormal, benign tumors growing in the abdomen. The medical community has been familiar with endometriosis for over 200 years, and it is a travesty that so little has been done to research this disabling “female” disorder.

    So I mean it when I say I really appreciate your article. Any publicity that is generally truthful about endometriosis is a step forward in gaining recognition by the medical community.

Commenting has been closed for this post.