Imagine a painful, invisible disorder that strikes once a month (if not more often). Only women are afflicted by this condition (over one and a half billion worldwide) with the potential to affect their fertility. Now imagine that many women do not seek treatment or receive any care for this invisible illness, suffering in silence and endangering their ability to have children (much less live a pain-free life!). While abdominal pain can have many different causes, endometriosis is a gender-specific type of chronic pain that affects between 2% to 10% of women in the U.S. If you or someone you love suffers from endometriosis, here is your guide to endometriosis pain treatment.
What does endometriosis feel like?
One of the challenges when dealing with endometriosis pain is how varied the pain can be. Endometriosis occurs when the endometrium – the lining of the uterus – grows on other organs outside of the uterus. This endometrium behaves outside the uterus just as it would inside, getting thicker as a woman’s menstrual cycle progresses and shedding itself when her period starts.
When blood touches organs inside the abdomen, inflammation and irritation result, causing pain. Over time, scar tissue develops from the endometriosis (sometimes referred to as lesions). These also contribute to endometriosis pain.
Endometriosis pain is unique to each woman who experiences it. Some women only have pain around the time of their period, while others experience nearly constant pain all month long. The type of pain can be sharp and stabbing. Sometimes it feels like electrical shocks or burning in the abdomen.
Some women report feeling dull or achy, experiencing lower back pain in addition to abdominal pain. Abdominal swelling (or a feeling of fullness) can create pressure on the bladder and bowels, resulting in painful urination or bowel movements.
Endometriosis pain can also affect the sciatic nerve. This longest nerve in the body originates in the lower back and wraps around the buttocks and side of the hip before diving down the legs, all the way to the top of the foot. This pain can be burning and searing as well, eventually causing a “pins and needles” feeling or numbness in the toes and feet.
What causes endometriosis pain?
The exact cause of endometriosis is not certain. In some women, retrograde menstruation may contribute. This occurs when menstrual flow reverses direction, moving back into the fallopian tubes instead of through the vagina.
Other possible endometriosis causes include:
- Ineffective immune system: A woman’s immune system fails to destroy endometrium that migrates to the outside of the uterus
- Change in cell type: Cells in the pelvic area change into endometrial cells in a process called coelomic metaplasia
- In utero factors: Endometrial cells form outside of the developing uterus before birth
- Excess of a prostaglandin called PGE2: Hormone-like chemicals that can, in excess, cause inflammation and contract muscles
- Excessive levels of estrogen: This can cause thickening of the endometrium
A family history of endometriosis seems to contribute to the development of this disorder. Although endometriosis pain can affect any woman of reproductive age, older women who have no had children are at a higher risk, as are women who have early menstruation (before the age of 11).
Very heavy periods on a shorter cycle (less than 27 days) seem to be common among women with endometriosis pain.
What are the first signs of endometriosis?
Unfortunately, the first signs of endometriosis are often written off by both doctor and patient as just a “bad period.”
Heavy periods with cramping and back pain that starts several days before your period and continues through and past menstruation are often the first endometriosis symptoms that women experience. Because these can also occur with normal menstrual periods, many women will ignore these symptoms until others begin to appear.
What are the major endometriosis symptoms?
Endometriosis lesions can be located not only in the reproductive organs but also in several different places in the abdomen. These include the:
- Fallopian tubes
- Rectovaginal septum
In addition to the endometriosis symptoms first experienced, other symptoms can begin to present themselves as the condition progresses. These include:
- Diarrhea or constipation
- Heavy, long-lasting menstrual flow
- Painful sexual intercourse
- Painful urination and bowel movements
- Pelvic pain (different from abdominal pain)
- Infertility or difficulty becoming pregnant
Women may experience mild or severe endometriosis pain that can change as their menstrual cycle progresses.
How to diagnose endometriosis
The average delay of diagnosis for endometriosis is just over nine years, with many patients not even seeking help for four or more years after symptoms arise. Sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts, endometriosis pain is not often the first thought in diagnosis. It shares some symptoms with irritable bowel syndrome (IBS), too. Indeed, IBS is sometimes comorbid with endometriosis, further complicating the diagnosis.
The first step towards endometriosis pain relief is working with a doctor who trusts you, believes you, and is committed to working with you to help get an accurate diagnosis.
Common diagnostic tools include:
- Pelvic exam
- Blood tests (to rule out other conditions)
Together with a thorough patient history, these tools can help you get a timely and accurate diagnosis.
8 endometriosis pain treatment options
Here are eight of the most common endometriosis pain treatment options:
- Dietary changes
- Alternative medicine
- Acute pain care
- Anti-inflammatory medications
- Hormone therapies
- Laparoscopic surgery
Obviously, some of these are much more invasive than others. What works for you will depend on the severity of your symptoms and other factors. Let’s look at each of these in more detail.
1. Dietary changes
You may feel cravings for salt, fat, and sugar as your period approaches, but it is important to note that all of these can increase inflammation in the body. Sugar especially contributes to not only inflammation but also unhealthy spikes in blood sugar that can leave you feeling even more wiped out.
Maintaining a healthy, anti-inflammatory diet that adds tons of fresh fruit and vegetables plus healthy whole grains and lean meats will help you feel your best. If your endometriosis comes with irritable bowel syndrome, a diet that helps to heal the gut can improve symptoms as well.
Exercise is a proven stress-reliever that can improve your mental and physical outlook. During your most painful days, you need not incorporate a strenuous workout, but gentle stretches and even yogic breathing can help release endorphins to decrease pain.
Some women swear by the meditative, pain-relieving effects of yoga, while others find pain relief in a swimming pool. Whatever you choose, some amount of daily movement is crucial to a successful treatment plan.
3. Alternative medicine
From chiropractic care to maintain the mobility and stability of the spine to acupuncture to clear your meridians, alternative medicine has many different treatments to help relieve endometriosis pain.
When used in conjunction with other treatments, these types of complementary alternative medical treatments can ease pain without side effects.
4. Acute pain care
Acute pain care is simply taking time to care for your body during your most painful flareups.
Some women find tremendous relief with a heating pad and a few days of rest. Others might find warm baths – with or without essential oils for endometriosis – soothing. Your doctor can recommend other pain care treatments, depending on the severity of your pain.
5. Anti-inflammatory medications
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) can be very effective for mild endometriosis pain. There is only anecdotal evidence that NSAIDs are effective for severe endometriosis pain, though, and caution must be used.
NSAIDs block prostaglandin production as part of their pain-relieving effects, but only before prostaglandin production begins (before you feel pain). It is also important to take these only as directed by your doctor, as overuse can cause gastrointestinal side effects.
6. Hormone therapies
There are a variety of hormone therapies that can help treat endometriosis pain. Hormonal contraceptives such as birth control pills, patches, and vaginal rings can regulate and control the buildup of endometrial tissue. The lighter and shorter menstrual flow that results can also help relieve, reduce, or eliminate pain for some women.
Another hormone therapy is gonadotropin-releasing hormone (Gn-RH) agonists and antagonists. These drugs lower estrogen levels and prevent menstruation by blocking the production of ovarian-stimulating hormones (causing endometrial tissue to shrink). Essentially, these drugs create an artificial menopause. Most women take low doses of estrogen or progestin along with Gn-RH agonists and antagonists to decrease the side effects of menopause (e.g., hot flashes, vaginal dryness, and bone loss).
Progestin therapies, including an intrauterine device (Mirena), contraceptive implant, contraceptive injection (Depo-Provera) or progestin pills, stop menstrual periods. This also stops endometrial implants, relieving endometriosis symptoms.
Aromatase inhibitors reduce estrogen in your body. This hormone therapy is usually prescribed in conjunction with a progestin or combination hormonal contraceptive to treat endometriosis.
It can take several tries to find the appropriate hormone therapy for treatment of endometriosis pain. Hormone therapy is often the final treatment option before moving to more invasive treatments.
7. Laparoscopic surgery
When scar tissue or endometrial lesions are present, laparoscopic surgery is a good option. This is considered a conservative surgery for endometriosis, as the incision is made through the belly button and the surgery preserves your uterus and ovaries.
Your doctor will identify the scars or lesions using the laparoscope before surgically removing them. This procedure is often completed in conjunction with hormone therapy or other endometriosis treatments.
Even women with severe endometriosis pain may find relief with this more conservative surgical approach. In some patients, lesions do return (as does pain) and more invasive surgery might be necessary.
In the past, surgeons recommended a full hysterectomy as a first-line treatment for endometriosis. These days, doctors know that this type of surgery is only offered after patients have tried more conservative approaches. A full hysterectomy (including removal of the ovaries) results in early menopause. With early menopause, the risk of heart disease, certain metabolic conditions, and early death increases. Adding to this, removing the uterus and ovaries may not permanently relieve endometriosis pain.
Because the risks associated with this surgery are so high, your doctor may first elect to carefully remove all endometrial tissue and treat with other conservative methods before recommending a hysterectomy.
Young women who wish to have a baby but opt for a hysterectomy will also want to freeze their eggs for future pregnancies (often with a surrogate).
It is crucial to work with a doctor that you trust. Endometriosis treatment options are highly personal, and the process of treatment can be an emotional one.
Whether you have been diagnosed or are still in the process of unpacking your endometriosis diagnosis, a pain specialist can help with your endometriosis pain treatment. You can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.