Twenty years ago, very few people had even heard of endometriosis.
Today, we know this inflammatory disease affects around 1 in 10 women during their reproductive years. That’s more than 175 million women worldwide.
A lot more is now known about this physically and emotionally debilitating disorder.
Currently, there’s no cure for endometriosis. Fortunately, though, there are treatment options.
Let’s take a look at what this inflammatory disorder is and how to access treatment for it.
What is endometriosis?
Endometriosis affects women of childbearing age. It’s an inflammatory condition, caused by endometrial-like tissue that grows outside the uterus, on pelvic organs. This tissue is described as endometriosis lesions.
The tissue resembles the normal endometrium or the lining of the uterus. The lining is composed of blood and tissue. It nourishes a baby during pregnancy or is expelled through the vagina during your period.
Tissue growth can be found on pelvic organs such as the bladder, bowel, uterus, ovaries, and intestines. Less commonly, it’s been found on organs outside of the pelvis such as the lungs, heart, and brain.
The tissue becomes inflamed throughout the monthly menstrual cycle. This is caused by fluctuating hormones levels during the cycle.
The inflammation causes severe pelvic pain and other symptoms. The pain can also be caused when lesions attach to other organs.
Research has shown certain genetic markers predispose women to develop endo. It’s more likely to occur in women who have a family member with the condition.
The exact cause of endometriosis hasn’t yet been found, but there are ways to prevent it from getting worse.
What are the symptoms of endometriosis?
It is normal and common for most women to experience mild discomfort during a period. This is due to the uterus contracting to shed and expel the lining. Certain hormones called prostaglandins which are involved in pain and inflammation trigger these contractions.
Contrary to popular belief, severe pain during menstruation isn’t normal. Severe pain with menstruation is the most common symptom of endometriosis.
If your periods are interfering with your daily life, this is something you should talk about with your doctor.
Find out more about what’s normal during menstrual periods and what’s not by reading Period Pain and PMS – 5 Things Every Woman Needs To Know.
Other endometriosis symptoms might include:
- Pain during or after sex
- Chronic pelvic pain
- Ovulatory pain
- Painful bowel movements
- Pain with urination
- Chronic fatigue
- Bloated, pregnant looking belly (endobelly)
- Shooting vaginal pain
- Rectal pain
- Heavy menstrual flow
- Dark, clotting menstrual blood
- Mood swings.
How is endometriosis diagnosed?
It’s not exactly easy to diagnose endometriosis. On average, it takes about 7 years for women to get an endometriosis diagnosis.
Why? There are several reasons.
Symptoms very closely mimic other disorders such as Irritable Bowel Syndrome. Women have also been misdiagnosed with interstitial cystitis or urinary tract disorders instead of endo.
There is only a small number of physicians who actually specialize in endometriosis. Many doctors are unfamiliar with the disease. This makes it difficult for them to recognize the symptoms.
Due to this unfamiliarity with the condition, a doctor might not believe or understand the severity of the pain. This also leads to misdiagnosis.
According to the American College of Obstetricians and Gynecologists, the gold standard of diagnosing endometriosis is laparoscopic surgery with biopsy.
The Royal College of Obstetricians and Gynaecologists agrees with this recommendation.
According to both health organizations, endometriosis cannot be diagnosed simply through imaging. Neither can it be diagnosed through a pelvic exam or blood tests.
It’s sometimes possible, on imaging, to see endo that’s deeply embedded in organs or ligaments. It’s also possible for there to be signs indicating endo on a pelvic exam.
These things might point toward endometriosis. Without laparoscopic surgery, though, there can be no definitive diagnosis.
Laparoscopy is a procedure in which one or more small incisions are made near the belly button and on the abdomen. A small scope is then used to visualize endometriosis patches of tissue in the pelvic cavity.
A biopsy can be taken of the tissue, and then sent to the lab for a diagnosis.
What is the treatment for endometriosis?
While there is no known cause of endometriosis and no cure, there are ways to treat endometriosis symptoms.
Options to treat endometriosis include natural and holistic treatment, hormone therapy, and surgery.
Some women with endometriosis may choose to take the surgery route. Excision surgery is the gold standard endometriosis treatment.
Surgery isn’t right for everyone; some women choose to natural treatments. Most often though, a combination of surgery and natural treatment is most effective.
Endometriosis treatment options
Let’s dive deeper into some of the other treatment options, and ways to manage the symptoms of endometriosis.
- NSAIDs – anti-inflammatory, over the counter pain medications
- Excision surgery – removal of adhesions and lesions, with a 10-50% recurrence rate within 12 months
- Ablation surgery –This option is no longer recommended; it involves lasering the adhesions or lesions. There is a high recurrence rate and risk of further scar tissue
- Birth control – This suppresses ovulatory hormones and the hormone estrogen
- Gonadotropin-releasing hormone agonists – hormone suppression, which induces menopause, and risks bone loss
- Gonadotropin-releasing hormone antagonists – They suppresses estrogen production, suspending ovulation
- Danazol – hormone suppression, which induces chemical menopause and has associated risks
- Hysterectomy surgery – This is not a cure, as endo is often outside the uterus.
Endometriosis pain treatment
The most commonly used treatments for immediate pain relief are nonsteroidal anti-inflammatory drugs (NSAIDs).
The most common NSAIDs recommended by doctors for endometriosis pain are ibuprofen and naproxen sodium. These medications reduce inflammation and relieve pain.
Many women report temporary relief, but most still report pain after using these medications.
It’s common for NSAIDs to be overused for these disorders. It’s also important to note NSAIDs carry some side effects, especially with long-term use.
Some common side effects are:
- Decreased appetite.
Long term use can sometimes cause:
- Kidney failure
- Liver failure
- Bleeding or clotting problems or disorders
It’s important to discuss the use of NSAIDs with your doctor. They are not a permanent treatment for pain.
Other treatments, such as natural treatments or surgery, are more long-term and carry fewer side effects.
Endometriosis treatment surgery
In the past, the only surgery solution was ablation surgery, or lasering the lesions. This surgery has a recurrence rate of up to 80%. It can also increase the risk of causing more scar tissue.
Excision surgery has now replaced ablation in endometriosis treatment options. It offers better relief with a lower chance of recurrence.
Endometriosis usually recurs because only the symptoms are treated.
Surgery can relieve pain but it doesn’t get to the root of the problem. If the cause isn’t addressed, chances of long-term symptom management with surgery are slim.
Endometriosis treatment hysterectomy
Hysterectomy isn’t a cure. Unfortunately, doctors who don’t fully understand the disease recommend it all the time.
In the days when it was believed the uterine lining was the cause, hysterectomy might have made more sense.
We now know the uterus does not cause endo, so removing the uterus only removes menstrual cycle pain. It doesn’t get to the root cause, neither does it relieve other symptoms of endo.
Hysterectomy can have long-term effects on your health. Always do proper research on the risks and benefits before making this decision.
Endometriosis treatment diet
The increasing level of hormones in our food and the products we use hasn’t helped the number of endo cases.
A diet high in gluten and sugar results in increased levels of insulin, which leads to inflammation. This further fuels the endo problem.
There are all sorts of diets that are claimed to be cures for endo.
Research shows an anti-inflammatory diet can help reduce the severity of symptoms. This diet involves restricting gluten, carbs and sugars, and increasing protein.
Endo is believed to be exacerbated by estrogen. Therefore, lowering estrogen levels and helping your body metabolize it better can help reduce the inflammation.
You should also remove food allergens that cause inflammation – things such as wheat, gluten, soy, and sometimes dairy. Soy is known to have estrogenic properties and would be best to avoid.
Alcohol, caffeine, and nicotine also create inflammation in the body.
Eating only organic and non-GMO foods will help reduce estrogen and inflammation.
Conventional produce is known for its treatment with pesticides, and non-organic meats are loaded with hormones. Eating non-organic foods will certainly contribute to inflammation.
Some foods that can reduce inflammation and metabolize estrogen are:
- Brussel sprouts
- Collard greens
Increasing protein intake, as well as consuming essential fatty acids, can also help to balance and metabolize hormones. Salmon, nuts, seeds, avocado, coconut oil are all excellent sources of essential fatty acids.
Hormone treatment for endometriosis
Some of the treatments for endometriosis include hormone therapy. This can be in the form of birth control pills, injections, implants, or IUDs.
Birth control should be progestin-based for women with endo, since estrogen should be avoided.
Higher levels of progesterone throughout the cycle convince the body not to ovulate. This suppresses ovulatory hormones and reduces estrogen production from the ovaries.
This can help to reduce inflammation. It isn’t a cure, however, and must be followed up with more long-term treatment, such as excision, diet, and lifestyle changes.
Birth control isn’t to be confused with GHRH agonists and antagonists such as Depot Lupron, Orlissa, or Oriahnn.
These medications actually stimulate or suppress the pituitary gland in the brain and induce menopause. They don’t contain hormones.
Treating endometriosis without birth control pills
Since endo is exacerbated by estrogen, helping the body to metabolize it naturally is one way.
Avoiding an overabundance of estrogen is another way. This helps reduce inflammation of the lesions.
Let’s look further into what this might look like.
Endometriosis – natural treatment
We know excess estrogen can lead to endo inflammation. This is due to excess estrogen in foods and also in our environment.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists guidelines for treating endometriosis include acupuncture and Traditional Chinese Medicine as a recommended therapy.
Many women have seen substantial reduction in symptoms from these types of treatment.
Endometriosis treatment for fertility
Of the women who suffer with endometriosis, 30-50% of them will also struggle with infertility.
There are a few ways in which endometriosis affects fertility.
It’s believed the adhesions distort pelvic organs, such as the ovaries and fallopian tubes.
This distortion can prevent an egg from being released from the ovary. Or perhaps an egg is released, but the fallopian tubes have difficulty receiving the egg.
There could also be adhesions on the fallopian tubes, causing them to be blocked. This prevents the sperm and egg from meeting.
Lesions and adhesions on the uterus can also distort it physically. This can interfere with implantation or the ability to hold the pregnancy.
Endometriosis treatment options such as surgery and natural treatments can also treat the fertility problems. Assisted reproduction methods such as IVF and IUI might also be an option.
Be sure to read IVF and Infertility – Causes, Risk, and IVF Success for more on IVF treatment.
What is the best treatment for endometriosis?
The real solution for women with endometriosis is a combined approach.
This includes excision surgery, natural remedies, diet, and lifestyle changes, as well as mindfulness for a better quality of life.