Treating the pain of endometriosis – Harvard Health Blog

Many women go through years of painful periods before they can get an answer about what is causing them: a common and often undiagnosed condition called endometriosis.

What is endometriosis?

Endometriosis is a disease that occurs when tissue similar to the tissue that lines a woman’s uterus – called an endometrium – begins to grow in other places inside the body. Most often, these growths are found in the pelvis, such as on the ovaries, fallopian tubes, the outer surface of the uterus, or the bladder.

During the menstrual cycle each month, the tissue lining the uterus grows larger and then breaks down as blood that comes out through the vagina. The capricious tissue growths of endometriosis respond to the same hormones as the uterine lining. But instead of flowing through the vagina during the menstrual period, blood from growing tissues elsewhere in the body has nowhere to go. It builds up around nearby organs and tissues, irritating and inflaming them, and sometimes causing scarring. In addition to pain, endometriosis can cause other symptoms, such as bowel and bladder problems, heavy periods, sexual discomfort, and infertility.

Diagnosing endometriosis can take a long time

In some cases, the diagnosis of endometriosis is delayed because adolescent girls and adult women assume their symptoms are an integral part of menstruation. Those who seek help are sometimes dismissed as overreacting to normal menstrual symptoms. In other cases, the condition can be mistaken for other disorders, such as pelvic inflammatory disease or irritable bowel syndrome.

A study by the World Endometriosis Research Foundation found that in women aged 18 to 45, there was an average of seven years between onset of symptoms and the time of diagnosis. Most cases are diagnosed when women are in their thirties or forties. The problem of getting an accurate diagnosis and treatment is worse for some minority groups, including people of color and Indigenous people, according to the Endometriosis Foundation of America.

Getting relief from endometriosis

While there is no known cure for endometriosis, the good news is that medications, surgery, and lifestyle changes can help you find relief and manage the condition.

Your doctor may recommend one or more treatments to help relieve pain and other symptoms. These include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These can be prescription or over-the-counter formulations including ibuprofen (Advil, Motrin) and naproxen (Aleve), which are used for pain relief.
  • Hormonal therapies. Because endometriosis is caused by hormones, adjusting hormone levels in your body can sometimes help reduce pain. Hormonal drugs are prescribed in different forms, from pills, vaginal rings and intrauterine devices to injections and nasal sprays. The goal is to change or stop the monthly cycle of egg release that causes much of the pain and other symptoms associated with endometriosis.
  • Acupuncture. It is an alternative medicine treatment, which uses small needles applied to specific places on the body to relieve chronic pain.
  • Pelvic floor physiotherapy. This practice addresses issues with the pelvic floor, a bowl-shaped group of muscles inside the pelvis that supports the bladder, bowel, rectum, and uterus. Pelvic pain sometimes occurs when the muscles in the pelvic floor are too tight, causing muscle irritation and muscle pain, called myofascial pain. To treat myofascial pain, a specially trained physiotherapist uses her hands to perform external and internal manipulations of the pelvic floor muscles. Relaxing tightened and shortened muscles can help relieve pain in the pelvic floor, just as it would in other muscles in the body.
  • Cognitive-behavioral therapy. Another option to help manage pain is cognitive behavioral therapy (CBT). Although few studies have examined the effects of CBT on symptoms of endometriosis, it has been used to successfully manage other conditions that cause chronic pain. CBT is based on the idea that healthier thought patterns can help reduce pain and disability, and help people cope with pain more effectively.
  • Stress management. Chronic pain can cause stress, which can increase sensitivity to pain, creating a vicious cycle. Because stress can make pain worse, stress management is an important part of managing endometriosis.
  • Lifestyle improvements. Maintaining a regular exercise program, a healthy sleep schedule, and a healthy, balanced diet can help you better cope with and manage the stress associated with your endometriosis.
  • Surgery. Your doctor may recommend surgery to remove or destroy the abnormal tissue growth, to improve your quality of life or your chances of getting pregnant. Some studies have shown that removing growths of abnormal tissue and scar tissue caused by mild to moderate endometriosis can increase the likelihood of getting pregnant.

Ultimately, finding the right combination of treatments to relieve the pain and manage this condition can take time. But by working closely with your doctor, you’re more likely to be able to do this.

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Jothi Venkat

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