Endometriosis

Note: Endometriosis is a condition connected to the menstrual cycle and one worth ruling out if you are experiencing severe period pain, or heavy bleeding.

The information shared here is taken from the Endometriosis UK website [1], please contact them directly for further information, or if you have any questions or comments: www.endometriosis-uk.org

Endometriosis (pronounced en-doh–mee–tree–oh–sis) is the name given to the condition where cells like the ones in the lining of the womb (uterus) are found elsewhere in the body. Each month these cells react in the same way to those in the womb, building up and then breaking down and bleeding. Unlike the cells in the womb that leave the body as a period, this blood has no way to escape.

Because endometriosis manifests itself in a variety of ways and shares symptoms with other conditions, diagnosis can be difficult and often delayed. Recent research shows that there is now an average of 7.5 years between women first seeing a doctor about their symptoms and receiving a firm diagnosis. Scans, blood tests and internal examinations are not a conclusive way to diagnose endometriosis and a normal scan, blood test and internal examination does not mean that you do not have endometriosis.

The only definitive way to diagnose endometriosis is by a laparoscopy – an operation in which a camera (a laparoscope) is inserted into the pelvis via a small cut near the navel. The surgeon uses the camera to see the pelvic organs and look for any signs of endometriosis. If endometriosis is diagnosed, the endometriosis may be treated or removed for further examination during the laparoscopy.

Main symptoms: Extremely painful or heavy periods. It may also lead to infertility, fatigue, bowel (constipation, bloating, diarrhoea), and bladder problems.

Endometriosis can be chronic and debilitating, and most medical treatments carry side effects. However, there are ways of managing symptoms and the disease. It is important that you have a good relationship with your GP and your specialist so that you can discuss the different treatment options, and decide which one is right for you personally.

Check out this fact sheet [2] about getting diagnosis for endometriosis…

Remember: it is your body. Always ask about the benefits of any treatment – either medical or surgical – and the side effects and risks of that treatment. We do not recommend any particular treatment for endometriosis, but support patients seeking treatment options appropriate to their individual circumstances.

The options are:

Surgery
Hormone treatment
Pain management
Nutrition
Complementary therapies
Emotional support

TOP TIP! Some myths still exist about treatment: Pregnancy and hysterectomy are not ‘cures’ for endometriosis.

Non medication-based interventions:

1. Transcutaneous Electrical Nerve Stimulator (TENS) machines are small, unobtrusive machines with electrodes that attach to the skin and send electrical pulses into the body. The electrical pulses are thought to work by either blocking the pain messages as they travel through the nerves or by helping the body produce endorphins which are natural pain-fighters. Some TENS machines can be clipped to a belt. Check with your GP before using a TENS machine as they are not suitable for those who have a heart condition.

2. Physiotherapists can develop a programme of exercise and relaxation techniques designed to help strengthen pelvic floor muscles, reduce pain, and manage stress and anxiety. After surgery, rehabilitation in the form of gentle exercises, yoga, or Pilates can help the body get back into shape by strengthening compromised abdominal and back muscles.

3. Pain clinics and Expert Patient Programmes – usually involve a team approach to manage not only the pain itself, but also factors such as anxiety, depression and quality of sleep – all of which can affect how we feel pain. A comprehensive pain treatment plan may include medications, injections, counselling, exercise programmes and other treatments.

4. Acupuncture may be beneficial for the treatment of pain. An acupuncturist inserts needles into certain points on your body to stimulate nerve endings and release endorphins (that have pain relieving qualities). Acupuncture also aims to break up ‘stuck’ blood, which would reduce the pain.

5. There has been quite a lot of research into diet and endometriosis, which suggests that avoiding certain foods and eating more of others, may stop endometriosis from developing and /or reduce symptoms – including pain. We recommend the book ‘Endometriosis – A key to healing through nutrition’ by Dian Shepperson Mills and Michael Vernon.

6. We recognise that some complementary therapies may be beneficial in controlling the symptoms of endometriosis. However, in the absence of evidence based on clinical trials, we cannot endorse claims that such therapies control the disease itself. It is important to follow the advice of a registered practitioner. Always consult your GP before you try a complementary therapy.

Medication-based interventions:

For full details please see the Endometriosis UK treatment fact sheet.

1. Superior hypogastric block– an injection of local anaesthetic and steroid around the sympathetic nerves which supply the organs of the pelvis. These nerves are located on either side of the spine in the lower abdomen. This is to stop the patient feeling pain in the pelvic area.

2. Surgery can be used to alleviate pain by removing endometriosis, dividing adhesions or removing cysts. A hysterectomy could also relieve painful symptoms, but only those caused by the removed organs. With laparoscopic surgery, different rates are reported, but studies suggest a 62.5% improvement or resolution of pain at 6 months, with 55% still improved at 12 months. Failure to respond to surgical treatment may be due to incomplete removal or destruction of the disease, or because of recurrence.

3. Antidepressants – mainly Amitriptyline – can be used for chronic pain, in a lower dose than for the treatment of depression. They have been found to have an effect on the nervous system and the way the body manages pain. The pain messages travel through the body’s central nervous system, but these drugs can help to stop those messages from reaching the brain. Other drugs used include anti-epileptic drugs (gabapentin and pregabalin), which work on the neurons to reduce pain signals.

4. Hormonal medications– These are used to act on the endometriosis and stop its growth. They either put the patient into a pseudo-pregnancy or pseudo-menopause. (Pseudo means simulated or artificial – both states are reversed when the patient has stopped taking the hormones.)