 March is National Endometriosis Awareness Month
Endometriosis is a painful reproductive and immunological disease afflicting over 7 million women and teens in the
United States alone (twice the number of Alzheimer's patients and seven times those with Parkinson's Disease), The disease is a leading cause of female infertility, chronic pelvic pain and
gynecologic surgery, and accounts for more than 120,000 of the 500,000 hysterectomies performed annually. There is no cure for endometriosis, but there are several methods of treatment, which may alleviate some of the pain and symptoms associated with it.
What is Endometriosis?
Endometriosis is a disease in which tissue like the endometrium (the tissue that lines the inside of the uterus which builds up and is shed each month during menstruation) is found outside the uterus, in other areas of the body. These implants still respond to hormonal commands each month, and break down and bleed. However, unlike the lining of the uterus, the tissue has no way of leaving the body. The result is internal bleeding, degeneration of blood and tissue shed from the growths, inflammation of the surrounding areas, and formation of scar tissue. In addition, depending on the location of the growths, interference with bowel, bladder, intestines and/or other areas of the pelvic cavity can occur. While uncommon, endometriosis has also been found lodged in the skin, as "nodules" that present themselves as "blue bumps", in the arm, leg, and even the brain.
Symptoms
Some women with endometriosis do not have symptoms. Other women have symptoms that range from mild to severe. Endometriosis symptoms are often most severe just before and during the menstrual cycle and get better as the menstrual period is ending. But for some women, pain is ongoing and does not improve during the menstrual cycle. Ongoing pain is especially common in teens with endometriosis.
Symptoms may include:
- Pain, which can be:
o Pelvic pain.
o Severe menstrual cramps.
o Low backache 1 or 2 days before the start of the menstrual period (or earlier), becoming less during the period.
o Pain during sexual intercourse.
o Rectal pain.
o Pain during bowel movements.
- Infertility, which may be the only sign that you have endometriosis. Between 20% and 40% of women who are infertile have endometriosis.
- Abnormal bleeding. This can include:
o Blood in the urine or stool.
o Some vaginal bleeding before the start of the menstrual period (premenstrual spotting).
o Vaginal bleeding after intercourse.
Diagnosis and Treatment
Currently, the gold standard for a positive diagnosis of endometriosis is via surgery, either a laparoscopy or the more invasive laparotomy. A sonogram might give indications to make a doctor suspect endometriosis, such as cysts or fibroids. It can also be helpful in diagnosing ruptured endometriomas or cysts. The disease itself, however, cannot be positively diagnosed with a sonogram, CT scan, MRI or other diagnostic procedure. The use of high-power color sonograms are currently being investigated, but their detection rates seem limited at this time to confirming recurrence of the disease in previously diagnosed patients.
The most effective thing an endometriosis patient can do is to find a specialist who treats the disease, such as an experienced gynecologist with a history of treating endometriosis patients or a reproductive endocrinologist, especially if infertility is a concern. Form a partnership with this professional, in which you make informed decisions regarding your treatment plan together. Endometriosis is a serious disease, which requires serious treatment.
If you have endometrial pain or bleeding and no immediate plans to become pregnant, birth control hormones (patch, pills, or ring) or anti-inflammatories (NSAIDs) may be all that you need to control pain. Birth control hormones help shrink endometrial tissue and reduce pain for most women. They are also likely to keep endometriosis from getting worse. Anti-inflammatories reduce bleeding, inflammation, and pain. Most women can use these medicines safely for the long term with few side effects.
If you have more severe symptoms or if birth control hormones and NSAIDs do not work, you might try a stronger hormone therapy such as therapy with a gonadotropin-releasing hormone agonist (GnRH-a), progestin, a progestin intrauterine device (Mirena), danazol, or aromatase inhibitors. Some doctors will first do a laparoscopy to look for signs of endometriosis in the pelvis. But many think this is not needed unless there is a chance that you have another problem.
If hormone therapy does not work or if growths are affecting other organs, surgery to remove endometrial growths and scar tissue is the next step. This can usually be done through one or more small incisions, using laparoscopy. Some studies suggest that using hormone therapy after surgery can make the pain-free period longer by preventing the growth of new or returning endometriosis. Surgery relieves pain for a year or two in most women, although about 20% of women report no improvement after surgery.
In severe cases, removing the uterus and ovaries (hysterectomy and oophorectomy) is an option. This surgery causes early menopause. It is reserved for women with no pregnancy plans who have had little relief with other treatments. But up to 15% of women continue to have pain after this major surgery.
How Physical Therapy Can Help
Misplaced endometrial tissue responds to the menstrual cycle as if it were in the uterus. But unlike menstrual fluid that leaves the body every cycle, endometrial implants have no place to go. These implants are thought to swell during each cycle, causing endometriosis pain. The related adhesions may pull on internal structures when walking, moving, or breathing. The pull of these adhesions on pain-sensitive structures may be one cause of severe endometriosis pain. Manual physical therapy treatment has shown success decreasing endometriosis pain and increasing reproductive and digestive function in many women, by addressing the adhesions that appear to cause endometriosis pain. The focus of physical therapy is to decrease endometriosis pain and the adhesions that form at endometrial tissues, as well as to promote good posture and movement strategies for successful management of the pain.
Resources
Content for this article came from WebMD, Endometriosis Research Center, and National Women's Health Information Center.
Gardening Health and Safety Tips
 As the weather gets nicer, we all get the itch to get outside and enjoy the warmth. Gardening can be a great way to enjoy the outdoors, get physical activity, beautify the community, and grow nutritious fruits and vegetables. Whether you are a beginner or expert gardener, health and safety are important. Below are some tips to help keep you safe and healthy so that you can enjoy the beauty and bounty gardening can bring.
Enjoy the Benefit of Physical Activity
Gardening is an excellent way to get physical activity. Active people are less likely than inactive people to be obese or have high blood pressure, type 2 diabetes, osteoporosis, coronary artery disease, stroke, depression, colon cancer, and premature death.
- If you have been inactive, start out with just a few minutes of physical activity each day. Gradually build up time and intensity.
- Vary your gardening activities to keep your interest and to broaden the range of benefits.
- Use a push mower instead of a rider.
- Vary your activities - break up a post-hole digging session with some quiet weeding or transplanting.
- Make sure the total daily time of garden activities adds up to 30 minutes. Each individual activity should last at least eight minutes.
Know Your Limits
Talk to your health care provider if you have physical, mental, or environmental concerns that may impair your ability to work in the garden safely.
- If you have arthritis, use tools that are easy to grasp and that fit your ability. Research shows that moderate physical activity three or more days a week can give you more energy and can help relieve arthritis pain and stiffness.
- If you are taking medications that may make you drowsy or impair your judgment or reaction time, don’t operate machinery, climb ladders, or do activities that may increase your risk for injury.
- Listen to your body. Monitor your level of fatigue, heart rate, and physical discomfort.
- Call 911 if you experience warning signs of a heart attack (sweating, chest and arm pain, dizziness, and/or lightheadedness) or heat-related illness.
Take Pain out of Gardening
- Stretch before and after each gardening session
- Drink water throughout the day
- Do not do any one activity for more than 20 minutes at a time
- Use knee pads or a padded kneeling bench for weeding
- Change positions often
Dress To Protect
Gear up to protect yourself from lawn and garden chemicals, equipment, insects, and the sun.
- Wear safety goggles, sturdy shoes, and long pants when using lawn mowers and other machinery.
- Protect your hearing when using machinery. If you have to raise your voice to talk to someone who is an arm's length away, the noise can be potentially harmful to your hearing.
- Wear gloves to lower the risk for skin irritations, cuts, and certain contaminants.
- Protect yourself from diseases caused by mosquitoes and ticks. Use insect repellent containing DEET. Wear clothing treated with permethrin, long-sleeved shirts, and pants tucked in your socks. You may also want to wear high rubber boots since ticks are usually located close to the ground.
- Lower your risk for sunburn and skin cancer. Wear long sleeves, wide-brimmed hats, sunglasses, and sunscreen with SPF 15 or higher.
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