Living With Endometriosis

Living with endometriosis is more than just a painful menstrual cycle. This condition, which occurs in 10 percent of women, can impact your sex life, ability to have children and alter your day-to-day life.

This blog will address how some simple dietary changes, along with certain medical treatments, can help you live a more enjoyable life with endometriosis. 

What does endometriosis feel like?

Endometriosis occurs when tissue similar to that found in the uterine lining grows abnormally in your pelvic organs – uterus, ovaries, fallopian tubes, intestines or bladder. Each month, the abnormal tissue sheds without anywhere to go, causing lesions, adhesions and cysts to form in these areas.

Some women with endometriosis have mild or no symptoms at all. Those with symptoms typically experience painful menstrual cramps, painful intercourse, pelvic pain or infertility.

Menstrual cramps

Menstrual cramps are a normal part of a woman’s monthly cycle. However, severe cramping, called dysmenorrhea, can occur due to endometriosis. This pain becomes symptomatic either before or after your cycle. Heavy bleeding may also coincide with the painful cramps. You may also experience pain while urinating or having a bowel movement.

Painful Intercourse

When having sexual intercourse, certain positions and the depth of penetration can become painful. In most cases, this pain comes from coming in contact with scar tissue, a cyst, lesions, or adhesions.

The location, not the size, of the abnormal tissue determines how severe the pain is. For example, tissue behind the vagina and uterus can become painful. In healthy women, a layer of tissue separates the vagina, uterus and rectum. Endometriosis tissue can adhere to these organs, sometimes fusing them together to create limited mobility. 

Talk to your partner if you experience painful sex. Often, the presence of pain can become cyclical by creating anxiety and doubt. Then, when engaging in intercourse, the anxiety and stress can cause the vagina to tighten, making intercourse even more painful.

While eliminating intercourse altogether is an option, some women find relief simply by timing when to have sex with their partner. The time before and after a menstrual cycle may not be as painful.

Pelvic and abdominal pain

Pelvic and lower abdominal pain occurs due to abnormal tissue growth on or around organs in these areas – ovaries, fallopian tubes, uterus, rectum, colon and bladder. This pain isn’t limited to menstrual cycles, either. Some people with endometriosis experience constant, chronic pain.

Even people with stage 1 endometriosis can still have significant pain due to lesions that have their own nerve connections. These nerves still send signals to your brain to signify pain, even if there are only a few lesions.

Because the abnormal tissue can interfere with the lower digestive tract, such as the colon and rectum, endometriosis may also produce pain during bowel movements. In some cases, it can impact the intestine’s ability to absorb water (causing diaherra) or when stool moves too slowly through the colon (constipation). It can also affect the bladder, which can make it difficult to urinate.

Infertility

The impact of endometriosis goes beyond physical pain and discomfort. Anywhere from 30 to 50 percent of women with endometriosis can experience infertility. Women with moderate to severe endometriosis have a monthly pregnancy rate of less than 2 percent compared to 2 to 4.5 percent for mild endometriosis and 15 to 20 percent for women without endometriosis, according to the American Society for Reproductive Medicine.

It’s unclear what the exact cause of infertility is, but the presumed theory involves inflammation that disrupts the joining of the sperm and egg to form an embryo. When large lesions, adhesions or cysts are present, infertility may become higher due to a physical blockage. For instance, a growth near the ovary can prevent eggs from releasing.

Endometriosis stages

Endometriosis can be classified as one of four stages via a system developed by the American Society of Reproductive Medicine. Using specific criteria, endometriosis is scored using a numerical point system based on the location of the tissue, the number of implants and the depth of the implants. 

Most women with endometriosis fall under the minimal or mild category, although it’s important to note staging doesn’t factor in severity of symptoms. In other words, a person with endometriosis may experience severe pain with a stage 1 diagnosis of just a few implants while someone with a stage 3 diagnosis may have no symptoms at all.

Stage 1: Minimal – This category includes few superficial implants.

Stage 2: Mild – This category includes more implants that are deeper.

Stage 3: Moderate – This category includes many deep implants, including small cysts on the ovaries. These blood-filled cysts are called endometriomas, or chocolate cysts, due to their deep, brown color. There is also the presence of filmy adhesions.

Stage 4: Severe – This category includes many deept implants, including large cysts on the ovaries as big as a grapefruit. There are also many dense adhesions. Severe endometriosis can cause scarring, fallopian tube blockages and ovary damage.

Endometriosis diet

The abnormal tissue associated with endometriosis can lead to inflammation that causes pain and swelling. One way to help control this inflammation – or at least not make the existing inflammation worse – is through the foods you eat.

What to eat

One way to fight inflammation is to load up on foods with antioxidant properties. Many fruits and vegetables contain polyphenols, which are chemicals found in plants. Polyphenols can have antioxidant properties that help fight inflammation.

Examples of foods naturally high in antioxidants include:

• Berries
• Apples
• Leafy greens (spinach, kale)
• Sweet potatoes
• Tomatoes
• Citrus fruits
• Nuts
• Carrots
• Legumes
• Peppers
• Eggs

Because vitamin B1 and magnesium have been shown to reduce symptoms associated with menstrual cramps, they may also help relax painful reproductive organs affected by endometriosis. Whole grains, nuts, seeds, legumes and certain fruits and vegetables (oranges, spinach, avocado and kale) are high in these minerals.

For more information, here are more foods to eat to reduce inflammation.

As for estrogen, regular bowel movements help the body remove excess estrogen. Foods high in fiber, such as fruits, vegetables, whole grains and legumes, add bulk to stool to help it move through the digestive tract.

What not to eat

Any food that has pro-inflammatory properties should be avoided if you have endometriosis. This includes:

• Coffee and other caffeinated beverages
• Large quantities of alcohol
• Protein high in saturated fat, such as red meat and pork
• Added sugars
• Processed foods
• Fried foods

How to treat endometriosis

Pain medications and hormonal therapy are usually the first line of defense to treat endometriosis. In more severe cases, surgery is required to remove growths.

Pain medications

Pain relievers, such as over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), may help reduce mild symptoms associated with endometriosis. Prescription pain relievers can also be given by your doctor for more severe symptoms.

Hormonal therapy

Much like a menstrual cycle, endometriosis uses hormones to go through a cycle. Hormonal therapy can help relieve symptoms by altering hormone levels.

For women who aren’t trying to become pregnant, birth control pills, progestins and gonadotropin-releasing hormone (GnRH) agonists can help slow or stop the growth of endometriosis tissue.

Birth control pills: Administered orally, these pills usually contain estrogen and progestin (synthetic progesterone) to reduce both the duration and heaviness of a period.

Progesterone/progestin: Administered orally, by injection or through an implanted device, these medications reduce menstrual flow and can help reduce the size of lesions.

Danazol: Administered orally, this male hormone makes growths inactive so they can’t grow. It also lowers estrogen levels to help reduce symptoms.

GnRH agonists: Administered orally, by injection or nasal spray, this medication prevents ovulating and menstruation by lowering estrogen levels to menopause levels.

Surgery

Women who wish to become pregnant or who experience infertility often choose surgical interventions to help endometriosis.

Surgical options include the following procedures:

• Laparoscopy: This type of minimally-invasive surgery involves a tiny camera with a light attached that is inserted through a small incision. Once inside the pelvis, a surgeon can then excise (remove) or cauterize (destroy) the lesions. Scar tissue can also be removed during this procedure.
• Laparotomy: Considered a major surgery with a larger incision, a laparotomy is an abdominal procedure that removes larger growths.
• Hysterectomy: Often viewed as a last resort treatment option, this surgery involves the removal of the uterus. In some cases, the ovaries and fallopian tubes are also removed in a procedure called a total hysterectomy and bilateral salpingo-oophorectomy. The major downside of a hysterectomy is you lose the ability to have children in the future.

If you or a family member are dealing with painful symptoms from endometriosis, know that there are options to help you live a better life with this condition. Contact your OBGYN to learn more about the treatment options and lifestyle changes that can provide relief.