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Endometriosis Awareness Month

by Allyson Augusta Shrikhande, MD, CMO

March is Endometriosis Awareness Month, dedicated to shining a spotlight on a serious chronic illness that affects one in ten women in the United States. While endometriosis has been gaining in visibility over recent years, with more organizations emerging to promote awareness and some celebrities like Chrissy Teigen and Padma Lakshmi coming forward to share their personal experiences with endo, we still have a long way to go in building greater understanding of this disorder among patients and healthcare providers alike. It’s so important to recognize the very real impact that this invisible illness has on people’s lives and promote awareness of the ways that it can be treated.

What does endometriosis do to the body?

Endometriosis is a disorder which causes tissue similar to the lining of the uterus to grow outside the uterus, creating lesions and growths in other parts of the anatomy, usually the pelvic and abdominal region. During menstruation, these lesions break down and bleed, but unlike ordinary uterine lining, there is no way for this tissue to leave the body. This may cause heavy periods, chronic pain and bloating, pain during or after sex, constipation, urinary urgency and other symptoms that can seriously disrupt your life. Over time it can even result in infertility and other chronic conditions.

The physical effects of endo are covered in greater detail in this previous Rosy post by Dr. Angie Stoehr.

How can endometriosis affect a person’s mental and emotional state?

Chronic pain often has a ripple effect that can dramatically impact your quality of life beyond the physical symptoms of the disorder. Living with endometriosis pain can cause stress, anxiety, and depression. It’s important to acknowledge the way that your illness is affecting your mental state and let your healthcare provider know how you are feeling emotionally.

These symptoms can also be addressed with one-on-one help from a cognitive behavioral psychologist. Other stress relief techniques may also prove helpful. Practices such as diaphragmatic breathing, muscle relaxation and meditation can help calm down the nervous system to promote feelings of calm, safety, and emotional wellness.

How can endo-related pain during intercourse be treated?

Pain during penetrative sex is a relatively common experience for people with endometriosis. This can be contributed to by a variety of factors including nerve inflammation and myofascial pain. Removing all lesions with proper excision surgery can be a major help in dealing with these issues. Beyond that, a comprehensive outpatient protocol with pelvic floor physical therapy, physiatry, cognitive behavioral therapy and medications as needed can help treat the muscle and nerve dysfunction that almost always comes with endometriosis.

Endometriosis Surgery: Ablation vs Excision

Ablation surgery and excision surgery are both procedures to remove endometrial lesions and alleviate endo pain, but there are significant differences between the two.

Ablation surgery is performed by using heat (laser or electrosurgery) to destroy endometriosis tissue. This is not the recommended type of surgery, as it frequently fails to fully remove lesions and they may regrow within a short period of time. Ablation surgery also has a higher likelihood of causing heat damage to healthy tissue.

Excision surgery is a procedure in which a surgeon cuts away all diseased tissue. While more difficult and time-consuming than ablation surgery, it has been proven to be more effective in removing all endometriosis lesions and reducing the likelihood of symptoms returning.

What other procedures may help alleviate endometriosis symptoms?

Pelvic floor physical therapy and ultrasound-guided trigger point and peripheral nerve block injections may also have positive results in treating the pelvic muscle and nerve dysfunction that can be a major factor in endometriosis-related pain. These treatments are designed to decrease nerve inflammation and compression by reversing muscle spasms in the pelvic floor. The goal is ultimately to heal the muscle and nerve dysfunction that causes pain and discomfort.

Endometriosis Awareness: Get Involved!

If you or someone you know has suffered from this invisible illness, you know how disorienting, frustrating, and isolating it can be. Just know that you’re not alone! Endometriosis awareness events for March can be found on the Endometriosis Foundation website, and you can see other people’s stories and join the conversation on social media by using hashtags like #endometriosisawareness and #1in10. Endo sucks - there’s no way around that - but there is help, treatment, and a growing community of support out there if you look for it!

Dr. Allyson Shrikhande, a board certified Physical Medicine and Rehabilitation specialist, is the Chief Medical Officer of Pelvic Rehabilitation Medicine. A leading expert on pelvic health and a respected researcher, author and lecturer, Dr. Shrikhande is a recognized authority on male and female pelvic pain diagnosis and treatment.