Category "Endometriosis & Pelvic Pain"

This myth can actually be traced back to Hippocrates in 5th century BC.  He believed that women had “wandering wombs” that caused “hysteria” and that only by having sex and procreation with a man, would they be cured.

 

I’d like to believe we’ve advanced our thinking since then, but unfortunately with the current American College of Obstetrics and Gynecology (ACOG) endometriosis guidelines, and the lack of clinical evidence around endometriosis and women’s health in general, myths like these can prevail in the clinical setting.  As a physician, it’s difficult to see OB-GYN’s in 2018 “prescribe” pregnancy as a cure for endometriosis when it is patently untrue.

 

Now, is it true that if a woman’s pain is only a few days around her period she may get relief during her pregnancy and for a period of time following delivery, especially if she is breast feeding. Some women may experience a generalized decrease in pain while pregnant. This is most likely due to hormonal changes and possibly a result of autoimmune features of pregnancy and stem cells that are produced during this time.  While unlikely, there are others who will have pregnancies that may have complications because of endometriosis (increased risk of placenta previa with deeply invasive disease), or become highly symptomatic in the post-partum period, and beyond, which of course can be very detrimental to both mother and child.

 

Pregnancy does not cure endometriosis. It is irresponsible and negligent for doctors to suggest pregnancy to a woman as a treatment for endometriosis, especially if she is in severe pain, as the pain will usually return after delivery. Having to take care of a newborn child while dealing with incapacitating pain only creates more problems for a woman suffering from endometriosis.  A physician recommending pregnancy as treatment for endometriosis is a red flag as it is a sign of a basic misunderstanding of this disease by the physician and makes it likely the patient hasn’t been properly treated, or sometimes even diagnosed.  As well, for a woman who does want to have children at that time, it can cause psychological trauma if she does not become pregnant after trying. All in all, it is time to take this centuries-old myth out of clinically-evidenced based medical practices.

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Yesterday in the New York Times endometriosis patient Sindha Agha (not my patient) wrote a thought-provoking op-ed about her adventures in pharmaceutical hormone treatment for her endometriosis. What struck me the most about her accounts was the repetitive nature of hormones the care providers she saw offered. Over and over they offered her palliative treatments to her disease, with no thought to side effects or to an effective patient outcome. While Agha rightly was careful not to demonize birth control, what we are really talking about here is not birth control but treatment options for a disease than strike as many women as diabetes in their prime years, often rendering them with chronic, debilitating pain and organ dysfunction.

As a physician who treats endometriosis patients with wide excision surgical therapy, this makes me so sad. The fact that here we are more than twenty five years after wide excision was pioneered, numerous clinical, peer-reviewed publications demonstrate it’s effectiveness, and the successes I’ve seen in my own practice of wide excision restoring women to their original vitality – yet ob-gyns are still just offering palliative care in the form of hormones, is dismaying to say the least. If hormones get the patient to the outcome she desires – functionality and return of quality of life, then they are an effective treatment. However, if they do not, we now know that delaying effective treatment to endometriosis patients in the form of palliative care, can allow the disease to get more invasive, and symptomatic. While there is currently no cure for endometriosis, wide excision surgery done by someone who can effectively identify the disease can be a highly effective therapy, and even curative. In addition, many women successfully manage their symptoms with alternative modalities from dietary changes to acupuncture. In short, health and wellness is not a pharmaceutical deficiency.

There are so many factors that play into the reasons for the lack of treatment options, including the American Congress of Obstetricians and Gynecologists (ACOG) refusing to update their outdated standards of care for endometriosis, to larger structural issues our entire healthcare system now grapples with. Over and over, women who have this disease get lost in the shuffle. Fortunately there are so many amazing clinical and patient activists who fight daily for changes in standards of care from Casey Berna to Shannon Cohn.

When I see my patients, the first thing I always do is just listen. This simple but powerful tool allows me as the physician a window into a woman’s experience. I’m hoping ob-gyn’s across the country, ACOG, and the larger medical system start to listen too.

Dr. Andrew Cook


Introducing :

The Endometriosis Health & Diet Program, co-authored by Dr. Andrew Cook and Danielle Cook.

This comprehensive, integrative program for treating endometriosis, and serves as a starting point for building an individualized program. It explains the medical side of endometriosis and how lifestyle factors may impact the disease — it answers the “why” of this condition, including ways to strengthen your body to optimize your health through detoxification and stress reduction. This program includes 100 delicious inflammation reducing recipes and useful tips to manage symptoms and potentially slow or halt endometriosis disease.

Now available for order on Amazon: The Endometriosis Health & Diet Program

Please tune into your local CBS station to see Dr Cook on Monday, 12-5-16, on The Doctors TV Program. It will air in California at various times, depending on location. Check this link and select your state to view broadcast times in your area: The Doctors Local Viewing Times.  For those unable to watch the program at the airing time, there will be a post airing video available on our website, our Facebook page, and on The Doctors CBS website.  San Francisco Bay Area residents can view on KRON-TV at 2pm, Los Angeles Area can view on KCAL-TV at 11am.

Director and Producer Shannon Cohn announces the premier screening of her documentary film Endo What? this April 13th at the Delaney Street Theatre in San Francisco.  Please join Dr. Andrew Cook and Libby Hopton, Director of Research & Evidence Based Medicine, as we gather with a group of esteemed panelists to answer questions on Endometriosis, and discuss issues relating to public awareness of this disease. Don’t miss your chance to view this important film which includes heartfelt stories from patients and insightful commentary by world renowned Endometriosis experts and leaders in the field.  Tickets are available on the Endo What? website at  http://endowhat.com

Announcing ~  Special 25% discount on tickets when you enter VitalHealth on the tickets page !  Special thanks to Shannon Cohn for this discount offer for all of our patients and Facebook fans ! 

Congratulations to Director and Producer Shannon Cohn, along with her production team : Patricio Cohn, Producer and Cinematographer, and Arix Zalace, Producer / Editor for this fine production.  We would like to extend a special thank you to the women in this film who so bravely and generously shared their stories and personal experiences. These testimonies have contributed greatly to the core content and are truly instrumental in depicting the impact of Endometriosis on women worldwide.  

 

 

 

Because so few people know that 70% of teens who experience chronic pelvic pain are later given an endometriosis diagnosis, many young women suffer years of pain when it’s overlooked as a potential diagnosis. Endometriosis is generally thought of as unique to grown women and not considered as a possibility for adolescents and teens.

One young woman, Erika, would like to change that lack of awareness for young girls and teens experiencing chronic pelvic pain. Endometriosis Excision Ends Teen’s Years of Pelvic Pain is Erika’s video story of her four-year journey to reclaim her life without disabling pelvic pain.


“I just want other girls to realize that there is hope. You can regain your life. It’s not a life sentence of pain. If you get to the right surgeon you can regain your life and you can progress as a person without pain.”


Erika’s Endometriosis Diagnosis Mission

Erika has “gone public” with her story in the hope of helping other young girls and teens to avoid what she had to endure. Erika’s story recounts the battle she and her mother fought to overcome years of pelvic pain and misdiagnosis to finally reclaim her life.

Erika’s story – and her mother’s story – is a story of resilience and determination to find answers that would restore Erika’s life. Today, after her endometriosis surgery, she is without pelvic pain and living a normal life. Her message: “You can regain your life. It’s not a life sentence of pain.”

Erika had help – her mother, family and a streak of perseverance that finally got her a correct diagnosis of endometriosis. And she’s now just as tenacious in wanting young women and their families to insist on having their physicians consider the possibility of an endometriosis diagnosis in their diagnostic quest.

 

Are you sometimes so bloated that you feel like you are pregnant? Or even had people ask you if you are pregnant? Do you have an extra set of clothes set aside for those times when you are so bloated that it’s time for a wardrobe switch? Maybe you are like Samantha, a woman just trying to deal with this painfully inconvenient, embarrassing physical disruption, along with all of the other frustrating and painful effects of Endometriosis.

We met Samantha in a forum recently, and she agreed to share her story and photo. She says: “I now only go out to doctors/hospitals or dentist as I cannot cope with people thinking and staring at me thinking I am pregnant. Every doctor blames the bloating on something else, but no one has investigated or tried to do anything about it. I would be so grateful for any help, as I feel totally alone.”


The severe bloating that goes hand-in-hand with endometriosis is too often dismissed by doctors as a minor symptom. For the patient, however, this symptom can be emotionally and physically devastating.


Endo Belly is also an example of the wide array of symptoms endometriosis patients experience and one of the very common misunderstandings about this disease. Physicians, patients, and even endometriosis specialists often misunderstand the root cause of many “endo symptoms”.  Are they always a result of endo, or could there be other causes?

Good progress has been made on increasing awareness of endometriosis and optimal treatment. Proper surgical treatment of endometriosis requires wide excision of the endometriotic implants rather than just burning or cautery. Surgery that simply burns the surface of the implants leaving underlying disease behind is often associated with either continued symptoms or recurrence of symptoms soon after surgery.

This is not the full story, however, and to truly understand this condition, we need to raise awareness of the missing pieces in the puzzle. In my 25 years of practice specializing in endometriosis, I have come to appreciate the complexity of the pattern of symptoms many of my patients deal with. While approximately half of my patients are primarily affected by endometriosis, which is effectively resolved by excision surgery, the other half have other conditions or health problems that co-exist with their endometriosis. In this latter group of patients, while excision surgery provides the foundation of their treatment, complete resolution of their symptoms requires that we address additional health problems, including multi-systemic dysfunction. In these patients, it is a mistake to automatically assume that continued symptoms after surgery are due to persistent or recurrent endometriosis. The real problem may well extend beyond this diagnosis and often encapsulates other often-related health conditions that may masquerade or be overshadowed by the initial diagnosis of endometriosis.


“Endo Belly” can be the result of endometriosis implants and may get better after surgical removal of the disease. Endometriosis implants, however,
are not the only cause of “Endo Belly”.


One such example is the infamous “Endo Belly”. While “Endo Belly” can be the result of endometriotic implants, and may resolve after complete excision of all endometriosis, this is certainly not always the case and other health problems can also cause or contribute to those all-too-familiar flares of extreme bloating and distention. At our center, we therefore approach endometriosis and its associated health problems from a multi-disciplinary paradigm including traditional medicine (e.g., excision surgery), as well as a variety of integrative and holistic modalities.

Our approach is based upon the most recent scientific information. We treat the whole patient, not simply surgical removal of the endometriosis implants. One example of this is the role of the bowel, including the human microbiome (the bacteria that live in our bowel), in causing pelvic pain and other health problems. We will discuss below the importance of gut bacteria as a contributing causal factor in bloating and “Endo Belly”. This is a very brief overview and covers just a few of the important facts about the critical impact of our intestinal health on our overall health.

Best wishes,

Dr. Andrew Cook

Gut Bacteria & Endo Belly ~
Why You Look & Feel So Bloated

What does your gut bacteria have to do with that annoying bloating and gastrointestinal discomfort? A lot!

We have more bacteria living in our guts than we do human cells in our body. We have a balance of beneficial (commensal) bacteria and potentially pathogenic bacteria (disease causing unfriendly bacteria). This is actually one of the most complex ecosystems in nature. It is important to maintain a healthy balance of bacteria in the gut.

These beneficial bacteria are not simply along for the ride, but rather, they play a critical role in our health. For example, they are involved in digesting food that we eat, producing vitamins such as vitamin K2 and biotin, converting thyroid hormone into its active form, detoxification, reducing inflammation, reducing pathogenic forms of bacteria, and energy production. These are only a few of their important jobs! We also have yeasts and viruses in our guts. It’s important to keep a healthy balance of these microorganisms in our guts too.

Gastrointestinal problems can be a result of bacterial problems in the small and/or large bowel. Most of the bacteria are in the large bowel. A little is in the small bowel, but not nearly as much as in the large bowel. Dysbiosis is a condition where an imbalance in beneficial and potentially disease producing pathogenic bacteria occur in the bowel. SIBO (Small Bowel Intestinal Overgrowth) is a condition where the bacteria from the large bowel migrate up into the small bowel. With SIBO, the over abundance of bacteria in the wrong location is exposed to undigested food, which it eats and turns into a large amount of gas (bloating, pain, indigestion).

Factors that may negatively alter the sensitive bacterial balance lead to dysbiosis or SIBO and include:

  • Antibiotics (with certain antibiotics it can take up to 2 years to regain a healthy microbial balance in your gut)
  • Chronic stress
  • Non-steroidal anti-inflammatories (NSAIDS)
  • Constipation
  • Standard American Diet (SAD diet – high in unhealthy fats, processed carbohydrates, and sugar and low in fiber and vegetables)
  • Food allergies and Sensitivities
  • A weakened immune system
  • Intestinal infections (such as yeast overgrowth) and parasites
  • Inflammation
  • Poor function or removal of the ileocecal valve (valve between the small and large intestine)

There are several common symptoms of dysbiosis and SIBO. You may be experiencing several of them. They include :

  • Bloating, belching, burning, flatulence after eating
  • A sense of fullness after eating
  • Indigestion, diarrhea, constipation
  • Systemic reactions after eating (such as headaches and joint pain)
  • Nausea or diarrhea after taking supplements (especially multivitamins and B vitamins)
  • Weak or cracked finger nails
  • Dilated capillaries in the cheeks and nose (in a non-alcoholic)
  • Iron deficiency
  • Chronic intestinal infections, parasites, yeast, unfriendly bacteria
  • Undigested food in stools
  • Greasy stools
  • Skin that bruises easily
  • Fatigue
  • Amenorrhea (absence of menstruation)
  • Chronic vaginitis (vaginal irritation)
  • Pelvic pain

Dysbiosis is not uncommon in women with endo. Endometriosis-associated intestinal inflammation may alter the balance of gut microflora.[i] Balley and Coe investigated the intestinal microflora in female rhesu monkeys and found an increased amount of intestinal inflammation and fewer aerobic lactobacilli and gram negative bacteria in monkeys with endometriosis compared to those without the disease. A disruption in the gut microflora (dysbiosis) can have negative health consequences including poor digestion, malabsorption of nutrients, increased inflammation, and increased gastrointestinal infections.[ii] Intestinal microflora act as a barrier to gut pathogens by blocking attachment to the gut-binding site and produce antibacterial substances.

Problems with an overgrowth of bacteria in the small bowel can also result in the common gastrointestinal complaints among women with endometriosis. Recent studies have demonstrated the presence of Small Intestinal Bacterial Overgrowth (SIBO) in women with endometriosis.


In one study, 40 out of 50 women with laparoscopic confirmed endometriosis were found to have SIBO. [iii] SIBO needs to be considered as a contributing factor anytime a woman has severe bloating.


The gut also plays an important role in estrogen elimination. Phase II detoxification in the liver (medical term for the process of eliminating many hormones including estrogen) utilizes conjugation of estrogen to other compounds so they can be excreted in bile.[iv] If the gut flora is unbalanced, certain bacteria secrete an enzyme called beta-glucuronidase, which cleaves the glucuronide molecule from estrogen, allowing estrogen to be reabsorbed into circulation vs excreted in the stool. Lactobacillus, a healthy bacteria, decreases the activity of B-glucoronidase.[v] If the activity of B-glucoronidase is increased, more estrogen will be reabsorbed and potentially worsen the endometriosis.

Do you have any of these symptoms? If you do, they may be caused by more than your endo inflammation. If you have these symptoms after good quality endometriosis excisional surgery, your endometriosis is gone, but your symptoms may be a result of other conditions such as the ones discussed above. Some tests that may be performed include a hydrogen/methane breath test, a comprehensive stool study through a lab such as Genova Diagnostics, organic acid testing, and food sensitivity testing. There may also be therapeutic diets that can be helpful for symptom management such as the Specific Carbohydrate diet, the FODMAP diet, the Microbiome Diet, and the Autoimmune Paleo Diet. There is no one size fits all treatment for dysbiosis. Some diets that help with dysbiosis can make SIBO worse. A qualified practitioner can help to determine what studies and treatment may be helpful.  Some of the lab tests which may be relevant are included in our Specialized Lab Testing at Vital Health Endometriosis Center.

You may be interested in this video : Enterome: the gut microbiome and it’s impact on our health:

Wishing you a happy and healthy day,

The Vital Health Team

 


Vital Health Endometriosis Center continues to provide the most comprehensive approach to the diagnosis and treatment of endometriosis.


Visit Our Resource Center to Learn More About Endometriosis

Read & Share What it Really Means to Have Endometriosis

 

[i]. Balley M, Coe C. Endometriosis is associated with an altered profile of intestinal microflora in female rhesus monkeys. Human Reproduction. 2002;17(7):1704-1708.

[ii]. Miniello V, et al. Gut microbiota biomodulators, when the stork comes by the scalpel. Clin Chim Acta. 2015. Web. Accessed February 25, 2015.

[iii]. Mathias JR, Franklin R, Quast DC, et al. Relation of endometriosis and neuromuscular disease of gastrointestinal tract: new insights. Fertil Steril. 1998; 70:81-88.

[iv]. Evans, J. An integrative approach to fibroids, endometriosis, and breast cancer prevention. Integrative Medicine. 2008; 7(5):28-31.

[v]. Goldin BR, Gorbach SL. The effect of milk and lactobacillus feeding on human intestinal bacterial enzyme activity. Amer J Clin Nutr. 1984;39(5):756-61.

 

This opportunity is exactly what I had hoped my public health education would offer: professional public health development in the field of endometriosis, working toward reducing the unnecessary suffering that so many women experience.


Kelly M. Heslin, of the Mel and Enid Zuckerman College of Public Health, University of Arizona, joins Vital Health Endometriosis Center this summer to complete the Internship for her Masters in Public Health Degree.  Kelly’s Internship plan is focused on the development of an Endometriosis Education Plan that will serve as an outreach program in our community and elsewhere.

In Kelly’s words: “Endometriosis is a reproductive disease that affects at least 1 in 10 women worldwide, causing pain and infertility, as well as numerous other symptoms that interfere with a woman’s health and productivity. Vital Health Endometriosis Center has invaluable connections to and direct involvement with the local community, as well as the endometriosis treatment and research community at large. I foresee this internship as merely a stepping off point, and I am optimistic that I will be able to continue working with this project specifically, or with one of the other major players in the endometriosis field to continue educating and advocating for women who are marginalized by the existing health system, both pre- and post-diagnosis”.

We warmly welcome Kelly to the Vital Health Team this summer,  for completion of this important work.

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