The Endometriosis Roller Coaster: Understanding Recurrence and How to Prevent It

The Endometriosis Roller Coaster: Understanding Recurrence and How to Prevent It

Surgery is a cornerstone for initial diagnosis of endometriosis and is an effective treatment option. But, it is not a guaranteed cure, because endometriosis can recur after surgery.  What? Why? 

The reasons for endo recurrence are complex and multifactorial and involve a combination of factors.  These include incomplete removal of the endometriosis tissue, hormonal imbalances, immune influences, toxin influences, molecular influences and probably even more we still do not fully understand. So, while thorough and meticulous initial excision is key, a poor excision is not the only reason for recurrence and progression.  Let’s look at these factors in more detail, and, more importantly, explore what you might be able to proactively do to help reduce the recurrence risk.   

Incomplete Excision

Incomplete removal of endometriosis lesions is probably the most common cause of recurrence after surgery.  Endo can be difficult to remove completely, especially if it has grown deep into the pelvic tissues and organs, and if an affected uterus and/or ovaries are being preserved. Of course, expert surgeons are trained to optimize excision and minimize recurrence.  But in some cases, the remaining lesions can be obscured by inflammation or microscopic and not visible to the surgeon, making it difficult or impossible to remove no matter what level skillset the surgeon has.  If even a small amount of endometriosis is left behind after surgery, it can and probably will grow back over time.  The more that is left behind, potentially the faster it may grow back.  However, this is not a linear growth relationship because of the factors we explore below.  Some lesions simply grow slower than others for various reasons, and some might not grow at all to a symptom-producing level.   

So, what can be done to improve the chances of initially optimal surgery?  We’ll explore the pros and cons of available tools below.  But first, what about the surgeon?  Depending on your situation and resources available to you, some combination of advanced surgeons will be key to your treatment in most cases. The details about your options are as follows.   

Published research generally favors excision (removal) over fulguration (burning) of endometriosis implants, especially in deep infiltrating endo and for endometriomas. While there is some debate over this, fulguration near delicate structures like the ureters or bowel can be very unsafe and fulguration generally causes more scarring or fibrosis.  Fibrosis itself may increase pain as your body heals, even if all the endo itself was destroyed.  

So, the first step is to make sure that your potential surgeon is trained and capable of excision surgery and not just fulguration.  There are a number of pathways to this.  General gynecologists that are trained to perform thorough excisions are very far and few between.  So the trail leads to gynecologists that have had additional training in excision and minimally invasive surgery.  Who are they?  

Most advanced endo excision surgeons have trained in a one to three year minimally invasive surgery or “MIGS” fellowship. These are not regulated or accredited by any boards but are usually sponsored by the AAGL (American Association of Gynecologic Laparoscopists). This means the training is usually quite good, but not all mentors are created equal and there is no board required standardization.  Hence, some surgeons graduate being far better at excision than others.  So, you should still do your due diligence about the surgeon you select, based on as much information as possible, including their background, their results, what patients say, and so on.  

The other consideration is that this MIGS training, at least in the United States, may not include bowel and urologic surgery and usually does not provide  the credentials to obtain hospital privileges in these procedures.  So, an excision surgeon will often work with general surgeons, urologists and others as a team to cover the bowel and urinary tract aspects of surgery.  This can be very effective, but in some centers, logistic coordination of multiple surgeons works better than in others.   Unless this coordination is well worked out, it might be better to seek someone that is trained to do all or most excision without requiring a large team of supporting surgeons.

The other main way that gynecologic surgeons get advanced complex surgical training is through a three to four year gynecologic oncology fellowship accredited by the American Board of Obstetrics and Gynecology (ABOG) and American Council for Graduate Medical Education (ACME). This training includes the ability to operate on any organ in the abdomen and pelvis, including the diaphragm.  However, the training focus is on cancer and not much, if anything, on the pathophysiology of endometriosis.  So, while this surgical training leads to the absolute pinnacle of gynecologic surgeon expertise, not many of them understand and/or know how to treat endometriosis beyond what they learned in residency.  So, in some cases, an excisionist works with a gynecologic oncologist instead of a general surgeon or urologist.  On the other hand, a relative handful of gynecologic oncologists do focus on advanced endometriosis. 

If chest endo is strongly suspected on imaging, a thoracic surgeon is required as part of the team for formal lung surgery.  Similarly, if large nerves such as the sciatic nerve to the leg is likely to be involved on imaging, a neurosurgeon may also be part of a team or backup.   

Regarding fertility issues, an ABOG/ACGME board-accredited fellowship leading to specialization in Reproductive Endocrinology also exists and such physicians may be involved in your care with advanced technologies such as in vitro fertilization (IVF).  This was historically a more surgically focused specialty in the United States.  Today it is not, but some REI specialists have retained an interest in things surgical and may be trained in excision surgery.    

Determining the surgical strategy in your specific case can influence the outcome as well.  Related potential contributors to endometriosis recurrence after surgery include age, disease severity, and the type of planned surgical procedure performed. Older patients and those with more severe endometriosis are at higher risk of recurrence after surgery, unless perhaps the uterus and both ovaries are removed.  Patients who undergo conservative surgery, which aims to preserve fertility by removing as little normal tissue as possible, may also be at higher risk of recurrence compared to those who undergo more aggressive surgery.  This depends on the disease locations and the skill of the surgeon.  Conservative surgery can still result in removal of all visible endometriosis in many cases, with the right surgeon and right equipment.  So, discussion of your ranked, and possibly competing, priorities with your surgeon is essential for the best outcome.   For example, is the main goal pain relief or is it fertility preservation?  Or is it both? What is most important to you?  Being on the same page with your main surgeon, especially if there is a team involved with potential multiple opinions, is crucial to get the results you want. 

Hormonal Influences

Hormonal imbalances play a crucial role in the development and recurrence of endometriosis. Endometriosis is believed to be strongly influenced by an excess of estrogen in the body, which can cause the endometrial-like tissue to grow outside the uterus. Hormonal therapies such as hormonal contraceptives, progestins, and gonadotropin-releasing hormone (GnRH) agonists and antagonists can be used to manage these hormonal imbalances.  The problem is that Mother Nature is infinitely smarter than the best doctor(s) and some of these therapies are worse than the disease, in terms of symptoms and side effects.  It really depends on the individual situation. 

Even after menopause, whether natural or by surgical excision of the ovaries, estrogen does not completely disappear.  Endo affected tissues can produce estrogen locally, other hormones and toxins you take in can convert to estrogen in your fat cells and, of course, hormonal replacement are all additional sources which can contribute to endometriosis recurrence. 

So, if the hormonal imbalances are not addressed, the endometriosis tissue can grow back after surgery.  But what does that really mean and what can you do to favorably influence this risk factor?   

One thing is for sure, doing something beyond surgery is better than nothing.  Anything you can do to reduce your estrogen load is first priority and use of progestins to balance this overload may also be recommended.  Whether or not to go for complete ovarian shutdown of estrogen production (GnRH analogs) is situation specific but usually not ideal due to the significant health effects of basically being in menopause.  The newer variations which provide some estrogen giveback are better but still have their limitations.  More often the pharmaceutical solution is oral contraceptives, which is far easier to handle in terms of potential side effects.   

One of the easiest things you can do yourself to reduce excess estrogen fairly quickly is to make sure your gut microbiome is functioning optimally.  This requires a close look at your diet, avoiding toxic junk food, and using probiotics and prebiotics.  When your gut bacteria are working well they metabolize the excess estrogen in your body and this leaves your body through bowel movements.  If not, excess estrogen is reabsorbed, recirculated and contributes to estrogen load.  

Another natural strategy is to lose weight.  Your fat cells store xenoestrogens from the toxins we all take in daily and slowly release this estrogen back into the bloodstream.  Also, the more fat cells you have the more other hormones are converted to estrogens which are also released into your blood stream. Weight loss is not a rapid proposition, but the best time to get started is yesterday.   

Reducing stress through mind-body techniques can also reduce estrogen levels.  Reducing alcohol intake improves your liver’s ability to break down estrogen.  Finally, some supplements, notably seaweed, can reduce estrogen in your body.  Others that top the list are Vitamin D, Magnesium, Milk Thistle, Omega 3 fatty acids (fish oil), Vitamin B6 and DIM (diindolylmethane).  DIM is found in cruciferous veggies, so you can up that intake easily through diet.  

Only after doing some of these things should you get radical on altering your hormones through medical pharmaceuticals.  There is a whole range of hormonal strategies including more natural compounded preparations.  Having said that, work with your doctor for the best strategy for your specific situation.   This is not something you should do on your own beyond diet and lifestyle modification.  The main take home message is that there is plenty of data which supports doing something to balance your estrogen and progesterone after surgery to reduce recurrence.   

Immune Influences

The immune system plays a critical role in the development and progression of endometriosis. Endometriosis implants produce inflammatory factors that attract immune cells to the site, which can cause inflammation and pain. However, immune cells can also help to fight recurrence.  

Surgery may temporarily disrupt the balance between pro-inflammatory and anti-inflammatory immune cells, but acute inflammation helps with healing and this is self-limited in almost all cases.  This type of inflammation you do not want to interfere with in the short term.  On the other hand, inflammation can contribute to recurrence if it is allowed to become chronic.   Research suggests that immune-modulating therapies such as immunosuppressive agents and immunomodulatory cytokines could be effective in preventing the recurrence of endometriosis after surgery.  However, there are no reliable pharmaceutical treatments along this line yet.  On the other hand, research suggests that natural killer cells (NK) are deficient in endo patients.  An integrative nutritional approach to enhancing NK number and function is mushroom consumption.  Work with an integrative specialist on this.  

A recent sub-theory for endo development and recurrence is the “bacterial contamination hypothesis”.  This is based on the role of bacterial endotoxin (lipopolysaccharide, LPS) stimulating the pelvic inflammatory immune response.  Since patients with a history of pelvic infection, chronic endometritis and SIBO are known to have higher incidence of endometriosis, the commonality is a bacterial endotoxin (LPS).  So, regardless of whether the bacterial LPS got there via intestinal translocation (micro-leaking) or retrograde menstruation, its presence is potentially key in stimulating endo growth and regrowth.  Along these lines, treatment with either natural or pharmaceutical antibiotics may help attenuate chronic low level infection related inflammation. 

This is certainly not mainstream thought but plausible and based on at least animal model evidence with some human study support as well.  Attention to keeping your microbiome healthy and minimizing leaky gut as well as vigilance for any gynecologic infections may be prudent and is low risk. 

Toxin Influences

Exposure to toxins and pollutants can also contribute to the development and recurrence of endometriosis. Certain toxins, such as dioxins and polychlorinated biphenyls (PCBs), have been shown to disrupt hormone levels, acting mainly as xenoestrogens, and increase the risk of endometriosis growth.  Therefore, lifestyle modifications such as avoiding environmental toxins and adopting a healthy diet may be beneficial in preventing the recurrence of endometriosis after surgery.  

Molecular Influences

Recent research has shown that molecular changes in endometriosis implants may also contribute to the development and recurrence of endometriosis. Mutations in certain genes involved in regulating inflammation and hormone levels are examples.  Environmental and inflammatory influences can also upregulate hormone receptors, which means less estrogen is required to stimulate regrowth from micro-foci of endometriosis.   All these changes can be genetic mutations or epigenetic influences which turn normal and abnormal genes on and off. 

There is a lot of molecular crosstalk that regulates hormonal, inflammatory, immune, neurologic and other processes.  This is the glue that interconnects all of these factors that affect progression of endo and symptom causation.   

If your endo recurrence seems to be too rapid after a good excision surgery, or you have multiple recurrences and especially if you are older and/or have a family history of cancer or endo, please consider the following.  While rare, endo can degenerate into cancer or increase ovarian cancer risk and, even before that might happen, some gene mutations (e.g. ARID1A, KRAS, PIK3CA) can contribute to a more aggressive variant of endometriosis.  To determine if this is a contributor to your disease, genetic counseling and testing may be a good idea. 

Surgical Equipment Influences

Minimally invasive surgery is the gold standard of endometriosis surgery these days, not surgery though a big incision called a laparotomy.  Having said that, after multiple prior surgeries, a surgeon may try to convince you that a laparotomy is what you need because you probably have too many scars or fibrosis and, therefore, minimally invasive surgery may be too risky.  While this may be true in very rare cases, it is not true in the vast majority of cases and you should probably seek other opinions.  Laparotomy surgery often leaves behind much more scarring than minimally invasive surgery.  There is always a possibility you may need yet another surgery, so find an expert to minimize all risks for this surgery and possibly subsequent ones. 

Minimally invasive surgery may mean laparoscopy or it may mean robotically assisted laparoscopy, depending on the surgeon you choose.  While laparoscopy has been around much longer, there are major technologic differences.  For simple to moderate cases, either is fine. However, for more complex cases and recurrence, you should understand the technical differences and what they mean.  Imaging may suggest but it is often not possible to accurately predict how much disease is present, or how much anatomic distortion there is, until the actual surgery starts.  But you can bet that if you are facing a repeat surgery, the anatomy may be more distorted than the first time.   

The following represents the opinion of this author surgeon who has used both laparoscopy and robotics over the past three decades, but, due to the reasons noted, has converted almost exclusively to robotics.  Having said that, it is important to understand that at the end of the day the skill of the surgeon trumps the equipment in most cases.  However, at some point, better technology does offer some clear advantages for most surgeons, should they choose to avail themselves of it.  Herein lies the problem.  Many have chosen to only dabble in robotics or ignore it altogether as an option.  So, beware of any surgeon who says that robotics is just a fad or training wheels for laparoscopy.  This is likely a surgeon who never took the time to master the superior technology offered by robotics to appreciate the difference.  The final major argument against robotics is that it costs too much or takes a little longer.  This does not affect the patient whatsoever because the costs to you are exactly the same.  In terms of surgery length, that is measurable in minutes.  So, wouldn’t you rather have a difficult surgery done properly or simply be the first one in the post-anesthesia recovery area?

Benefits of Robotic Surgery over Laparoscopy

Robotic surgery is a minimally invasive surgical technique that uses robotic arms to help perform the surgery with more precision. This offers several benefits over traditional laparoscopy that may help to reduce the risk of endometriosis recurrence. These benefits include more precise removal of endometriosis implants, less damage to surrounding tissue, reduced risk of complications, and possibly a shorter recovery time. 

Precise Instrumentation

Robotic surgery allows for more precise surgical movements, especially in delicate and anatomically distorted areas, reducing the risk of incomplete excision. The robotic arms move with reliably greater precision, dexterity and control than laparoscopic instruments.  During laparoscopy the surgeon is directly controlling the straight inflexible instruments with graspers and scissors at the tip.  This means that any undue exaggerated movements or tremors are amplified by the time they get to the tips, located twelve to seventeen inches away.  That is a long distance.  Try writing with a pen that long.  This does not happen with robotics which is micro-controlled.  In addition, the instruments at the tips of the robotic apparatus are wristed, meaning they are flexible and move like tiny human hands.  This also allows for more precision in difficult anatomical areas and in the presence of scar or fibrosis.   

Traditional laparoscopic instruments are limited by the possible motions at the surgical tips.  These motions are cutting, pushing, pulling and tearing, can be awkwardly unreliable and are reminiscent of eating with chopsticks.  One can certainly get good at it, but there are limitations. No question, the better the surgeon and the more that anatomy is normal, the smoother the surgery. However, at the end of the day, this can never match the smooth reliability of robotics. 

Due to the more precise control of instruments, robotic surgery can help reduce the risk of damage to surrounding tissues and organs. This helps reduce complications (e.g inadvertent damage to bowel, ureters or blood vessels) and, in this manner, enhances and accelerates the healing process. 

Superior 3-Dimensional Optics

Robotics offers a 3-D magnified camera, which means there is depth perception as compared to laparoscopy.  In other words, you can see minute differences in how far one object is compared to one right next to it. There are laparoscopic simulated 3-D options available (3-D glasses as opposed to real binocular lenses as found in robotics), but most surgeons use a 2–D camera.  Using this, the surgeon cannot appreciate the distances accurately.  So, without depth perception, the surgeon can’t precisely tell the separation between tissues in a highly distorted anatomical situation. For example, there may be a section of bowel stuck to an endometrioma, or the blood vessels to the ovary may be obscured in inflammation. Dissecting this all safely is facilitated by a 3-D view. You can prove to yourself why 3-D is better. Put an eye patch on and try to (very carefully) try to do things around the house with only one eye to help you navigate. You will find that you underestimate or overestimate the distance between objects when you try to pick them up and might even bump into things too often. Hence you should not try this experiment without someone to help keep you steady. Humans are created with and are best equipped to function with 3-D vision, powered by two eyeballs. We can accommodate to 2-D but it is not natural or optimal.  This means with traditional laparoscopy your surgeon is operating with a handicap and, regardless of skill, that may make all the difference in some cases. 

Conclusion

In conclusion, endometriosis recurrence after surgery is a complex issue. Incomplete excision due to surgeon experience or technology differences, hormonal imbalances, immune influences, toxin influences, and molecular influences can all contribute to endometriosis recurrence after surgery.  Take time to digest all of this information and seek the best endometriosis specialist and surgeon available to you for your specific needs.  

Get in touch with Dr. Steve Vasilev

More articles from Dr. Steve Vasilev:

Endometriosis And Menopause; Everything You Need To Know

How to tell the difference between endometriosis and ovarian cancer

What would happen to the signs and symptoms of endometriosis after menopause?

References

Bulun SE. Endometriosis. N Engl J Med. 2009;360(3):268-279.

Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364(9447):1789-1799.

Guo SW. Recurrence of endometriosis and its control. Hum Reprod Update. 2009;15(4):441-461.

Abbott, J., Hawe, J., Hunter, D., Holmes, M., Finn, P., & Garry, R. (2004). Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Fertility and Sterility, 82(4), 878-884. https://doi.org/10.1016/j.fertnstert.2004.03.056

Aarts, J. W., Nieboer, T. E., Johnson, N., Tavender, E., Garry, R., Mol, B. W., & Kluivers, K. B. (2015). Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database of Systematic Reviews, (8). https://doi.org/10.1002/14651858.CD003677.pub5

Kho, R. M., & Akl, M. N. (2014). The role of robotic surgery in endometriosis management. International Journal of Women’s Health, 6, 967–972. https://doi.org/10.2147/IJWH.S50365

Magrina, J. F. (2013). Robotic surgery in gynecology. Best Practice & Research Clinical Obstetrics & Gynaecology, 27(3), 421–430. https://doi.org/10.1016/j.bpobgyn.2013.01.004

Nezhat, C., Saberi, N. S., Shahmohamady, B., & Nezhat, F. (2006). Robotic-assisted laparoscopy in gynecological surgery. JSLS: Journal of the Society of Laparoendoscopic Surgeons, 10(3), 317–320.

Alkatout, I., Mettler, L., Beteta, C., Hedderich, J., & Jonat, W. (2013). Laparoscopic management of endometriosis and uterine fibroids. Minimally Invasive Therapy & Allied Technologies, 22(6), 363–369. https://doi.org/10.3109/13645706.2013.836658

Wang, Y. Z., Deng, L., Xu, H. C., & Zhang, Y. (2014). Robot-assisted versus conventional laparoscopic surgery for endometriosis: A meta-analysis. Journal of Obstetrics and Gynaecology Research, 40(4), 897–904. https://doi.org/10.1111/jog.12317

Chapron, C., Bourret, A., Chopin, N., Dousset, B., Leconte, M., Amsellem-Ouazana, D., … & Borghese, B. (2010). Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions. Human Reproduction, 25(4), 884-889. https://doi.org/10.1093/humrep/dep468

Hsu WC, Huang HY, Huang CY, et al. Robotic surgery for the treatment of endometriosis: a systematic review and meta-analysis. J Minim Invasive Gynecol. 2019;26(6):1035-1045.

Nezhat C, Saberi NS, Shahmohamady B, Nezhat F. Robotic-assisted laparoscopy vs conventional laparoscopy for the treatment of advanced stage endometriosis. JSLS. 2009;13(4):364-369.

Vercellini, P., Crosignani, P. G., Abbiati, A., Somigliana, E., Viganò, P., & Fedele, L. (2009). The effect of surgery for symptomatic endometriosis: the other side of the story. Human Reproduction Update, 15(2), 177-188. https://doi.org/10.1093/humupd/dmn062

Kyama, C. M., Mihalyi, A., Simsa, P., Falconer, H., Fulop, V., Mwenda, J. M., & D’Hooghe, T. M. (2009). Role of cytokines in the endometrial-peritoneal cross-talk and development of endometriosis. Frontiers in Bioscience, 14, 1795-1812. https://doi.org/10.2741/3332

Khan KN, Kitajima M, Hiraki K, et al. Immunological aspects of endometriosis. Reprod Med Biol. 2018;17(4):220-237.

InCheul Jeung, Keunyoung Cheon, Mee-Ran Kim, et al. Decreased Cytotoxicity of Peripheral and Peritoneal Natural Killer Cell in Endometriosis  PMID: 27294113 PMCID: PMC4880704 DOI: 10.1155/2016/2916070

Khan, K. N., Fujishita, A., Kitajima, M., Hiraki, K., Nakashima, M., Masuzaki, H. (2016). Intra-uterine microbial colonization and occurrence of endometritis in women with endometriosis†. Human Reproduction, 31(3), 568-579. https://doi.org/10.1093/humrep/dev321

Rier, S. E., & Foster, W. G. (2002). Environmental dioxins and endometriosis. Toxicological Sciences, 70(2), 161-170. https://doi.org/10.1093/toxsci/70.2.161

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Grechukhina, O., Petracco, R., Popkhadze, S., Massasa, E., Paranjape, T., & Chan, E. (2012). A polymorphism in a let-7 microRNA binding site of KRAS in women with endometriosis. EMBO Molecular Medicine, 4(3), 206-217. https://doi.org/10.1002/emmm.201100200

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2 years ago Endometriosis No comment

Endometriosis and Adenomyosis: Decoding Their Contribution To Pelvic Pain

Endometriosis and adenomyosis affect millions of women worldwide. While they share certain similarities, they also exhibit differences in their pathophysiology, clinical presentation, and management. Let’s compare and contrast endometriosis and adenomyosis, shedding light on their associations and highlighting relevant references.

Table of contents

• Similarities
• Difference s
  • 1. Anatomical location
  • 2. Prevalence
  • 3. Diagnosis
  • 4. Treatment
• Associations
• Research and Future Directions

Similarities

Both endometriosis and adenomyosis involve the growth of endometrial-like tissue outside the uterine cavity. This ectopic tissue remains responsive to hormonal changes, leading to inflammation, pain, and other similar symptoms that can significantly interfere with the quality of life (1).

Both conditions predominantly affect women of reproductive age and are associated with dysmenorrhea (painful periods), dyspareunia (painful intercourse), and infertility (2). The exact cause of these conditions remains unclear, but a combination of genetic, hormonal, and immune factors is thought to be involved in both (3). Both can also continue beyond or even be present initially after menopause.

Differences

1. Anatomical location 

While both endometriosis and adenomyosis involve the growth of ectopic endometrial-like tissue, they differ in anatomical location. Endometriosis is characterized by the presence of endometrial-like tissue outside the uterus, commonly on the ovaries, fallopian tubes, the peritoneum (pelvic and abdominal skin-like lining), and other organs (4). In contrast, adenomyosis is defined by the invasion of endometrial-like tissue into the myometrium (muscular wall) of the uterus (5).

2. Prevalence

Endometriosis affects approximately 10% of women of reproductive age, while adenomyosis is thought to impact between 20% and 35% of women in this age group (6). But the true prevalence of both conditions may be underestimated due to the invasive nature of diagnostic procedures and non-specific symptoms (7).

3. Diagnosis

The gold standard for diagnosing endometriosis is surgery using laparoscopy or robotics, both minimally invasive surgical procedures that allow for direct visualization and, if necessary, excision of endometrial-like tissue lesions (8). In contrast, adenomyosis is typically suspected using imaging techniques such as transvaginal ultrasound or magnetic resonance imaging (MRI). It can usually only be confirmed by the pathologist when the uterus is removed (9). An accurate preoperative biopsy is very difficult, although removal of discrete adenomyomas, leaving the uterus behind, is sometimes possible when the adenomyosis is not diffuse throughout the myometrium of the uterus.

4. Treatment

Both conditions are managed with a combination of medical and surgical therapies, depending on the severity of symptoms and reproductive goals. Hormonal therapies, including oral contraceptives, progestins, and gonadotropin-releasing hormone (GnRH) agonists and antagonists, are commonly used to manage symptoms in both endometriosis and adenomyosis (10). Integrative measures, including anti-inflammatory and anti-oxidant hormone-modulating nutrition and lifestyle modification, can also help not just control symptoms but also contribute to treating the root causes. 

However, surgical approaches differ between the two conditions. In endometriosis, the preferred surgical intervention is laparoscopic and robotic excision of the ectopic tissue (11). For adenomyosis, hysterectomy (removal of the uterus) may be considered in severe cases where fertility preservation is not a concern (12). Again, in some cases, when discrete adenomyomas are identified by imaging, they can be removed while leaving the uterus intact—this decision of removing the uterusis a highly individualized issue. 

Associations

It is not uncommon for endometriosis and adenomyosis to coexist in the same patient. One study found that the prevalence of adenomyosis was significantly higher among women with endometriosis (13). The coexistence of these conditions may exacerbate symptoms and pose additional challenges in diagnosis and management (14).

Both endometriosis and adenomyosis have been linked to a variety of other health conditions, some of which include:

1. Chronic pelvic pain: Women with either endometriosis or adenomyosis may experience chronic pelvic pain, which can be debilitating and significantly impact daily life (15).

2. Uterine fibroids: Although they are distinct conditions, adenomyosis and uterine fibroids (leiomyomas) can coexist in the same patient, further complicating the diagnosis and treatment (16). 

3. Autoimmune and inflammatory diseases: Women with endometriosis have an increased risk of developing autoimmune and inflammatory disorders, such as rheumatoid arthritis, systemic lupus erythematosus, and inflammatory bowel disease (17). This association is less well-established for adenomyosis but has been suggested in some studies (18).

4. Mental health: Both endometriosis and adenomyosis have been linked to mental health issues, including depression, anxiety, and decreased quality of life due to chronic pain and infertility (19).

Research and Future Directions

There is a growing body of research focused on understanding the pathophysiology, diagnosis, and treatment of endometriosis and adenomyosis. Some key areas of interest include:

1. Biomarkers: Identifying specific biomarkers for endometriosis and adenomyosis could greatly improve the diagnostic process and allow for earlier intervention, potentially improving patient outcomes (20).

2. Non-invasive imaging techniques: The development of more accurate, non-invasive imaging techniques for diagnosing both endometriosis and adenomyosis is a priority for researchers, as this would reduce the need for invasive diagnostic procedures (21).

3. Novel treatment approaches: Researchers are exploring novel treatment approaches, such as targeted hormonal therapies, immunomodulators, and anti-inflammatory agents, to improve symptom management and fertility outcomes in both endometriosis and adenomyosis (22).

4. Genetic and epigenetic factors: Investigating the genetic and epigenetic factors that contribute to the development and progression of endometriosis and adenomyosis may lead to a better understanding of these conditions and inform future therapeutic strategies (23).

Get in touch with Dr. Steve Vasilev

More articles from Dr. Steve Vasilev:

Endometriosis And Menopause; Everything You Need To Know

How to tell the difference between endometriosis and ovarian cancer

What would happen to the signs and symptoms of endometriosis after menopause?

References

1. Vercellini P, Viganò P, Somigliana E, Fedele L. (2014). Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 10(5): 261-75.
2. Parazzini F, Esposito G, Tozzi L, Noli S, Bianchi S. (2017). Epidemiology of endometriosis and its comorbidities. Eur J Obstet Gynecol Reprod Biol. 209: 3-7.
3. Zondervan KT, Becker CM, Koga K, Missmer SA, Taylor RN, Viganò P. (2018). Endometriosis. Nat Rev Dis Primers. 4(1): 9.
4. Giudice LC, Kao LC. (2004). Endometriosis. Lancet. 364(9447): 1789-99.
5. Vannuccini S, Tosti C, Carmona F, Huang SJ, Chapron C, Guo SW, Petraglia F. (2017). Pathogenesis of adenomyosis: an update on molecular mechanisms. Reprod Biomed Online. 35(5): 592-601.
6. Garcia L, Isaacson K. (2011). Adenomyosis: review of the literature. J Minim Invasive Gynecol. 18(4): 428-37.
7. Chapron C, Marcellin L, Borghese B, Santulli P. (2019). Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 15(11): 666-82.
8. Johnson NP, Hummelshoj L, Adamson GD, Keckstein J, Taylor HS, Abrao MS, et al. (2017). World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod. 32(2): 315-24.
9. Champaneria R, Abedin P, Daniels J, Balogun M, Khan KS. (2010). Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review comparing test accuracy. Acta Obstet Gynecol Scand. 89(11): 1374-84.
10. Vercellini P, Buggio L, Berlanda N, Barbara G, Somigliana E, Bosari S. (2016). Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril. 106(7): 1552-71.e2.
11. Yeung P Jr, Sinervo K, Winer W, Albee RB Jr. (2011). Complete laparoscopic excision of endometriosis in teenagers: is postoperative hormonal suppression necessary? Fertil Steril. 95(6): 1909-12, 1912.e1.
12. García-Solares J, Donnez J, Donnez O, Dolmans MM. (2018). Pathogenesis of uterine adenomyosis: invagination or metaplasia? Fertil Steril. 109(3): 371-9.
13. Mijatovic V, Florijn E, Halim N, Schats R, Hompes P. (2010). Adenomyosis has no adverse effects on IVF/ICSI outcomes in women with endometriosis treated with long-term pituitary down-regulation before IVF/ICSI. Eur J Obstet Gynecol Reprod Biol. 151(1): 62-7.
14. Pinzauti S, Lazzeri L, Tosti C, Centini G, Orlandini C, Luisi S, et al. (2015). Coexistence of endometriosis and adenomyosis in women with chronic pelvic pain. J Obstet Gynaecol Res. 41(6): 909-14.
15. Howard FM. (2003). Chronic pelvic pain. Obstet Gynecol. 101(3): 594-611.
16. Stewart EA. (2015). Uterine fibroids. Lancet. 387(10022): 1189-99.
17. Sinaii N, Cleary SD, Ballweg ML, Nieman LK, Stratton P. (2002). High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis. Hum Reprod. 17(10): 2715-24.
18. Benagiano G, Brosens I, Habiba M. (2015). Structural and molecular features of the endomyometrium in endometriosis and adenomyosis. Hum Reprod Update. 21(4): 445-58.
19. Roomaney R, Kagee A. (2016). The association between pain, disability, fatigue and depression in women diagnosed with endometriosis: a moderated mediation analysis. J Psychosom Obstet Gynaecol. 37(4): 137-44.
20. Nisenblat V, Bossuyt PM, Shaikh R, Farquhar C, Jordan V, Scheffers CS, et al. (2016). Blood biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 5: CD012179.
21. Brosens I, Gordts S, Campo R, Benagiano G. (2016). Non-invasive methods of diagnosis of endometriosis. Curr Opin Obstet Gynecol. 28(4): 267-76.
22. Stratton P, Berkley KJ. (2011). Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications. Hum Reprod Update. 17(3): 327-46.
23. Zondervan KT, Rahmioglu N, Morris AP, Nyholt DR, Montgomery GW, Becker CM, et al. (2016). Beyond endometriosis genome-wide association study: from genomics to phenomics to the patient. Semin Reprod Med. 34(4): 242-54.

2 years ago Endometriosis No comment

The Importance of Endometriosis Awareness Month

Table of contents

• What is Endometriosis
• Common Symptoms
• Endometriosis Treatment Options and Management Strategies

Every March, the world comes together to recognize and raise awareness for endometriosis. This global health issue affects hundreds of millions of humans worldwide yet is rarely discussed due to a lack of education and knowledge. Endometriosis Awareness Month allows us to learn more about this debilitating condition and how it impacts those who suffer from it.

What is Endometriosis

Endometriosis is a chronic disorder affecting up to 10% of women worldwide. Endometriosis can impact other genders as well. This disease occurs when tissue similar to the lining of the uterus grows outside the uterus and on other organs in the body, such as the ovaries, bladder, bowels, and abdomen. While endometriosis can occur at any age, it most commonly impacts women between 15-50 years old.

Common Symptoms

The most common symptom of endometriosis is pelvic pain. This pain can range from mild cramping or discomfort to severe period pain lasting days or weeks. Other symptoms include heavy periods (with large clots), painful bowel movements or urination during menstrual cycles, painful sex, fatigue, and infertility. Unfortunately, these symptoms are often misdiagnosed as menstrual cramps or irritable bowel syndrome (IBS).

Endometriosis Treatment Options and Management Strategies

Endometriosis cannot be cured, but treatment options are available to help manage its symptoms. These include surgical removal of endometrial growths, hormone therapy, pain management, and dietary changes. Additionally, lifestyle modifications like stress reduction techniques and exercise can help alleviate some symptoms of endometriosis.

Endometriosis Awareness Month is important in educating everyone about this chronic disorder that affects hundreds of millions globally. We must learn more about endometriosis so that those suffering from this condition can get the proper diagnosis and care they need. Together we can make a difference in raising awareness for this disease!

2 years ago Endometriosis No comment

Integrative Therapies for Endometriosis

Table of contents

• What is Integrative Therapy?
  • Acupuncture
  • Acupressure
  • Massage Therapy
  • Mind-Body Techniques
  • Diet and Nutrition
  • Supplements
  • Herbal Medicine
  • Aromatherapy
  • Hyperbaric Oxygen Therapy (HBOT)
• Summary

While there is no known cure for endometriosis, several mainstream treatment options can help manage the symptoms and improve quality of life. These are primarily focused on surgery and hormonal therapy.   Research is ongoing to find additional multidisciplinary treatment options on the basis of immunomodulation, anti-inflammatory therapy, and molecular pathway signal alteration. Absent curative mainstream therapy, an approach that has gained popularity in recent years to help reduce symptoms and treat some underlying endo pathology, is “integrative therapy,” which adds a holistic natural component. 

What is Integrative Therapy?

Integrative therapy is an approach to healthcare that takes into account the whole person, including their physical, emotional, and spiritual health. It involves combining conventional medical treatment with complementary therapies such as nutrition, supplementation, botanicals, acupuncture, massage, yoga, and much more. Integrative therapy aims to address the underlying causes of a person’s health concerns rather than simply treating the symptoms. While it often employs some aspects of Eastern medicine, it is not the same as “alternative therapy,” which can be ineffective, costly, and even dangerous in some situations. This overview article only scratches the surface of available options and is not meant to be authoritative in scope or depth. 

Some of the complementary therapies that may be used in integrative therapy for endometriosis include:

Acupuncture

Everybody has heard of this, but briefly, acupuncture is a form of Traditional Chinese Medicine that involves the insertion of extremely thin needles into specific points along body pathways called meridians. These meridians and acupoints are close to where we know peripheral nerves course through your body. It has been used for centuries to treat a wide range of conditions, including chronic pain, headaches, anxiety, and infertility.

Acupuncture is believed to work by stimulating the body’s natural healing mechanisms, promoting the flow of energy, or Qi, throughout the body. It could also have an effect on the nerves from a mainstream perspective. In the context of endometriosis, acupuncture is thought to help by reducing inflammation and promoting the relaxation of the pelvic muscles, which can reduce pain and improve fertility.  

One thing is for sure; it is not just a placebo effect. A systematic review published in the Cochrane Library in 2018 evaluated the effectiveness of acupuncture in treating pelvic pain associated with endometriosis. The review included seven randomized controlled trials involving a total of 527 participants. The authors found that acupuncture was associated with a statistically significant reduction in pain intensity compared to no acupuncture or sham acupuncture. 

Another systematic review published in the Journal of Obstetrics and Gynecology in 2021 evaluated the effectiveness of acupuncture in treating endometriosis-related dysmenorrhea. The review included 17 randomized controlled trials involving a total of 1232 participants. The authors found that acupuncture was associated with a statistically significant reduction in pain intensity and duration compared to no acupuncture or sham acupuncture. They concluded that acupuncture might be a safe and effective therapy for managing endometriosis-related dysmenorrhea.

While the evidence for the effectiveness of acupuncture in treating endometriosis is promising, it is important to note that acupuncture is not a cure for endometriosis. Acupuncture may help to manage pain and other symptoms associated with the condition, but it does not address the underlying disease process other than helping reduce inflammation. Therefore, it should be used as part of a comprehensive treatment plan that includes conventional medical treatment as well as lifestyle modifications and other complementary therapies.

Acupressure

Acupressure is a related form of traditional Chinese medicine that involves applying pressure to specific points on the body to promote healing and reduce pain. Acupressure points that are commonly used in the treatment of endometriosis include the lower abdomen, lower back, and inner ankle. These points are believed to help regulate menstrual flow, reduce inflammation, and promote relaxation.

A randomized controlled trial published in the Journal of Complementary and Alternative Medicine in 2013 evaluated the effects of acupressure on pain and quality of life in women with endometriosis. The study included 60 participants who received either acupressure or a placebo. The authors found that acupressure was associated with a statistically significant reduction in pain intensity and an improvement in quality of life.

Another study published in the Journal of Obstetrics and Gynaecology Research in 2018 evaluated the effects of acupressure on menstrual pain and quality of life in women with endometriosis. The study included 62 participants who received either acupressure or a placebo. The authors found that acupressure was associated with a statistically significant reduction in menstrual pain intensity and an improvement in quality of life.

Massage Therapy

Massage therapy is a complementary therapy that involves the manipulation of soft tissues in the body, such as muscles and tendons, to promote relaxation and reduce pain. It has been used for centuries to treat a variety of conditions, including chronic pain, anxiety, and depression. We are talking about massage that is in addition to 

Endometriosis can cause significant pain and discomfort, particularly during menstruation. Massage therapy can help ease tension in the pelvic muscles and reduce pain. A systematic review published in the Journal of Nursing Scholarship in 2019 evaluated the effectiveness of massage therapy in reducing pain and improving the quality of life in patients with endometriosis. The review included 13 studies involving a total of 602 participants. The authors found that massage therapy was associated with a statistically significant reduction in pain intensity and duration and improvements in quality of life and anxiety levels. 

Massage therapy may also be beneficial for reducing stress and anxiety, which are common symptoms of endometriosis. Chronic pain can cause significant emotional distress, and massage therapy has been shown to be effective in reducing anxiety levels and promoting relaxation. A randomized controlled trial published in the Journal of Psychosomatic Obstetrics and Gynecology in 2018 evaluated the effects of massage therapy on anxiety levels in women with endometriosis. The study included 60 participants who received either massage therapy or no treatment. The authors found that massage therapy was associated with a statistically significant reduction in anxiety levels compared to no treatment.

In addition to its potential benefits for reducing pain and anxiety, massage therapy may also help to improve circulation and promote lymphatic drainage, which can help to reduce inflammation and promote healing. A review published in the Journal of Manual and Manipulative Therapy in 2016 evaluated the effectiveness of massage therapy for managing chronic pelvic pain, including endometriosis. The authors concluded that massage therapy might be a safe and effective therapy for managing chronic pelvic pain, mainly when used with other therapies.

Mind-Body Techniques

Meditation, yoga, Tai chi, and others are complementary therapies that can be used in the treatment of endometriosis to help manage physical, emotional, and mental support. These techniques focus on the connection between the mind and the body and are designed to help individuals learn how to use their thoughts and emotions to promote healing and reduce pain.

Endometriosis is often associated with significant emotional and mental distress, including anxiety, depression, and stress. Mind-body techniques can help to manage these symptoms by promoting relaxation and reducing stress levels. A systematic review published in the journal Obstetrics and Gynecology Clinics of North America in 2020 evaluated the effectiveness of mind-body therapies for managing chronic pain, including endometriosis. The review included 20 studies involving a total of 1126 participants. The authors found that mind-body therapies, including meditation, yoga, and Tai chi, were associated with statistically significant reductions in pain intensity, pain duration, and stress levels.

Meditation is a mind-body technique that involves focusing the mind on a particular object or thought to promote relaxation and reduce stress levels. A randomized controlled trial published in the journal Pain Medicine in 2018 evaluated the effects of mindfulness meditation on pain and quality of life in women with endometriosis. The study included 20 participants who received either mindfulness meditation or no treatment. The authors found that mindfulness meditation was associated with a statistically significant reduction in pain intensity and an improvement in quality of life.

Yoga is a mind-body technique that combines physical postures, breathing exercises, and meditation to promote relaxation and reduce stress levels. A randomized controlled trial published in the journal Obstetrics and Gynecology in 2018 evaluated the effects of yoga on pain and quality of life in women with endometriosis. The study included 90 participants who received either yoga or no treatment. The authors found that yoga was associated with a statistically significant reduction in pain intensity and improved quality of life.

Tai chi is a mind-body technique that involves slow, gentle movements and deep breathing exercises to promote relaxation and reduce stress levels. A systematic review published in the journal Pain Medicine in 2015 evaluated the effectiveness of Tai chi for managing chronic pain, including endometriosis. The review included ten studies involving a total of 494 participants. The authors found that Tai chi was associated with statistically significant reductions in pain intensity and duration and stress levels.

Diet and Nutrition

Diet modification can directly impact inflammation, hormone balance, and immune system function. While no specific diet has been shown to cure endometriosis, dietary changes, and nutritional supplements may be beneficial in reducing inflammation and pain associated with the condition.  

Inflammation is a key factor in the development and progression of endometriosis. Certain foods and nutrients can contribute to inflammation in the body, while others have anti-inflammatory properties that can help to reduce inflammation. Omega-3 fatty acids, found in fatty fish such as salmon and mackerel, as well as in flaxseeds and chia seeds, have been shown to have potent anti-inflammatory effects. Magnesium, found in leafy greens, nuts, and whole grains, can also help to reduce inflammation and muscle tension. Vitamin D, found in fatty fish, eggs, and fortified dairy products, may help to regulate immune system function and reduce inflammation. Overall, the most anti-inflammatory antioxidant diet is whole-food plant-based.

Hormone balance is another important consideration in the management of endometriosis. Certain foods can help to balance hormones, while others can disrupt hormone balance and exacerbate symptoms. Phytoestrogens, found in foods such as soy products, flaxseeds, and lentils, can help to balance estrogen levels and reduce symptoms of endometriosis. On the other hand, foods high in saturated and trans fats, such as red meat and processed foods, can increase inflammation and disrupt hormone balance.

A systematic review published in the journal Nutrients in 2021 evaluated the effectiveness of dietary interventions for managing endometriosis. The review included 17 studies involving a total of 1311 participants. The authors found that dietary interventions, such as increasing intake of fruits and vegetables, omega-3 fatty acids, and phytoestrogens, and decreasing intake of saturated and trans fats, were associated with improved pain and quality of life, and other symptoms of endometriosis.

Supplements

Similar to diet, supplements may be beneficial in managing endometriosis by reducing inflammation, promoting hormonal balance, and supporting immune system function. While it is best to focus on transitioning to an anti-inflammatory, antioxidant diet, targeted supplementation may enhance the effect in some cases. 

A randomized controlled trial published in the Journal of Reproductive Medicine in 2013 evaluated the effects of omega-3 fatty acids on pain and quality of life in women with endometriosis. The study included 59 participants who received either omega-3 fatty acids or a placebo. The authors found that omega-3 fatty acids were associated with a statistically significant reduction in pain intensity and improved quality of life.

A systematic review published in the European Journal of Obstetrics, Gynecology, and Reproductive Biology in 2017 evaluated the effectiveness of magnesium for managing menstrual pain, including endometriosis-related pain. The review included 13 studies involving a total of 1870 participants. The authors found that magnesium was associated with a statistically significant reduction in menstrual pain intensity and duration.

The study mentioned above also evaluated the effectiveness of vitamin D for managing menstrual pain, including endometriosis-related pain. The review included five studies involving a total of 238 participants. The authors found that vitamin D was associated with a statistically significant reduction in menstrual pain intensity and duration. Vitamin D supplementation is often essential because even in sunbelt areas of the world, up to 30% of the population is deficient.  

It is important to note that supplements can have side effects and may interact with other medications, so it is essential to consult with a healthcare provider before using supplements for endometriosis. 

Herbal Medicine

Herbal medicine, also known as herbalism, is the use of plants or plant extracts to treat or prevent disease. Many herbs have anti-inflammatory and pain-relieving properties, making them useful in managing endometriosis. While further research is needed to understand the effectiveness of herbal medicine for endometriosis fully, many women have reported positive outcomes from using herbal remedies as a complementary therapy.

Turmeric is one herb that has been suggested to effectively reduce inflammation and pain associated with endometriosis. Turmeric contains a compound called curcumin, which has potent anti-inflammatory effects. A randomized controlled trial published in the journal Complementary Therapies in Medicine in 2013 evaluated the effects of curcumin on pain and quality of life in women with endometriosis. The study included 67 participants who received either curcumin or a placebo. The authors found that curcumin was associated with a statistically significant reduction in pain intensity and an improvement in quality of life.

Ginger is another herb that has been suggested to be effective in reducing inflammation and pain associated with endometriosis. Ginger contains compounds called gingerols and shogaols, which have anti-inflammatory and pain-relieving effects. A randomized controlled trial published in the journal Pain in 2014 evaluated the effects of ginger on pain and menstrual symptoms in women with endometriosis. The study included 70 participants who received either ginger or a placebo. The authors found that ginger was associated with a statistically significant reduction in pain intensity and an improvement in menstrual symptoms.

Chasteberry, also known as vitex, is an herb that has been suggested to be effective in regulating hormones and reducing symptoms of endometriosis. Chasteberry contains compounds that can help to balance estrogen and progesterone levels, which can help to reduce inflammation and pain. A systematic review published in the journal Complementary Therapies in Medicine in 2018 evaluated the effectiveness of chasteberry for managing endometriosis-related pain. The review included six studies involving a total of 596 participants. Chasteberry was associated with a statistically significant reduction in pain intensity and duration compared to no treatment in this study.

Just as in the case of supplements, work with an expert in the field to avoid interactions with prescription medications. 

Aromatherapy

Aromatherapy is a form of complementary therapy that involves using essential oils to promote health and well-being. Essential oils are concentrated plant extracts that are believed to have therapeutic properties. They can be used in several ways, such as inhaled, applied topically, or added to a bath.

While there is limited scientific research on the effectiveness of aromatherapy for endometriosis, some women with the condition have reported that it has helped to manage their symptoms. Aromatherapy may be particularly helpful for managing emotional symptoms, such as anxiety and depression, which are all too common. 

A short list of essential oils that may be helpful for women with endometriosis includes Lavender, Clary sage, Rose, Peppermint, and Eucalyptus. 

When using aromatherapy, it is important to dilute the essential oils with a carrier oil, such as coconut oil or almond oil, as they can be irritating to the skin when used undiluted. Aromatherapy should also be used with caution in women who are pregnant or breastfeeding, as some essential oils may not be safe for use during pregnancy or while breastfeeding.

Hyperbaric Oxygen Therapy (HBOT)

The theory behind using HBOT for endometriosis is that the increased oxygen levels in the body may help to reduce inflammation and promote the healing of damaged tissues. Some preliminary studies have suggested that HBOT may be effective in reducing pain and improving quality of life in women with endometriosis, although larger studies are needed to confirm these findings.

It is important to note that HBOT is not currently approved by the U.S. Food and Drug Administration (FDA) for the treatment of endometriosis, and it should only be used under the guidance of a qualified healthcare provider. There are also some risks associated with HBOT, including ear pain, sinus pressure, and oxygen toxicity, which can be serious in rare cases.

Summary

By addressing both the physical and emotional aspects of endometriosis, integrative therapy can help women to achieve a better quality of life and attach some of the suspected root causes of endo as well. This can include improvements in energy levels, sleep quality, and overall sense of well-being.

Integrative therapy is not a replacement for conventional medical treatment for endometriosis but rather a complementary approach that can be used in conjunction with conventional treatments to achieve better outcomes. 

In conclusion, endometriosis is a complex condition that requires a multidisciplinary approach to treatment. Integrative therapy offers a promising addition to managing the symptoms of endometriosis by combining conventional medical treatments with complementary therapies that address the physical, emotional, and spiritual aspects of care. 

Your endometriosis specialist can help guide you to practitioners who may be best suited for applying integrative therapies to endometriosis. It is ideal if you can find a specialist who is also certified in some aspect of East-West integrative medicine. These are hard to find but are out there. 

Get in touch with Dr. Steve Vasilev

More articles from Dr. Steve Vasilev:

Endometriosis And Menopause; Everything You Need To Know

How to tell the difference between endometriosis and ovarian cancer

What would happen to the signs and symptoms of endometriosis after menopause?

References:

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Fernández-Martínez E, Onieva-Zafra MD, Parra-Fernández ML, et al. Effects of Massage on Pain, Anxiety, and Quality of Life in Patients With Endometriosis: A Systematic Review. J Nurs Scholarsh. 2019;51(6):614-623. doi:10.1111/jnu.12516

Soares TR, de Melo NH, de Lima Martins F, et al. The effectiveness of yoga in pain, menstrual disturbances, quality of life, and inflammatory markers in women with endometriosis: a systematic review. Complement Ther Clin Pract. 2021;44:101368. doi:10.1016/j.ctcp.2021.101368

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Pan J, Dai Q, Zhang J, et al. Omega-3 fatty acids intake and risk of endometriosis: a systematic review and meta-analysis. Nutrients. 2018;10(10):1542. doi:10.3390/nu10101542

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Gottfried SF, Long B, Wittlake WA. Hyperbaric oxygen therapy for endometriosis: a systematic review. Undersea Hyperb Med. 2018;45(1):27-37. PMID: 29698797.

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2 years ago Endometriosis No comment

Endometriosis: What to Do After Diagnosis

Table of contents

• Educate Yourself About Endometriosis
• Find an Endometriosis Doctor
• Talk to Your Doctor About Endometriosis Treatment Options
• Make Lifestyle Changes
• Join a Support Group

If you’ve been diagnosed with endometriosis, you may wonder what your next steps should be. Here’s a quick overview of some things you can do after receiving a diagnosis of endometriosis.

Educate Yourself About Endometriosis

One of the best things you can do after an endometriosis diagnosis is to educate yourself about the condition. Knowledge will help you better understand your symptoms and give you an idea of available treatments. You can also ask questions about your diagnosis to your doctor or another healthcare provider.

Find an Endometriosis Doctor

When treating and managing endometriosis, all doctors are not the same. If you have or suspect you might have endometriosis, you should never just walk into the office of a random obstetrics/gynecology (OB-GYN) surgeon.

However, it can be tricky to find an endometriosis specialist who is highly skilled and follows the best treatment practices for this disorder. To learn more about endometriosis, read this article that introduces the condition, signs and symptoms, causes, complications, and treatments.

With so many myths about endometriosis (endo) – it’s essential to separate facts from fiction. Arm yourself with research and a solid foundation of knowledge to help you simplify the process and to get in touch with a trusted endo expert. Please keep reading to find out why using an endo expert is important, red flags your doctor/surgeon is not the right fit, and how to find an endometriosis specialist near you.

Talk to Your Doctor About Endometriosis Treatment Options

There is no cure for endometriosis, but there are treatments that can help lessen your symptoms and improve your quality of life. Some common treatments for endometriosis include excision surgery, medications for symptom management, and lifestyle changes. Talk to your doctor about which treatment or combination of options may be right for you.

Make Lifestyle Changes

Specific lifestyle changes can help lessen the symptoms of endometriosis. These include regular exercise, managing stress, and eating a healthy diet rich in fruits, vegetables, whole grains, and lean protein. Making these changes can help improve your overall health and well-being.

Join a Support Group

It can be helpful to talk to other women dealing with endometriosis. There are many online and in-person support groups available for women with endometriosis. Joining one of these groups can help you feel less alone and provide you with valuable information and support from others who understand what you’re going through.

If you’ve been diagnosed with endometriosis, you’re not alone. And there are things you can do to manage your symptoms and improve your quality of life. Educate yourself about the condition, talk to your doctor about treatment options, make lifestyle changes, and join a support group if possible. These steps will help you better cope with your diagnosis and live a fuller life despite having endometriosis.

2 years ago Endometriosis No comment

5 Signs You Need to See a Gynecologist

Table of contents

• You Haven’t Been in a While (Or Ever)
• You’re Experiencing Abnormal Bleeding
• You Have Painful Periods
• You Have Pelvic Pain Outside of Your Periods
• You Have New and Unusual Symptoms

Regular gynecologist visits are essential to maintaining sexual and reproductive health. However, many women put off making an appointment until they are pregnant or facing a problem. There are several reasons to visit a gynecologist. If you’re unsure whether you need to see a gynecologist, here are five signs that it’s time to schedule an appointment.

You Haven’t Been in a While (Or Ever)

The American College of Obstetricians and Gynecologists (ACOG) recommends that women have their first gynecological visit when they turn 18 or become sexually active, whichever comes first. If you’re overdue for a checkup, it’s time to schedule an appointment. Remember that you don’t need to be sexually active to see a gynecologist – they can provide comprehensive care for all aspects of your reproductive health, even if you’re not sexually active.

You’re Experiencing Abnormal Bleeding

If you’re bleeding between periods, after sex, or after menopause, it’s time to see a gynecologist. Abnormal bleeding can be caused by everything from uterine fibroids to endometriosis to cervical cancer, so getting checked out as soon as possible is important.

You Have Painful Periods

Periods are supposed to be discomforting, but they shouldn’t be so painful that they interfere with your daily life. If you miss work or school because of period pain, it’s time to see a gynecologist. They may be able to diagnose the underlying reason for your pain and help with the treatment. 

You Have Pelvic Pain Outside of Your Periods

If you’re experiencing pelvic pain at any time other than during your period, it could be a sign of endometriosis, pelvic inflammatory disease, or another condition. Many conditions that cause pelvic pain can be treated if they’re caught early, so don’t hesitate to make an appointment with your gynecologist.

You Have New and Unusual Symptoms

If you’ve started experiencing new and unusual symptoms – like changes in your vaginal discharge or burning during urination – it’s time to go to the gynecologist. These could be signs of infection or another problem, so getting checked out as soon as possible is best.

If you’re experiencing any of the above symptoms, don’t wait – schedule an appointment with your gynecologist today! The sooner you get checked out, the sooner you can start feeling better and return to your normal routine. In addition to the five signs we reviewed here, there are countless other reasons to visit a gynecologist. So it would be best to stay informed about your health and communicate with your doctors about any questions or concerns.

2 years ago Endometriosis No comment

Understanding the Link Between Endometriosis and Insomnia

People living with endometriosis often struggle to get a good night’s rest. While it may seem like a mystery, there is a strong connection between endometriosis and insomnia. In this blog post, we’ll look at how endometriosis can lead to insomnia and what you can do to get better sleep if you have endometriosis.

Table of contents

• What Is Endometriosis?
• How Can Endometriosis Lead To Insomnia?
• What To Do With Endometriosis And Insomnia

What Is Endometriosis?

Endometriosis is a chronic medical condition that mostly affects women of reproductive age. It occurs when tissue similar to the lining of the uterus grows outside of the uterus, usually in the abdominal cavity or on other organs in the pelvic area. This tissue can cause pain, inflammation during menstruation, and other symptoms such as fatigue, nausea, and bloating.

How Can Endometriosis Lead To Insomnia?

There are several ways that endometriosis can contribute to insomnia. The most common way is through chronic pain. Painful cramps, bloating, and nausea can make it difficult for an individual with endometriosis to fall asleep or stay asleep throughout the night. Additionally, many women experience increased pain during their period—when they usually try to get some rest—making it even more challenging to sleep well while living with endometriosis.

Another factor contributing to insomnia in women with endometriosis is anxiety and stress associated with managing this chronic condition. It’s not uncommon for people with endometriosis to feel overwhelmed or anxious about managing their symptoms on top of everything else going on in their lives. Unfortunately, this anxiety can lead to difficulty falling asleep or staying asleep at night.

What To Do With Endometriosis And Insomnia

Endometriosis has been linked directly to insomnia in many studies. However, there are steps you can take if you’re experiencing difficulty sleeping due to this condition. First and foremost, talk with your doctor about your options for treating your endo-related pains. Additionally, reducing stress levels by finding healthy coping mechanisms such as yoga or meditation may also help improve your overall sleep quality since stress has been known to contribute to insomnia in those living with endo-related complications. Finally, getting enough exercise during the day (but not too close before bedtime), eating healthier foods, avoiding caffeine late in the day, and creating an ideal sleeping environment may all help promote a better quality of restful sleep at night. These steps improve your chances of getting a good night’s rest despite having endo-related complications.

Endometriosis can result in insomnia because of pain, anxiety, and other endo-related issues. However, you can help yourself to have a better sleep by talking with your doctor to plan a treatment that reduces your pain and other issues. Meanwhile, some lifestyle hacks such as relaxation techniques, regular exercise, healthy eating, less caffeine, and a good sleep environment can also be helpful.

2 years ago Endometriosis No comment

Silent Endometriosis: What You Need to Know

Endometriosis is a condition where a tissue similar to the lining of the uterus grows outside of it, causing pain and other symptoms. But many people don’t realize there is a type of endometriosis that is often “silent,” meaning it does not cause any symptoms. Let’s explore silent endometriosis and what it means for a person.

Table of contents

• What is Silent Endometriosis?
• How Is Silent Endometriosis Diagnosed?

What is Silent Endometriosis?

Silent endometriosis, also known as asymptomatic endometriosis, is a condition in which the endometriosis tissue does not cause any pain or other symptoms. This may sound like an oxymoron—how can something be endometriosis if it doesn’t cause pain? But this type of endometriosis occurs more often than you might think. Up to 25% of women with endometriosis have no symptoms. Diagnosis only happens when they have infertility or have another surgery in their pelvis or abdomen.

It’s important to note that silent endometriosis does not mean the condition won’t eventually become symptomatic. Sometimes, silent endometriosis can become symptomatic (painful) endometriosis over time. That’s why people need to be aware of this condition and get tested for it if they experience any signs or symptoms.

How Is Silent Endometriosis Diagnosed?

The only way to diagnose silent endometriosis definitively is through laparoscopic surgery and biopsy. During this procedure, a doctor will make incisions in your abdomen and insert a tiny camera into it so they can see inside your body and examine any endometriosis lesions or growths on your organs. They may also take samples from these lesions for further testing to determine whether or not they are cancerous or benign (noncancerous). However, due to the invasive nature of this procedure, many doctors will only recommend it if signs or symptoms of endometriosis are present.

Silent endometriosis is an often overlooked form of endometriosis due to its lack of obvious signs and symptoms. While some people may never experience any issues related to their silent endometriosis diagnosis, some silent endometriosis can turn into symptomatic conditions. 

2 years ago Endometriosis , Teen Endometriosis No comment

Endometriosis in Teens – What You Need to Know

Adolescence is a transformative phase marked by physical and emotional changes, but for some young individuals, this journey is overshadowed by a debilitating condition known as endometriosis.

Endometriosis is a painful and often misunderstood and misdiagnosed condition that affects 1 in 10 individuals assigned female at birth (AFAB) most commonly (but not exclusively) between the ages of 15-50. Teen endometriosis is a silent struggle that demands greater awareness and prompt intervention. This condition can be particularly difficult, as they are just beginning to navigate the world of menstrual health. Knowing the signs and symptoms of endometriosis from parents and schools and looking for endometriosis specialists for teens can help them get the treatment they need and make it easier to manage their pain.

Table of contents

• What is Endometriosis in Teens?
• Symptoms: Unveiling the Silent Struggle
  • Common Symptoms of Teen Endometriosis:
• Diagnosing Endometriosis in Teens
• Treatment Options & Endometriosis Specialist for Teens
• Fertility Preservation: Safeguarding Future Possibilities
• Empowering Teens: Advocacy and Support
• Igniting Hope and Empowerment

What is Endometriosis in Teens?

Endometriosis is when cells similar to the lining of the uterus (endometrium) grow outside the uterus onto tissues and organs, in the abdomen, pelvis, and even distant sites such as the lungs or diaphragm. These endometriosis lesions behave similarly to the endometrium in some ways, but there are some distinct differences. They produce substances that promote inflammation, pain, and tissue scarring, making it difficult for some women to become pregnant. They can also produce their own estrogen via aromatase.  Symptoms vary from mild to severe, including pelvic pain during menstruation, heavy periods, pain during intercourse, gastrointestinal issues like cramps or diarrhea, fatigue, and more.

While endometriosis can affect individuals of any age, its onset often traces back to adolescence, with a staggering 38% of those diagnosed reporting symptoms before the age of 15. Despite its prevalence, the journey to an accurate diagnosis can be arduous, with an average delay of over nine years from the onset of symptoms.

Symptoms: Unveiling the Silent Struggle

The symptoms of endometriosis in teens can be diverse and perplexing, often leading to misdiagnosis or dismissal as “normal menstrual cramps.” However, these symptoms should not be ignored, as they can significantly impact a young woman’s quality of life and development.

Common Symptoms of Teen Endometriosis:

• Severe, debilitating menstrual cramps: Unlike typical menstrual discomfort, endometriosis-related cramps are often resistant to over-the-counter pain medications and can persist throughout the entire menstrual cycle.
• Heavy or irregular periods: Abnormal bleeding patterns, such as heavy menstrual flow or spotting between periods, can be indicators of endometriosis.
• Pelvic or lower abdominal pain: Endometriosis can cause chronic pelvic or lower abdominal pain that may worsen during menstruation or intercourse.
• Gastrointestinal distress: Nausea, constipation, diarrhea, and painful bowel movements can accompany endometriosis due to the proximity of endometrial lesions to the digestive tract.
• Urinary issues: Endometriosis can lead to painful urination, frequent urination, or blood in the urine.
• Fatigue and mood changes: The constant pain and hormonal fluctuations associated with endometriosis can contribute to fatigue, irritability, and mood swings.

While these symptoms may initially be dismissed as normal adolescent experiences, their persistence and severity should prompt further investigation.

Diagnosing Endometriosis in Teens

Diagnosing endometriosis in teens can be a complex and frustrating process, often involving multiple healthcare providers and misdiagnoses. It can be tricky because its symptoms may resemble normal period discomfort, ovarian cysts, or uterine fibroids. If a teen experiences any of these symptoms, taking them seriously and seeking medical attention is essential. 

The doctor may perform a pelvic exam or an ultrasound to look for signs of endometriosis deposits on other organs. The only definitive way to diagnose endometriosis is through a minimally invasive surgical procedure called laparoscopy, which allows the doctor to visually inspect the pelvic region and obtain tissue samples for biopsy.

However, before undergoing laparoscopy, healthcare providers may recommend various diagnostic steps, including:

• Detailed medical history: A comprehensive review of symptoms, family history, and menstrual patterns can provide valuable insights.
• Pelvic examination: While not definitive, a pelvic exam can help identify potential sources of pain or abnormalities.
• Imaging tests: Ultrasounds or magnetic resonance imaging (MRI) may be used to rule out other conditions or detect endometrial cysts (endometriomas).
• Hormone therapy trial: Prescribing hormonal birth control or medications that suppress ovulation can help determine if symptoms improve, this may suggest the presence of endometriosis but is not definitive as a significant number of individuals with endometriosis do not respond to hormonal contraceptives for symptom management.

It’s important to note that endometriosis lesions in teens can have an atypical appearance, making visual diagnosis during laparoscopy challenging. Therefore, seeking care from a gynecologist experienced in diagnosing and treating endometriosis in adolescents is crucial.

Treatment Options & Endometriosis Specialist for Teens

While endometriosis has no cure, various treatment approaches can effectively manage symptoms and improve the quality of life for teens with the condition. Once a teen is suspected of having endometriosis, several treatment options are available, depending on their individual needs. A multidisciplinary team, including gynecologists, pain management specialists, physical therapists, and mental health professionals, may be involved in developing a comprehensive treatment plan. Common treatment options for teen endometriosis include:

• Hormonal therapies: Hormonal birth control pills, progestin-only medications, or hormonal intrauterine devices (IUDs) can help suppress menstruation and help with symptom management.
• Pain management: Over-the-counter or prescription pain medications, as well as alternative therapies like acupuncture or massage, can help alleviate chronic pain associated with endometriosis.
• Surgery: Minimally invasive laparoscopic surgery may be recommended to remove endometriosis lesions and adhesions; however, surgery for this population is a bit controversial because of the young age and chance of recurrence of endometriosis.
• Physical therapy: Pelvic floor physical therapy can help relax pelvic muscles, reduce pain, and improve overall function.
• Psychological support: Counseling or support groups can assist teens in coping with the emotional and social impacts of endometriosis.

The treatment approach should be tailored to the individual’s symptoms, severity, and personal preferences, with ongoing monitoring and adjustments as necessary.

Fertility Preservation: Safeguarding Future Possibilities

While endometriosis is not directly linked to infertility in teens, the condition can progress and potentially impact future fertility if left untreated. As endometriosis lesions and adhesions accumulate over time, they can distort pelvic anatomy, block fallopian tubes, or impair ovarian function, making conception more difficult.

For this reason, early diagnosis and treatment of endometriosis in adolescence are crucial for preserving fertility potential. Additionally, some endometriosis clinics offer fertility preservation services, such as egg or embryo freezing, for teens who may undergo treatments that could temporarily or permanently impact their fertility.

By addressing endometriosis early and proactively considering fertility preservation options, young women can take control of their reproductive health and increase their chances of conceiving in the future.

Empowering Teens: Advocacy and Support

Endometriosis can be an isolating and misunderstood condition, particularly for teens who may feel alone in their struggle. However, several organizations and support networks have emerged to empower young women and raise awareness about teen endometriosis.

Organizations like the Endometriosis Association and the World Endometriosis Research Foundation provide valuable resources, including educational materials, online support communities, and advocacy initiatives. These platforms offer teens and their families a space to connect, share experiences, and access reliable information about endometriosis.

Additionally, some endometriosis clinics and advocacy groups encourage teens to become advocates themselves, sharing their stories, and raising awareness within their communities. By breaking the silence surrounding endometriosis, these young advocates can inspire others to seek help and foster a more inclusive and supportive environment for those affected by the condition.

Igniting Hope and Empowerment

Endometriosis is a complex condition that affects many people throughout their lives, but teens especially need extra care due to their developing bodies and hormones. Endometriosis in teens is a silent struggle that demands greater awareness, understanding, and action. 

Knowing the symptoms, seeking early diagnosis and treatment, and embracing a multidisciplinary approach, teens don’t have to suffer needlessly from this often debilitating condition any longer than necessary! With proper care and support, they can manage their condition and live abundantly despite endometriosis!

Through the combined efforts of healthcare providers, researchers, advocacy groups, and the endometriosis community itself, we can ignite hope and empowerment for teens affected by this condition. By breaking the silence and fostering a supportive environment, we can ensure that no young person feels alone in her battle against endometriosis. Together, we can unveil the silent struggle and pave the way for a future where endometriosis no longer defines the lives of those affected but rather serves as a testament to their resilience and strength.

REFERENCES

https://www.childrensmercy.org/departments-and-clinics/gynecology/endometriosis-in-teens

https://www.yalemedicine.org/news/teens-endometriosis

https://www.medicalnewstoday.com/articles/endometriosis-in-teens

https://willowobgyn.com/blog/endometriosis-in-teens-what-you-need-to-know

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4432718/

Updated Post: August 7, 2024

2 years ago Endometriosis No comment

Endometriosis Vs Cancer Symptoms: How to Tell The Difference

Ovarian cancer and endometriosis are two conditions that can affect a woman’s reproductive system. It is very important to know how they might be related and how they differ. Ovarian cancer is relatively uncommon, with approximately 20,000 new cases found annually in the United States (lifetime risk is 1 in 78). At the same time, millions of women live with endometriosis (up to 1 in 10). Since they share some similar symptoms, you should know the differences between the two to get an accurate diagnosis and proper treatment. This article will explore how to tell the difference between ovarian cancer and endometriosis. 

Table of contents

• What is Endometriosis?
  • Symptoms of Endometriosis:
• What is Ovarian Cancer?
  • Symptoms of Ovarian Cancer:
• Navigating Specialist Care: Choosing the Right Expert for Endometriosis or Ovarian Cancer Concerns

What is Endometriosis?

Endometriosis is a condition where tissue similar to the lining of the inside of the uterus grows outside of the uterus, such as on the ovaries, fallopian tubes, and other organs in the pelvis and beyond. It can cause pain, infertility, and many other problems. A diagnosis can be suspected by symptoms, blood tests, and various scans, but surgery is the only way to determine if endo is present accurately. 

Symptoms of Endometriosis:

• Painful periods
• Pain during sex
• Chronic pelvic pain
• Bloating and pain after eating
• Fatigue
• Infertility

What is Ovarian Cancer?

Ovarian cancer is a type of cancer that begins in the ovaries and Fallopian tubes. It is often called the “silent killer” because it is difficult to detect in the early stages when it is more curable. Similar to endometriosis, a diagnosis can be suspected using scans and blood tests but the only way to be sure is a biopsy, which is usually performed during surgery. 

Symptoms of Ovarian Cancer:

• Bloating
• Pelvic pain or pressure 
• Abdominal pain, initially vague
• Difficulty eating or feeling full quickly
• Urinary symptoms, such as urgency or frequency

So, the symptoms are similar. But there are subtle innuendoes and some clear differences in Endometriosis and Ovarian Cancer findings and symptoms. 

1. Pain: While both endometriosis and ovarian cancer can cause pelvic and abdominal pain, the pain from endometriosis tends to be more cyclical, happening around the time of the menstrual cycle. The pain from ovarian cancer, on the other hand, is often more constant and dull. However, there is a lot of overlap, and endometriosis pain is variable.

2. Bloating: Bloating due to endometriosis can come and go and is usually caused by intestinal gas caused by endo-induced inflammation and related conditions such as small intestinal bacterial overgrowth (SIBO). Ovarian cancer bloating can also be due to gas and an accumulation of a fluid called ascites. This bloating of ovarian cancer usually worsens and does not come and go. 

3. Age: Endometriosis is typically diagnosed in women of reproductive age, while the most common type of ovarian cancer is usually found in women over 50. Again, there is some overlap, and endo can persist into menopause, or symptoms can even begin after menopause.  

4. Family history: Women with a family history of ovarian cancer are at a higher risk of developing the disease, and there are genetic links that can be tested for. Conversely, endometriosis does not have a clear genetic link but also runs in families. 

5. Symptom duration: The symptoms of endometriosis tend to develop gradually over time (years), while the symptoms of ovarian cancer may come on more suddenly (weeks to months), and bloating can be more pronounced and unremitting.  

In general, ovarian cancer presents an immediate threat to life. Endo, on the other hand, presents a lifelong threat to the quality of life, which may stretch over decades. Unfortunately, the two can overlap because the risk of developing ovarian cancer in women with endometriosis is elevated by 1.5 to 3-fold. That worrisome increase in risk still represents a tiny percentage. But even a fraction of one percent of millions of women means thousands or tens of thousands can be affected. Expert opinion from a specialist and possibly genetic testing can help determine your risk. Research is underway to discover gene-driven biomarkers that will allow more accurate diagnosis. 

It is important to note that both endometriosis and ovarian cancer can have overlapping symptoms, and some women may end up with both conditions simultaneously. If you are experiencing any of the symptoms mentioned above, it is important to talk to your healthcare provider. Many other conditions can cause the symptoms listed. But it’s better to be safe than sorry if they seem to persist and not go away. In other words, for example, everyone can have a bout of stomach flu with bloating, nausea, and painful diarrhea, but it usually passes over a few days to a week. Any unusual symptoms that go longer than that should be evaluated.

Navigating Specialist Care: Choosing the Right Expert for Endometriosis or Ovarian Cancer Concerns

In conclusion, endometriosis and ovarian cancer are distinct conditions affecting the female reproductive system. While they share some similar symptoms, such as pelvic pain, there are substantial differences that can help distinguish between the two. By understanding the differences between endometriosis and ovarian cancer, you and your doctor can take appropriate steps to get the right diagnosis and treatment.  

Getting an expert opinion from a specialist can be critical to get you on the right path for diagnosis and treatment. But, in a situation where you may be worried about both endo and cancer, perhaps because you are older or have a worrisome family history, what type of specialist should you seek for that opinion? In most cases, a general gynecologist can point you in the right direction. But if the concern is not heard and you are left wondering, an endometriosis specialist would be a good bet if endo seems to be most likely. If both are a concern due to your symptoms, age, or family history, then a gynecologic oncologist may be the better bet or an additional opinion to seek. There are a few gynecologic oncologists out there that truly specialize in both endo and ovarian cancer.  

Serdar EB et al Epithelial Mutations in Endometriosis: Link to Ovarian Cancer. Endocrinology 2019 Mar 1;160(3):626-638.

2 years ago Endometriosis No comment

Understanding the Connection between Endometriosis and Cancer Risk

Table of contents

• Endometriosis and Cancer Risk Transformation
• Endometriosis and Cancer Risk for Ovarian
• Endometriosis and Thyroid Cancer
• Endometriosis and Breast Cancer
• Endometriosis and Cervical Cancer
• Endometriosis and Cancer Risk
• Managing Your Endometriosis and Cancer Risk
• Endometriosis and Cancer: A Systematic Review and Meta-Analysis

Endometriosis and cancer are very different conditions, but unfortunately, they share some connections. Endometriosis is a benign, painful condition where the tissue that resembles the internal lining of the uterus grows outside of it inside your abdomen and pelvis (and sometimes beyond), causing inflammation and scarring. That reaction causes pain and usually impacts fertility as well. On the other hand, cancer is an uncontrolled malignant growth of abnormal cells that can spread throughout the body and kill.

While endometriosis is not cancerous, it can still act like cancer by directly invading tissues and organs or spreading through the lymphatic and blood systems. Research suggests that there may be molecular links between endometriosis and certain types of cancer, rooted in genetics and epigenetics (the study of how your environment turns genes on and off). Here’s what you need to know.

The overall endometriosis and cancer risk of developing cancer of different types seems to be slightly increased in women with endometriosis. Additional studies point to increased cancer risk in patients with the closely related condition of adenomyosis. The reasons for this are unclear, although molecular connections are being uncovered, and the risk differs by cancer type. 

Endometriosis and Cancer Risk Transformation

Endometriosis cells themselves can directly transform or degenerate into cancer. The specific types are clear cell, endometrioid, and, more rarely, stromal sarcoma. No one knows the exact percentage because of the under-reporting of both endometriosis and these cancer transformation events. However, the estimation is only a fraction of 1%. This transformation is a tiny percentage, but if you consider that millions of women have endometriosis, even a tiny percentage means tens of thousands of women may be at risk. 

Endometriosis and Cancer Risk for Ovarian

Endometriosis has been linked to an increased risk of developing certain types of ovarian cancer. Studies have found that women with endometriosis are more likely to develop clear cell and endometrioid ovarian cancers than women without the condition. In fact, the risk is estimated to be between 1.5 to 3 times higher in women with endometriosis. The risk is highest when endometriosis significantly involves the ovaries, such as the presence of endometriomas. 

The reasons for this link are not entirely clear. Still, it is thought that the inflammation and scarring caused by endometriosis may increase the risk of cancerous mutations or epigenetic events in the cells. It’s important to note that while the risk has increased, most women with endometriosis will not develop ovarian cancer. However, just as with direct malignant transformation, a small percentage of millions of women with endo can still mean thousands to tens of thousands of women can be affected.  

Endometriosis and Thyroid Cancer

A smaller but statistically significant 1.4-fold higher risk for thyroid cancer has been consistently reported in multiple studies. The reason for this is unknown, but some researchers suggest this link may be based on autoimmunity disorders, which can be shared between endometriosis, thyroid disease, and cancer.

Endometriosis and Breast Cancer

There is also some evidence to suggest that there may be a tiny link between endometriosis and breast cancer, amounting to only about 4% increased risk. Other studies point to a somewhat higher risk. However, this link is not as well established as the link between endometriosis and ovarian cancer, and more research is needed to confirm it.

Endometriosis and Cervical Cancer

Unlike ovarian and breast cancer, there is no clear link between endometriosis and cervical cancer. In fact, a handful of studies suggest that there may be a reduced risk of cervical cancer in women with endometriosis. The reason for this is unknown. 

Endometriosis and Cancer Risk

While one might think there may be an association with uterine endometrial cancer, this may or may not be the case. A recent meta-analysis (review of multiple studies) suggested no risk, while other studies have reported a significantly increased risk of endometrial cancer in women with endometriosis and adenomyosis. 

Similarly, there is conflicting information regarding colorectal cancer or skin cancers, including melanoma, leukemia, lymphoma, urinary cancers, and gastric or liver cancer. Of note, while a number of studies reported no increased risk for colon cancer, one study suggested the risk may be as high as thirteen-fold.

Managing Your Endometriosis and Cancer Risk

If you have endometriosis, it’s important to be aware of the potential risks of cancer and take steps to manage your risk. These steps may include regular cancer screening, maintaining a healthy lifestyle, and talking to your doctor about any concerns. In some cases, you may have a genetically founded increased risk. If cancer and/or endometriosis runs in the family, it may be best to consult with an expert. If you are older and have endometriosis, it may also be best to seek expert consultation. It’s important to be aware and proactive, but it’s also important to remember that while the risk may be increased, most women with endometriosis will not develop cancer.

Endometriosis and Cancer: A Systematic Review and Meta-Analysis

Marina Kvaskoff, Yahya Mahamat-Saleh, Leslie V Farland, Nina Shigesi, Kathryn L Terry, Holly R Harris, Horace Roman, Christian M Becker, Sawsan As-Sanie, Krina T Zondervan and more.

Human Reproduction Update, Volume 27, Issue 2, March-April 2021, Pages 393–420,

2 years ago Endometriosis No comment

Endometriosis vs. PCOS: What’s the Difference?

Table of contents

• Understanding Endometriosis: A Journey Beyond the Uterus
  • Symptoms of Endometriosis
  • Potential Causes and Risk Factors
• Exploring Polycystic Ovary Syndrome (PCOS): A Hormonal Imbalance
  • Symptoms of PCOS
  • Potential Causes and Risk Factors
• Distinguishing Endometriosis from PCOS: Key Differences
• Diagnostic Approaches: Unraveling the Mysteries
  • Diagnosing Endometriosis
  • Diagnosing PCOS
• Treatment Strategies: Tailored Approaches for Optimal Outcomes
  • Treatment Options for Endometriosis
  • Treatment Options for PCOS
• Coping Strategies: Embracing Holistic Well-Being
  • Emotional and Mental Health Support
  • Lifestyle Modifications
  • Complementary and Alternative Therapies
• Endometriosis and PCOS: Navigating the Journey Together
• Seeking Support: Empowering Advocacy and Awareness
• Conclusion: Embracing Hope and Resilience

Endometriosis and Polycystic Ovary Syndrome (PCOS) are two distinct conditions that profoundly impact the lives of countless people assigned female at birth (AFAB). While these disorders both impact the menstrual cycle and share concerns regarding fertility, they are fundamentally different in their underlying causes, manifestations, and treatment approaches. Unraveling the intricacies of these conditions is crucial for accurate diagnosis, effective management, and improved quality of life for those affected.

Understanding Endometriosis: A Journey Beyond the Uterus

Endometriosis is a complex disorder characterized by the abnormal growth of endometrial-like tissue outside the uterus. These lesions are mediated by hormones and respond to the hormonal fluctuations of the menstrual cycle, leading to inflammation, scarring, and the formation of adhesions or cysts. Endometriosis can affect various organs within the pelvic region, including the ovaries, fallopian tubes, bladder, and intestines, causing a range of debilitating symptoms.

Symptoms of Endometriosis

• Severe pelvic pain, particularly during menstrual periods (dysmenorrhea)
• Heavy or prolonged menstrual bleeding (for some individuals, not all)
• Painful intercourse (dyspareunia)
• Intestinal discomfort, such as diarrhea, constipation, or bloating, and dyschezia
• Urinary problems, like frequent urination or painful urination (dysuria)
• Infertility or difficulty conceiving
• Chronic fatigue and exhaustion

Potential Causes and Risk Factors

While the exact cause of endometriosis remains elusive, several theories have been proposed to explain its development:

• Retrograde menstruation: This theory suggests that during menstruation, endometrial cells flow backward through the fallopian tubes and implant in the pelvic cavity or other organs, and under the influence of various factors, they become endometriosis lesions. While this theory has long been thought to be the cause, evidence suggests otherwise.
• Embryonic cell migration: Endometrial-like cells may originate from embryonic cells that migrate to other areas during fetal development and become endometriosis lesions.
• Immune system dysfunction: An impaired immune system may fail to recognize and eliminate misplaced endometrial tissue, allowing it to proliferate.
• Genetics and family history: Endometriosis tends to run in families, suggesting a potential genetic component.

Exploring Polycystic Ovary Syndrome (PCOS): A Hormonal Imbalance

Polycystic ovarian syndrome (PCOS) is not classified as a disease but as a syndrome involving a number of factors that affect people assigned to females at birth during the reproductive years. It is characterized by an imbalance of reproductive hormones, primarily involving excess production of androgens (testosterone and DHEA), anovulatory cycles, insulin resistance, and infertility, resulting in a range of symptoms and complications, including irregular menstrual cycles, infertility, and metabolic issues.

Symptoms of PCOS

• Irregular or absent menstrual periods
• Excessive hair growth (hirsutism) on the face, chest, or back
• Acne or oily skin
• Thinning hair or male-pattern baldness
• Weight gain or difficulty losing weight
• Ovarian cysts (although not present in all cases)
• Infertility or difficulty conceiving

Potential Causes and Risk Factors

The exact cause of PCOS is not fully understood, but several factors are believed to contribute to its development:

• Insulin resistance: Insulin resistance, a condition in which the body’s cells become less responsive to insulin, can lead to elevated levels of insulin and androgens.
• Genetics: PCOS tends to run in families, suggesting a genetic component.
• Obesity: Being overweight or obese can exacerbate insulin resistance and hormonal imbalances associated with PCOS; however, the inflammatory nature of the disease may also be the cause of obesity.
• Inflammation: Chronic low-grade inflammation may play a role in the development of PCOS.

Distinguishing Endometriosis from PCOS: Key Differences

While endometriosis and PCOS are associated with menstrual problems, there are several distinct differences that set these conditions apart:

1. Hormonal Imbalances: Endometriosis is associated with estrogen and progesterone resistance, while PCOS is characterized by excess androgen production.
2. Menstrual Irregularities: Women with endometriosis often experience painful periods, while those with PCOS may have irregular or absent periods due to anovulation (lack of ovulation), which is not associated with pain.
3. Ovarian Cysts: While ovarian cysts are not always present in PCOS, they are a common feature of the condition and are often small cysts. In contrast, endometriosis can cause the formation of endometriomas (a type of endometriosis ) on the ovaries.
4. Pain and Discomfort: Endometriosis is often associated with severe pelvic pain, painful intercourse, and gastrointestinal discomfort, whereas these are not associated with PCOS.
5. Fertility Challenges: Both conditions can contribute to infertility, but the underlying mechanisms differ. Endometriosis can cause scarring and adhesions that interfere with fertility, while PCOS often leads to anovulation and hormonal imbalances that disrupt ovulation and conception.
6. Metabolic Complications: PCOS is closely linked to metabolic disorders such as insulin resistance, obesity, and an increased risk of developing type 2 diabetes, while these associations are less common in endometriosis; instead, endometriosis is often associated with other auto-immune conditions.

Diagnostic Approaches: Unraveling the Mysteries

Diagnosing endometriosis and PCOS can be challenging, as both conditions share some overlapping symptoms and may require a combination of tests and evaluations.

Diagnosing Endometriosis

• Medical History and Physical Examination: A healthcare provider will gather information about symptoms, menstrual history, and family history of endometriosis.
• Pelvic Exam: A pelvic examination may reveal abnormalities, such as ovarian cysts or scarring, which can indicate the presence of endometriosis.
• Imaging Tests: Ultrasound or magnetic resonance imaging (MRI) may be used to visualize endometrial lesions, cysts, or other abnormalities in the pelvic region.
• Laparoscopy: This minimally invasive surgical procedure involves inserting a small camera into the abdomen to directly visualize and potentially biopsy (remove a tissue sample) any endometriosis lesions. .

Diagnosing PCOS

• Medical History and Physical Examination: A healthcare provider will gather information about menstrual irregularities, hirsutism (excess hair growth), acne, and other symptoms associated with PCOS.
• Blood Tests: Blood tests may be performed to assess hormone levels, including androgens, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and insulin levels.
• Pelvic Ultrasound: An ultrasound examination can help identify the presence of ovarian cysts or other abnormalities in the ovaries.
• Exclusion of Other Conditions: PCOS is often diagnosed by ruling out other potential causes of irregular periods or androgen excess.
• Combination of Symptoms: PCOS typically requires three of four specific criteria, including the presence of ovarian cysts, signs or symptoms of androgen excess, insulin resistance, and anovulatory cycles. 

Treatment Strategies: Tailored Approaches for Optimal Outcomes

The treatment of endometriosis and PCOS is tailored to each individual’s specific needs, taking into account factors such as symptom severity, fertility goals, and overall health status.

Treatment Options for Endometriosis

• Pain Management: Over-the-counter or prescription pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may be prescribed to alleviate pelvic pain and menstrual cramps.
• Hormone Therapy: Hormonal treatments, such as birth control pills, progestin-only therapy, or gonadotropin-releasing hormone (GnRH) agonists, may have some impact on suppressing the growth of endometriosis  and managing symptoms, though these options are only short-term while on the medications and can have some serious side effects.
• Surgery: In some cases, surgical interventions may be recommended to remove endometrial lesions or cysts, or to address complications such as adhesions or scarring.
• Lifestyle Modifications: Adopting a healthy diet, regular exercise, stress management techniques, and other lifestyle changes can help manage endometriosis symptoms and improve overall well-being.

Treatment Options for PCOS

• Lifestyle Modifications: Weight loss through a balanced diet and regular exercise can help improve insulin sensitivity, regulate hormone levels, and alleviate symptoms of PCOS.
• Insulin-Sensitizing Medications: Drugs like metformin may be prescribed to improve insulin sensitivity and regulate menstrual cycles.
• Hormonal Therapy: Birth control pills or other hormonal contraceptives can help regulate menstrual cycles, reduce androgen levels, and alleviate symptoms like hirsutism and acne.
• Fertility Treatments: For women with PCOS struggling with infertility, medications like clomiphene citrate or letrozole may be prescribed to induce ovulation, or assisted reproductive technologies like in vitro fertilization (IVF) may be recommended.

Coping Strategies: Embracing Holistic Well-Being

Both endometriosis and PCOS can have a profound impact on physical, emotional, and mental well-being. Adopting a holistic approach that addresses various aspects of health can be beneficial in managing these conditions and improving overall quality of life.

Emotional and Mental Health Support

• Seek counseling or join support groups to cope with the emotional challenges associated with endometriosis or PCOS.
• Practice stress-reduction techniques, such as mindfulness meditation, yoga, or deep breathing exercises, to manage anxiety and promote relaxation.
• Prioritize self-care activities that bring joy and fulfillment.

Lifestyle Modifications

• Maintain a balanced and nutritious diet rich in anti-inflammatory foods, such as fruits, vegetables, whole grains, and lean proteins.
• Engage in regular physical activity, tailored to individual capabilities and preferences, to promote overall health and well-being.
• Establish a consistent sleep routine and prioritize adequate rest and relaxation.

Complementary and Alternative Therapies

• Explore complementary and alternative therapies, such as acupuncture, herbal remedies, or massage therapy, which may help alleviate symptoms and promote relaxation.
• Consult with healthcare professionals before incorporating any alternative therapies to ensure safety and compatibility with existing treatments.

Endometriosis and PCOS: Navigating the Journey Together

While endometriosis and PCOS are distinct conditions, it is possible for some individuals to experience both simultaneously. In such cases, a comprehensive and collaborative approach involving multiple healthcare professionals, such as gynecologists, endocrinologists, and fertility specialists, may be necessary to address the unique challenges and develop a personalized treatment plan.

Seeking Support: Empowering Advocacy and Awareness

Endometriosis and PCOS can be isolating and misunderstood conditions, which is why seeking support and raising awareness are crucial. By connecting with support groups, advocacy organizations, and healthcare professionals, individuals can access valuable resources, share experiences, and contribute to advancing research and understanding of these conditions.

Conclusion: Embracing Hope and Resilience

Endometriosis and PCOS present unique challenges, but with proper diagnosis, tailored treatment strategies, and a supportive network, individuals can navigate these conditions with resilience and hope. By understanding the distinctions between endometriosis and PCOS and embracing a holistic approach to well-being, women can reclaim control over their health and pursue their dreams with confidence and determination.

REFERENCES

https://www.medicalnewstoday.com/articles/endometriosis-vs-pcos

https://www.aucmed.edu/about/blog/endometriosis-vs-pcos-explained

https://www.aucmed.edu/about/blog/endometriosis-vs-pcos-explained

https://www.healthline.com/health/womens-health/endometriosis-vs-pcos

https://www.kofinasfertility.com/patient-info/pcos-and-endometriosis

Updated: August 9, 2024

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