“When all you know is pain you don’t know that that is not normal. It is not a woman’s lot to suffer, even if we’ve been raised that way.”
(Address, 2011 Endometriosis Foundation of America Blossom Ball)” -Susan Sarandon
Endometriosis is a painful disorder that classically presents during the reproductive years with debilitating cramps. It impacts more than 5 million women in the United States alone.
Although everyone has menstrual cramping during periods, women with endometriosis typically have menstrual pain that’s far worse than usual. Some women with endometriosis describe that the cramp feels like their insides are being pulled down. The pain begins one to two days before periods, persists throughout periods, and can continue for several days afterward. Women may also experience one or more of the following symptoms;
- Heavy menstrual periods
- Bleeding in between periods
- Painful sexual intercourse
- Pain during urination
- Pain during defecation
- Constipation or diarrhea
- Irregular bleeding
- Nausea or vomiting
- Feeling tired or lacking energy
In endometriosis, the tissue similar to the tissue that lines the inside of the uterus grows outside the uterus. With each menstrual cycle, the tissue thickens and bleeds. But because this tissue has no way to exit the body, it becomes trapped. This causes a lot of inflammation, which can lead to pain. Ovaries, fallopian tubes and tissues lining the pelvis are most commonly affected. The involvement of ovaries may lead to endometrioma (cysts). Scarring, adhesions and fertility problems may also develop.
Often there is a delay in the diagnosis of endometriosis. Studies have reported an average diagnostic delay of 7 to 12 years in women with endometriosis. The delay is because the symptoms of endometriosis are vague, the symptoms overlap with a number of gynecological and gastrointestinal processes, or women are embarrassed to talk about their symptoms, or that they believed the symptoms were just part of being a woman or were dismissed by their doctors for years. It is important that young women educate themselves about normal period pain and the pain of endometriosis and talk to the doctors if they believe their symptoms are distressing or things don’t seem to add up.
The mild to moderate pain is treated with NSAIDs with or without continuous hormonal contraceptives. NSAIDs work by preventing or slowing down the production of prostaglandins, which helps to relieve the painful cramps associated with endometriosis. Continuous hormonal contraceptives help control the hormones responsible for the buildup of endometrial tissue each month. They make the flow lighter, shorter and reduce or eliminate pain in some cases.
Other treatment options are progestin therapy, drugs that block the production of ovarian-stimulating hormones, aromatase inhibitors that reduce the amount of estrogen in the body.
You can also try measures at home to relieve your discomfort such as warm baths and a heating pad. Pelvic floor physical therapy is also recommended because endometriosis can cause the pelvic floor muscles to tense up.
Surgery is usually the choice for women with severe endometriosis with many growths, a great deal of pain, or fertility problems.
It is important to get diagnosed with endometriosis at an early stage to prevent scarring, adhesions, and infertility. This condition can also lead to decreased quality of life and can strain relationships with your partner, friends, children, and co-workers.
Please track your symptoms of endometriosis in the KnowYourMeds app and share it with your doctor. Your doctor may use this to assess the treatment for your condition.