You Don’t Have to Live With Endometriosis Pain: Treatments and Therapies
Endometriosis is a chronic condition, and at present time, there is no cure. Don’t let this make you lose hope! While the disease cannot be totally eradicated, patients can find a significant reduction of painful symptoms — and in some cases, complete relief — through various traditional and nontraditional treatments as well as diet and lifestyle modifications. Appropriate treatments depend on age, severity of symptoms and disease, and whether the patient wants to get pregnant.
Untreated endometriosis can have long-lasting effects such as chronic pelvic pain; scar tissue, which can cause obstruction; and infertility. Rarely, endometriosis can contain cancer within it, says Leena S. Nathan, MD, an assistant clinical professor in the department of obstetrics and gynecology at UCLA Health in Westlake Village, California.
Traditional Medicine for Treating Endometriosis
Oral medication
Used for pain control by reducing inflammation or interrupting or suppressing menstruation or the production of hormones, including estradiol, the dominant female sex hormone.
Nonsteroid anti-inflammatory medication (NSAIDs) such as ibuprofen and naproxen can help with pain management.
Hormonal therapy (via hormonal contraceptives such as birth control pills, the vaginal ring, or patch) helps stop the tissues from growing, lessening endometrial pain. If these measures fail, oral or injectable hormones called GnRH agonists and/or antiprogesterones can turn off one of the hormones earlier in the menstrual cycle. In a review of 15 trials involving 1,821 women, pain scores improved by 60 percent to 100 percent with the use of GnRH agonists.
Possibly coming soon: The FDA is in the process of evaluating a new GnRH antagonist called elagolix, which could be approved for use by spring 2018. It limits estrogen and progesterone production as well as menstrual and other pelvic pain. Elagolix can be useful in moderate to severe pain associated with endometriosis. “It will be interesting to see how well this medication works and if it can be used long term without side effects,” says Dr. Nathan.
Surgery for Treating Endometriosis
Used initially or after oral therapies have failed, surgery is also an option: Laparoscopic surgery removes endometriosis lesions through excision, cutting pain nerves, and laser ablation burns off lesions. Less frequently, a hysterectomy is recommended. Studies have shown that laparoscopic ablation can reduce pain by 65 percent.
Usually, these procedures can be done without the need for open surgery. A thin tube with a video camera is inserted into the pelvis through a small cut near the navel. The tube also contains surgical instruments. It lights up the internal cavity so the surgeon can see and with the instruments, excise lesions. You will receive general anesthesia.
Usually, this can be done as out-patient surgery, but depending on the severity of the case, you may need to spend a night in the hospital.
Can Endometriosis Symptoms Come Back After Surgery?
Endometriosis is a chronic condition that will recur unless the menstrual cycle is stopped. “After surgery, we commonly suppress recurrent endometriosis by starting continuous birth control pills. This is safe and effective. The goal is to avoid having a period, which can lead to further implants and bleeding within the pelvis,” says Nathan. This can be accomplished with hormonal IUDs and GnRH agonists and antagonists, all of which decrease or stop menstrual bleeding. The ultimate therapy would be a hysterectomy and removal of one or both ovaries. Menopause will also serve to treat endometriosis as the menstrual cycle has stopped.
What You Eat and Endometriosis
Eating to prevent endometriosis
Watch what you eat! Certain foods can actually increase or lessen your risk of getting endometriosis, according to researchers.
Get lots of fruits and veggies. In one study, women who ate 14 or more servings per week of green vegetables (compared with those had less than six servings) had a 70 percent lower risk of developing endometriosis; participants who ate 14 or more servings of fruit per week maintained a 20 percent lower risk than those who ate fewer than six servings.
Cut back on red meat, dairy, caffeine, and alcohol. Studies have shown that these can significantly increase your risk of developing endometriosis.
Eating when you have been diagnosed with endometriosis disease
If you already have endometriosis, diet is still an important factor. While studies have been inexact as to benefits, some experts believe certain diets will help reduce inflammation, estrogen in the body, and oxidative stress.
Eat fruits and vegetables, which contain fiber, beneficial nutrients, vitamins, and antioxidants. Avoid grapefruit and other citrus fruits, which can disrupt estrogen excretion.
Limit trans and saturated fats, such as red meat and high-fat dairy. Focus on fats with omega-3s, found in cold-water fish, tree nuts, seeds, and extra-virgin, cold-pressed olive oil. These can reduce inflammation and pump up your immune system.
Go organic, raw, and fresh. Foods that aren’t labeled "organic" may contain pesticide residue.
Avoid processed foods, which have additives.
Replace iron lost from excessive bleeding with green, leafy vegetables, beetroot, dried apricots, eggs, and fish.
Try for 30 grams (g) of fiber daily. Found in fruits, vegetables, nuts, seeds, legumes, and whole grains, fiber helps get rid of estrogen and will also help with constipation, often a symptom of endometriosis.
Stay hydrated. Avoid caffeine, added sugars, and alcohol.
Should You Go Gluten-Free?
Avoiding gluten seems to be the hot craze these days, but a very preliminary study found that some women did find symptom reduction by trying the diet. Discuss with your physician to see if it is worth it for you.
Supplements Used to Treat Endometriosis
Some supplements may interfere with medication you are taking (especially if you are on blood thinners), so run it by your physician before taking anything new.
Combine 1,000 milligrams (mg) of vitamin C and 1,200 international units (IU) of vitamin E daily to reduce aches and pains.
Vitamin B complex: 50 mg daily to maintain estrogen and hormone balance
Fish oil: 1,000 mg daily
Alternative Therapies and Approaches for Endometriosis Treatment
Caution: If you do decide to try alternative remedies, discuss your choices ahead of time with your physician. Some of these may not be right for your particular situation or may interfere with your medication. Do not forgo your traditional therapy for an alternative route. You can create a complementary route together as a team with your doctor.
Acupuncture. An ancient Chinese practice, acupuncture stimulates certain parts of the body by the insertion of thin needles into skin. A review of studies discovered that it can not only reduce pain from endometriosis, it can also decrease blood levels of CA-125, a protein that is associated with the disease. Western researchers believe that the result is achieved because the needles stimulate nerves and certain pain-relieving chemicals such as norepinephrine.
Exercise. Regular strenuous exercise has been shown to decrease your chance of getting endometriosis. But what if you already have it?
There is no conclusive data saying that exercise will help specifically with endometriosis pain, but experts have hypothesized that it may help by reducing estrogen levels and stress, and increasing anti-inflammatory and antioxidant agents. Another study found that practicing hatha yoga, a type of yoga that features physical postures, significantly reduced chronic pain.
Biofeedback. A process using guided imagery and sensory response gives you some control over your body’s reaction to stress and pain by teaching you to recognize and act on given responses. You can find a trained practitioner at the Biofeedback Certification International Alliance or the Association for Applied Psychophysiology and Biofeedback.
Transcutaneous electrical nerve stimulation (TENS) is a pain-relief therapy delivered via the application of low-voltage electrical current. It has been shown to be effective in reducing discomfort in women with deep infiltrating endometriosis, possibly because it scrambles pain signals from the nerves.
Herbal extracts. Curcumin, puerarin, resveratrol, green tea epigallocatechin-3-gallate (EGCG), and ginsenoside Rg3 have been shown to reduce endometriosis lesions.
Preliminary studies indicate that cannabinoids might have beneficial effects against deep infiltrating endometriosis, possibly by limiting cell migration and associated pain.