Physicians throughout history have had to confront disease.  As the centuries have marched on, we have been able to identify and categorize different types of disease and give that disease a name.  Not only that but we have made leaps and bounds in the treatment of diseases and chronic conditions.  We are living longer and living better because of the advances of science and medicine.  Each month the National Institutes of Health (NIH) promotes different diseases and conditions to enlighten Americans about prevention and treatment.  March is Endometriosis Awareness Month.

Endometriosis affects about 10% of women in their reproductive ages.  It can affect women who have it in many different ways.  It can be a source of chronic pain, dysmenorrhea (painful periods), infertility, dysparunea (painful sex), and/or a pelvic mass.  For those women who are bothered by endometriosis, the American Society of Reproductive Medicine (ASRM) classifies it as a chronic disease that  requires a life long management plan.

What is endometriosis?  It is the presence of endometrial glands and stroma outside of the uterus.  Normally, the endometrial glands and stroma line our uterus and it sloughs off each month to give us our cycle.  When it is found in our abdomen or pelvis, it can be a source of pain or cause infertility.  It can cause a mass to form called an endometrioma, or it can block the fallopian tube preventing pregnancy.  It can also cause scar tissue to form that can cause pain with sex, bowel movements, and menstrual cycles.   In some instances, it does not bother the woman in any way.  Endometriosis is estrogen dependant, and usually disappears with pregnancy or with menopause.

There have been extensive studies to determine how best to treat a patient who is affected by endometriosis.  What science has found is that there is no one treatment that is better than any other.  There are many treatment plans and for most, the treatment needs to be individualized.  Your physician can discuss all the options from prescription medications to surgery.

For those who are bothered by the pain and discomfort of endometriosis, there are some simple things you can try at home.  NSAIDS such as ibuprofen or naproxen have been found to work the best in ameliorating pain from endometriosis.  Heating pads, relaxation techniques, and exercise can help reduce pain.  For those who have painful intercourse, position changes may help reduce pain.  Several medical studies have not found any herbal supplement helpful.  One study found that auricular (ear) acupuncture was better than Chinese herbal medications.  There are no dietary guidelines for the treatment or prevention of endometriosis although a diet high in fruits, vegetables, and fiber may help reduce painful bowel movements.

Endometriosis can be very difficult to treat.  What one treatment works for one woman will not work for another.  Patients, families, and even physicians can become frustrated when an effective treatment plan remains elusive.  If you want to know more about endometriosis, the American Society of Reproductive Medicine (ASRM) has a booklet on this very subject.  You can find it under patient resources.

Cynthia Wilkes MD

Stafford Womens Health Associates

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