Endometriosis

It is estimated that about 10 out of every 100 reproductive-aged women are living with endometriosis. Endometriosis can develop at any time between when a woman starts having periods right up until the menopause and her periods stop.

 Understanding endometriosis

Each month the uterus prepares for pregnancy and an egg is released from the ovary.  If the egg is not fertilised by a sperm the lining of the uterus (called the endometrium) is not needed. 

Hormones start to change in the body and the current lining of the uterus breaks down.  The lining of the uterus passes out through the vagina as a bleed or period.  These periods are an essential part of a woman's fertility.

If bits of the endometrium occur outside of the uterus they are known as endometrial implants and it is these that react to the monthly hormonal changes and cause endometriosis. 

It is not known why in some women endometrial implants occur outside the uterus but when these are stimulated to grow, shed and bleed as they do inside the uterus, pain and inflammation can occur.

Identifying the symptoms of endometriosis

It is possible to have endometriosis without any symptoms but most women will experience at least some of the following symptoms
 
·         Very heavy periods
·         Spotting or bleeding between periods
·         Very painful periods with cramps that are so severe they can  limit normal activities
·         Pain when passing urine and on bowel movements during the period
·         These painful periods may get worse over the years
·         Pain during intercourse
·         Pain inserting and removing tampons
·         Long-term lower back or abdominal pain
·         Infertility.  If you have been having regular unprotected sex for over twelve months and have failed to get pregnant, you may have endometriosis. 
·         Endometriosis is the third most common cause of infertility.
 

Diagnosing endometriosis

If you visit your doctor with some of these symptoms it is likely that you will need further physical examinations and tests to diagnose endometriosis. 

You may be referred for an ultrasound scan or more details MRI (magnetic resonance imaging) or you may be advised to have a laparoscopy. 

This is the most reliable way of diagnosing endometriosis as a small camera is passed through the abdomen into the pelvic region to have a good look around and possibly take a small sample of the tissue for analysis in a laboratory to see if the tissue outside the uterus is endometrial tissue.
 

Treatment for endometriosis
 
Unfortunately although endometriosis can be treated it cannot be cured.  The treatment therefore concentrates on trying to control the symptoms. 

Because endometriosis is linked to menstrual periods the symptoms tend to be better controlled during pregnancy or after the menopause when a woman no longer has periods. 

The treatment aims to utilise hormones via tablets or injections to trick the body into a pregnancy like state and therefore avoid periods altogether.

The right treatment for you will depend on the severity of your symptoms and what works for you!  These are the treatments for period pains that may help endometriosis.

Warmth is usually a good start for milder pains.  Either a soak in the bath or a hot water bottle (but be careful not to burn yourself they can get really hot!!).  Curling up in bed with a cuppa and a good book can help you to relax and get some rest.

Though you may not really feel like it some exercise can help your body to release its own pain relieving chemicals and give you a feeling of well being.  Swimming, cycling or any aerobic exercise can help.  Even walking can ease the symptoms for some.

Try eating little and often and avoid big meals or getting really hungry. Eating fruit and vegetables and pasta and avoiding too much sugar, alcohol and caffeine may help.  Caffeine may make you more irritable and tense. 

Alcohol is a depressant and can make you feel more depressed though on the other hand it can have a relaxing and calming effect which some may find helpful.

Blood is lost during a period and this can contribute to some women can becoming anaemic.  The symptoms of anaemia are tiredness and weakness and in severe cases breathlessness and dizziness. 

Eating a diet rich in iron will help those susceptible to anaemia.  Red meat, fish, pulses and red wine are all good sources of iron.

Cutting down on your salt intake is important at any time but just before your period reducing the amount of salt you have will help stop fluid retention.

Gently massaging your lower tummy or asking someone else to carefully massage your lower back may reduce the pain.

Try to relax! Stress can make any pain more difficult to cope with.  Meditation, yoga or maybe just getting into a good film can help you relax and feel you can cope with the pain.  Some people find that lavender helps them to relax but be careful as lavender can cause headaches in some people.

Drink plenty of water to stop you becoming bloated!  If you drink plenty of water your body doesn’t feel the need the hang onto it at all costs and just passes the majority through your system.

Sex either on your own or with a partner can help to ease the pain!  An orgasm will help your cramping muscles to relax and will release lots of feel good and relaxing chemicals into your body.

Advice and managing period pain.

If these more simple methods don’t help then go and talk to your doctor.

Your own doctor will be able to advise you on which painkillers will be the most appropriate and beneficial for you.   You should always get persistent pain checked out by your doctor and then you are sure that you have primary dysmenorrhoea and not another more serious condition such as endometriosis.

Paracetamol may help milder pain, though aspirin or a non-steroidal anti-inflammatory drug (NSAIDs) such, as ibuprofen are generally more effective as they are said to have anti-prostaglandin effects.  (Remember the higher your level of the prostaglandin hormone, the higher the level of pain usually felt). 

The anti-inflammatory effect of ibuprofen may reduce the amount of bleeding.   The tablets tend to be more affective if taken throughout the day (as directed on the packet) rather than just when the pain gets bad.

You should always check with the pharmacist that an ‘over the counter’ medication is right for you as there are people who should not take ibuprofen.

Although there isn’t much proof, there is a lot written about the benefits of certain vitamins to help period pain.   Vitamin b6, vitamin e and magnesium are said to help but if taken incorrectly can produce side effects. 

Again always check with your doctor…don’t assume that all vitamins are safe ‘complementary’ type treatments, they are tablets and you should always be properly advised by your doctor who knows your medical history.

Calcium supplements/tablets have been found to reduce water retention and help period pain.  Calcium is also very important to maintain our bone density and so ask your doctor if you can take calcium.

Transcutaneous electronic nerves stimulation or TENS uses electrical stimulation to encourage your body to release its own pain relieving chemicals and the sensation of the tingling under the pads placed over the pain helps distract the brain from feeling the pain.  

TENS can be bought from most pharmacies now and are re usable so each month you can use the TENS.  (Though you will have to replace the sticky pads from time to time)  a TENS unit is very small and can be worn under your clothes whilst you are out and about.

Ask the pharmacist or your doctor if a TENS is safe for you to use and then always follow the instructions.

If you are still troubled with severe period pain your doctor may prescribe the birth control or contraceptive pill because as well as preventing pregnancy it may relieve period pain.  The contraceptive pill reduces the level of prostaglandin released by thinning the lining of the uterus, thus making the period less painful and reducing the amount of bleeding.

Your doctor can also prescribe stronger painkillers and anti inflammatory tablets than are available at the chemist but these should only be taken in extreme cases and for short periods of time.

Advice period pain.  Period pain tends to improve with age.  The nerve endings that detect the pain in the uterus degenerate over time.  During the latter part of pregnancy the nerves disappear and following pregnancy only some of the nerves will regenerate.

Endometriosis and infertility

It is still unknown exactly why endometriosis can cause infertility.  There are many different theories as to whether it affects the uterus lining preventing the egg implanting or whether it interferes with the transporting of the egg from the ovary to the uterus or whether it actually affects the egg itself.  Sometimes surgery to remove the endometrial implants helps but for other women IVF (in-vitro fertilization) is required.
 

In conclusion
 
Endometriosis is a condition that can vary widely from woman to woman.  In some, the symptoms are severe and other problems such as infertility can happen as a result.