Endometriosis affects approximately 1 in 10 women in their reproductive years. In this condition, tissue similar to that which normally lines the inside of the uterus (called endometrial tissue) is implanted outside of uterus on organs or structures in the pelvis or abdomen. Sites of implantation may include the ovaries, bladder, vagina, and even rarely the lungs. This can cause inflammation and symptoms such as heavy bleeding, fatigue, severe pain in the lower abdomen before and during periods, pain during or after sexual activity, and gastrointestinal symptoms such as nausea, constipation, and diarrhea. In addition, infertility affects about 30-40% of women with endometriosis.
Enduring endometriosis can significantly impact a woman’s work and daily activities. A multicenter study across ten countries conducted by the Global Study of Women’s Health consortium showed an overall work productivity loss of 10.8 hours a week on average in women with endometriosis, and an average 28.5% reduction in effectiveness while doing non-work-related activities, such as childcare, exercise, and housekeeping.
In addition, endometriosis can have a major effect on a woman’s social life, family relationships, and romantic relationships. One major challenge of endometriosis is that there is no visible handicap that comes along with it. A woman may look strong and healthy on the outside but feel fatigued and weak on the inside as a result of the pain and stress caused by endometriosis. It is always hard to understand the pain another person is experiencing, and it can be especially hard for friends and loved ones to comprehend the pain a woman with endometriosis is going through as there are not any outer physical manifestation of it. Women with endometriosis may have to frequently miss out on social gatherings and family events because of their symptoms, and this can be hard for family members and friends to come to terms with. Endometriosis can especially take a significant toll on romantic relationships. Dyspareunia, also known as pain during sex, is a common endometriosis symptom. This is typically caused by the stretching and pulling of endometrial growths during intercourse. As a result of other symptoms of endometriosis and side effects related to treatment, women may also experience fatigue, decreased libido, and stress, leading to a decreased desire to engage in sexual intercourse. In a study conducted of couples dealing with endometriosis, nearly half of the couples reported sex to be “non-existent or rare” in their relationship. Furthermore, endometriosis can cause additional stress in a romantic relationship through concerns about and struggles with infertility, as well as the financial burden of healthcare costs associated with endometriosis.
Treating Symptoms and Managing Pain
First line treatment options for endometriosis include over-the-counter anti-inflammatory pain relievers, such as ibuprofen or naproxen, and oral hormonal contraceptives (also known as birth control pills). Other hormonal therapies, such as aromatase inhibitor drug class and gonadotropin-releasing hormone agonists and antagonists may also be used. However, these are not permanent fixes and symptoms may return after a woman stops treatment. If hormonal therapies do not work, a woman may opt to have surgery. One surgical option for endometriosis is a conservative approach in which a laparoscopic operation is performed to remove endometriosis implants while preserving the uterus and ovaries. However, since the uterus and ovaries are still intact, there is a chance of recurrence. Another option is a complete hysterectomy with removal of both the uterus and ovaries. While this is the most effective treatment for endometriosis, it is not an appropriate option for women who desire to have children in the future, and it will lead to early menopause and the symptoms that come along with it, such as hot flashes, vaginal dryness, and night sweats. In addition, early menopause can lead to an increased risk of heart disease, osteoporosis, metabolic conditions, and even premature death.
Holistic options for the management of endometriosis may include:
- Nutrition Avoiding certain foods and drinks that cause inflammation and trigger estrogen production may help decrease the pain and inflammation caused by endometriosis. Foods and beverages such as red meat, trans fats, coffee, and alcohol can lead to increased endometriosis symptoms. A woman with endometriosis should try to follow a healthy diet that incorporates plenty of fruits, vegetables, whole grains, and omega-3 fatty acids. She might also consider keeping a food and symptom journal for a few weeks to determine whether certain foods are having an effect on her symptoms.
- Counseling Talking to a licensed professional counselor can help women deal with the stress caused by the health-related effects of endometriosis, as well as the social effects that dealing with this condition can have on a woman’s life. In addition, for women who are experiencing stress in their romantic relationships as a result of endometriosis and its effects on intimacy, fertility, and finances, couples counseling can be a great option for partners to express their concerns in a safe space, grow in their empathy and understanding of each other, and collaborate to improve their relationship.
- Massage Therapy Massage therapy is a low-risk complementary therapy option that has been shown to reduce pain caused by endometriosis through the physical manipulation of the body’s soft tissues. In addition to its pain-relieving effects, massage therapy can also induce a relaxation response, lowering cortisol (stress hormone) levels.
- Hemp Oil Studies have suggested that the endocannabinoid system, one of the body’s most important psychological systems, may play a role in the mechanism by which endometriosis growths cause pain. Thus, cannabinoid agents, such as Hemp oil products, may be effective in helping reduce endometriosis symptoms.
- Yoga Yoga is a practice more than 5,000 years old that helps integrate mind, body, and soul. A study conducted in Brazil followed fifteen women with endometriosis pain who practiced yoga twice weekly for eight weeks. Of the fifteen participants, all reported that yoga was beneficial in the management of endometriosis pain. Some participants also reported the development of greater self-knowledge, autonomy, and self-care, and some even reported the decreased use of pain medications.
Enduring life with endometriosis can be a difficult challenge for the approximately one in ten women who have this condition. However, endometriosis research and awareness are growing each year, and there are a number of medical, surgical, and complementary treatment options available to help treat endometriosis and the pain and stress caused by it. If you are experiencing signs and symptoms of endometriosis, do not suffer in silence! Reach out to your women’s health provider to talk about the symptoms you are experiencing and explore the options available to you.