What is Endometriosis?
Endometriosis is a painful condition that affects the tissue lining the inside of your uterus, known as the endometrium.(1) In this disorder, the tissue starts growing outside the uterus and commonly affects the fallopian tubes, ovaries, and the tissues lining the pelvis. In some rare cases, endometrial tissue can also spread beyond the pelvic organs and affect the abdomen as well.
One of the most common symptoms of endometriosis is chronic and severe pain, which tends to be worse around ovulation and menstruation.
Symptoms of endometriosis include:(2)
- Severe cramping
- Painful intercourse
- Very tight pelvic floor muscles
- Discomfort during urination and bowel movements
- Painful periods
- Excessive bleeding during menstruation
- Diarrhea or constipation
These symptoms are known to interfere with your everyday life.
There is no cure for endometriosis, but there are treatments that help you manage your symptoms. The effectiveness of the various treatments available varies from person to person, and the overall goal remains to stop the pain or at least improve the pain from endometriosis.
What are the Pain Relief Options with Endometriosis?
Pain Relief with Medications
There are both over-the-counter and prescription medications available that are used as the first option for pain management in endometriosis. In cases of moderate to severe endometriosis, many women find that over-the-counter pain drugs are not potent enough for addressing the pain. In this case, you can discuss with your doctor to find out about which prescription drugs will be best suited for you, depending on your symptoms and severity of your condition.
The most commonly used pain medication in endometriosis is non-steroidal anti-inflammatory drugs (NSAIDs). There are many over-the-counter NSAIDs available, including aspirin, ibuprofen, and naproxen. NSAIDs are also available on prescription.(3)
NSAIDs are useful for managing endometriosis pain as it blocks the development of prostaglandins, which is a type of biological compounds that are produced by the body. Prostaglandins are responsible for causing the swelling, pain, and inflammation that most women with endometriosis experience during menstruation and ovulation.
However, in order for NSAIDs to be useful for endometriosis, they need to be taken before your body begins producing prostaglandins, the pain-causing compounds. So if you are taking NSAIDs for managing the pain of endometriosis, you need to start taking them at least 24 to 48 hours before you begin ovulation and also before the first day of your menstrual cycle. This allows the medication time to block the development of the pain-causing prostaglandins in the body. If you have irregular periods, or if your periods are unpredictable, then your doctor might recommend that you start taking your pain medication for the whole week that leads up to your periods.
It is important to keep in mind that the same drugs do not work for everyone. Your doctor may suggest that you try a couple of different NSAIDs, or even a combination of other therapies along with NSAIDs, for getting pain relief. However, some NSAID medications should never be combined with other medicines. So make sure that you talk to your doctor before you begin any new medicines.(4)
Pain Relief with Hormone Therapy
Hormone therapy is another effective treatment of the pain associated with endometriosis as it controls the hormonal spikes that take place during your menstrual cycle. Hormonal therapy reduces or even stops menstruation altogether, thus relieving the pain. However, if you are trying to become pregnant, then hormone therapy is not an option for you.
The hormones that are released by your body around ovulation time and during your periods are known to cause a worsening of your endometriosis symptoms. This can also lead to scarring of the pelvis tissue or even make existing scarring worse.
The ultimate goal of hormone therapy is to prevent new or further scarring by maintaining your hormones at a steady level.(5)
There are several types of hormonal treatment available for endometriosis. These include:
Hormonal Birth Control
Many doctors prefer to prescribe hormonal birth control for controlling the symptoms and pain of endometriosis. In fact, combination birth control pills have been used for treating endometriosis since the 1950s. They are also considered to be one of the major treatments of endometriosis. Some other forms of birth control that are often prescribed for endometriosis include:
- Hormonal Intrauterine Device (IUD)
- Vaginal Rings
- Vaginal Patches
Commonly, though, oral contraceptives are used. Your doctor may recommend that you take the pill continuously, which means that you will stop having your periods altogether. This will also prevent the pain that goes along with it. In most cases, it is safe to skip having your periods for several months, or sometimes even a few years.(6)
Gn-RH Agonists and Antagonists
Gonadotropin-releasing hormone (Gn-RH) is used to put the body into a condition of artificial menopause. It helps decrease your estrogen levels and also stops both the processes of ovulation and menstruation. This, in turn, helps reduce or thin endometrial scarring.(7)
These medications are available for use in different forms – nasal spray, injection, and a daily pill.
Another treatment option for endometriosis is progestin therapy. It is believed that progestins play a role in decreasing the symptoms of endometriosis as it slows down endometrial scarring. Your doctor might recommend that you use a progestin injection, IUD, or even a pill for managing your symptoms, including pain.(9)
Hormonal therapies can be highly effective in decreasing the symptoms and pain of endometriosis. However, it is important that you remember that if you stop taking the progestin therapy at any time, then your symptoms might return.(10)
Pain Relief with Surgery
Surgical intervention is also another pain relief solution to endometriosis and its symptoms. This option involves treating the condition by removing all the endometrial lesions that are the primary source of pain. There are many types of surgery that can be used for this and according to the Endometriosis Foundation of America(11), the laparoscopic excision surgery is considered to the gold standard when it comes to endometriosis surgical options.(12)
Laparoscopic excision surgery is usually known to a more conservative approach to treating endometriosis, meaning that the surgery intends to preserve as much healthy tissue as possible while removing the endometrial lesions at the same time.
In 2016 a review published in the Women’s Health journal noted that surgery for endometriosis could be useful at alleviating the pain of endometriosis.(13)
In 2018, another study carried out by the University of Birmingham and published in BMJ(14) reported that laparoscopic excision surgery was effective in treating pelvic pain as well as bowel-related symptoms of endometriosis. The study further noted that the surgery helped to improve the overall quality of life for those who are living with endometriosis. The researching team had over 4,000 participants who were from different medical centers.
In the past, more invasive surgeries such as oophorectomy and hysterectomy were considered to be the best treatments for endometriosis. The surgeries focus on removing the ovaries and the uterus, respectively. However, these are no longer recommended for most women because even if the ovaries and uterus are removed, it is still possible for endometrial lesions to grow back or occur in other places.(15)
At the same time, it is important to keep in mind that undergoing surgery for endometriosis does not guarantee long-term relief. It is possible for endometrial lesions and the pain associated with them, to recur after the procedure.(16)
Alternative and Complementary Therapies for Endometriosis Pain Relief
Finding the treatment that is just right for helping you get relief from endometriosis pain is a process of trial and error. There are also some alternative and homeopathic treatment options that can be combined with your ongoing medical therapy. However, it is essential to remember that you must always discuss with your doctor before trying out any new treatment.
Some alternative therapies for pain relief in endometriosis may include:
Acupuncture: There is minimal research on whether or not acupuncture can help in the treatment of endometriosis. However, in 2017, a review of several existing studies found that acupuncture can actually help provide pain relief in endometriosis.(17)
Heat: Something as simple as heating pads and warm baths can help provide relief from pain in endometriosis. The heat helps relax tight muscles and gets the blood flowing better, thus relieving pain.(18)
TENS Machines: TENS devices stand for transcutaneous electrical nerve stimulation machines. These machines emit a low-level electrical current that helps reduce pain and also soothes the muscles.(19) A small study published in the European Journal of Obstetrics & Gynecology and Reproductive Biology in 2015 found that the TENS machines are very useful in decreasing pain, even when the treatment is self-administered.
Stress Relief: Stress is a significant factor linked to chronic inflammation and pain. It is known to also affect the hormone levels in the body. Practicing stress management methods such as yoga, coloring, walking, cycling, meditation, and regular exercise, can help keep your stress levels under control.
Endometriosis is a painful condition that tends to worsen during ovulation and menstruation. You can try the different pain relief therapies mentioned here to find out which one works best for you and helps you manage the pain and other symptoms effectively. Also, discuss your pain relief options with your doctor and find out about any alternative treatments that your doctor might recommend.
- Giudice, L.C., 2010. Endometriosis. New England Journal of Medicine, 362(25), pp.2389-2398.
- Jean Hailes For Women’s Health. (2019). [online] Available at: https://jeanhailes.org.au/health-a-z/endometriosis/symptoms-causes [Accessed 9 Aug. 2019].
- Efstathiou, J.A., Sampson, D.A., Levine, Z., Rohan, R.M., Zurakowski, D., Folkman, J., D’Amato, R.J. and Rupnick, M.A., 2005. Nonsteroidal antiinflammatory drugs differentially suppress endometriosis in a murine model. Fertility and sterility, 83(1), pp.171-181.
- Rodgers, A.K. and Falcone, T., 2008. Treatment strategies for endometriosis. Expert opinion on pharmacotherapy, 9(2), pp.243-255.
- Barbieri, R.L., 1992. Hormone treatment of endometriosis: the estrogenthreshold hypothesis. American journal of obstetrics and gynecology, 166(2), pp.740-745.
Center for Young Women’s Health. (2019). Endometriosis: Continuous Hormonal Pills (OCPs). [online] Available at: https://youngwomenshealth.org/2014/08/01/endometriosis-continuous-hormonal-pills-ocps/ [Accessed 9 Aug. 2019].
- Küpker, W., Felberbaum, R.E., Krapp, M., Schill, T., Malik, E. and Diedrich, K., 2002. Use of GnRH antagonists in the treatment of endometriosis. Reproductive biomedicine online, 5(1), pp.12-16.
- Endometriosis.org. (2019). GnRH « Endometriosis.org. [online] Available at: https://endometriosis.org/treatments/gnrh/ [Accessed 9 Aug. 2019].
- Gezer, A. and Oral, E., 2015. Progestin therapy in endometriosis. Women’s Health, 11(5), pp.643-652.
- Endometriosis.org. (2019). Progestins « Endometriosis.org. [online] Available at: http://endometriosis.org/treatments/progestins/ [Accessed 9 Aug. 2019].
- Endometriosis: Causes – Symptoms – Diagnosis – and Treatment. (2019). Endometriosis Treatment and Support. [online] Available at: https://www.endofound.org/endometriosis-treatment-support [Accessed 9 Aug. 2019].
- Uofmhealth.org. (2019). Laparoscopic Surgery for Endometriosis | Michigan Medicine. [online] Available at: https://www.uofmhealth.org/health-library/hw101171 [Accessed 9 Aug. 2019].
- SAGE Journals. (2019). Surgery for Endometriosis-Related Pain – Murat Api, 2015. [online] Available at: https://journals.sagepub.com/doi/10.2217/whe.15.52 [Accessed 9 Aug. 2019].
- Byrne, D., Curnow, T., Smith, P., Cutner, A., Saridogan, E. and Clark, T.J., 2018. Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study. BMJ open, 8(4), p.e018924.
- Uofmhealth.org. (2019). Endometriosis: Should I Have a Hysterectomy and Oophorectomy? | Michigan Medicine. [online] Available at: https://www.uofmhealth.org/health-library/tv7242 [Accessed 9 Aug. 2019].
- Rizk, B., Fischer, A.S., Lotfy, H.A., Turki, R., Zahed, H.A., Malik, R., Holliday, C.P., Glass, A., Fishel, H., Soliman, M.Y. and Herrera, D., 2014. Recurrence of endometriosis after hysterectomy. Facts, views & vision in ObGyn, 6(4), p.219.
- Xu, Y., Zhao, W., Li, T., Zhao, Y., Bu, H. and Song, S., 2017. Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis. PloS one, 12(10), p.e0186616.
- Endometriosis.net. (2019). Can Heat Therapy Help Relieve Endometriosis Symptoms?. [online] Available at: https://endometriosis.net/complementary-alternative-treatment/heat-pain-relief/ [Accessed 9 Aug. 2019].
- Mira, T.A., Giraldo, P.C., Yela, D.A. and Benetti-Pinto, C.L., 2015. Effectiveness of complementary pain treatment for women with deep endometriosis through Transcutaneous Electrical Nerve Stimulation (TENS): randomized controlled trial. European Journal of Obstetrics & Gynecology and Reproductive Biology, 194, pp.1-6.
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