Category "Endometriosis"

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.

drcook3

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

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.

 

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