Posts Tagged "Pelvic Pain"

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.

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.

 

Adequate management of pain is paramount in women with endometriosis, due to the chronic and debilitating nature of this painful condition. The type of treatments offered will depend on the type of pain, its severity and duration, and the specific needs and wishes of the patient.

What can be done about my pain?

Our aim is to offer permanent relief and resolution of pain through surgical and non-surgical interventions (excision surgery, nutritional counseling, pelvic physical therapy etc.). In some cases, however, short-term or ongoing pain management is required to allow our patients to function. Not all sources of pain can be resolved by therapeutic intervention and in some cases definitive treatments, such as hysterectomy for uterine disease, may not be desired due to a wish to preserve fertility. Instead, ongoing palliative management in the form of prescription and non-prescription drugs and interventional pain management (nerve blocks, pain pumps and catheters) may be required. Interventional treatments may warrant the specialist expertise of a pain-management physician who will work in close coordination with the rest of the patient’s healthcare team.

Non-prescription (over-the-counter) pain medications

Common non-prescription pain medications used by pelvic pain patients include Acetaminophen or Tylenol and non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and naproxen, which suppress inflammation. Care needs to be taken to not exceed safe daily dosages of pain medication and, in particular, when combining different non-prescription and prescription drugs. It is important for your safety that even over-the-counter medications are disclosed and carefully discussed with your doctor when considering pain management options.

Prescription pain medications

Prescribed pain medications include prescription NSAIDS and narcotics. Narcotics can be short acting (e.g., hydrocodone, oxycodone and hydromorphone) or long acting (e.g., morphine and long-acting oxycodone). Narcotic pain medications work by slowing down or stopping the signals from the nerves to the brain. The choice of narcotics prescribed will depend on whether your pain is acute (such as post-operative pain) or chronic (ongoing pain).

Pain-narcotic contract

If a patient receives prescription-narcotic pain management, she will be required to enter into a pain-narcotic contract which specifies what she can and cannot do while taking prescription-narcotic pain medications. All members of her healthcare team are aware of this contract and regular meetings are held among the staff to discuss and monitor the patients who are receiving prescription-narcotic pain management.

Interventional pain management treatments

Interventional pain management treatments for long-term pain include pain pumps (an implantable pain-management device), spinal cord stimulators (pain catheters), trigger-point injections or nerve blocks (temporary numbing injections to painful areas or overly sensitive nerves), and radiofrequency ablation (RFA), where targeted nerves are “stunned”, offering more prolonged relief than nerve blocks.

At Vital Health we offer an array of options to both resolve your pain and to manage acute and chronic pain. We firmly believe that no woman should suffer from pelvic pain and we strive to provide optimal relief to each and every patient who comes to us for help. Even when a patient suffers from intractable pain that does not respond to surgical and non-surgical intervention, ongoing pain can be managed with a variety of palliative approaches, offering hope, relief, and restoring your quality of life.

Pelvic floor dysfunction (PFD) is a common condition in women with endometriosis and other pelvic pain conditions, and occurs when the muscles that form the pelvic floor have tightened in response to chronic pelvic pain. Even after the original source of pelvic pain has been resolved, PFD persists as an acquired or secondary source of pelvic pain. In severe cases, the patient suffers from pelvic floor spasms, which can be excruciating and make intercourse impossible. Other common symptoms are pain and/or difficulty emptying the bladder or bowel and painful intercourse. Pelvic floor dysfunction can affect all the organs in the pelvis, including the urinary, genital, and bowel systems, and can have further reaching effects on the body (coordination, alignment, breathing, and mobility).


Pelvic Floor Dysfunction is a common condition in women with endometriosis and other pelvic pain conditions, and occurs when the muscles that form the pelvic floor have tightened in response to chronic pelvic pain.


Once a woman’s endometriosis has been successfully removed during surgery and healing is complete, if pain persists, she may be assessed for PFD and referred to our specialized pelvic floor physical therapist. Most physiotherapists lack the training and expertise to treat pelvic pain and pelvic floor spasm. If you are seeking relief of PFD it is important to find a practitioner who understands the specific needs of women with endometriosis and who has experience and training in treating PFD.

What happens during pelvic floor physical therapy and how does it help?

Chronic pelvic pain can affect body posture, muscle tone and alignment. Muscles may become shorter, tighter and misaligned due to the perpetual responses of the body to pelvic pain. The role of the pelvic floor physical therapist is therefore to train the patient to relax her body and restore balance and alignment. While the pain emanates from the pelvis, the effects of chronic pain are far-reaching due to the role of the pelvic floor in core activities such as movement and coordination. Effective physiotherapy may need to involve muscle groups throughout the body.

Patient history

Pelvic physical therapy begins with a thorough patient history. In her own words, the patient tells her story about living with endometriosis, her pain and the treatments she has endured. She is also asked to recant any other incidents in her life history that might have jolted her pelvis, such as a previous skiing accident.

Biomechanical and musculoskeletal assessment

The next step is a biomechanical and musculoskeletal assessment; the therapist observes how the patient moves and walks, her posture and breathing, where her core areas of pain are, and takes note of the over all condition of her muscles (strength, coordination, alignment and contraction).

Relaxation skills

Following this general assessment the therapist focuses on relaxation skills. Massage is directed at loosening and relaxing muscles and relieving abdominal and pelvic pain. The patient is then directed in self-massage and relaxation exercises, which she can continue at home.

Physical examination

Next the therapist performs a thorough physical exam to test overall body flexibility and mobility, paying particular attention to the hips and possible joint malformations, the sites of abdominal scars and the motility of the internal pelvic organs. The physical exam comprises both an external and internal exam. During the internal exam, the different layers of the pelvic floor are assessed to check muscle spasm, tone and mobility, tissue rigidity and pain trigger points. While some patients may feel uncomfortable, internal work is essential in order to access the core muscles and tissues involved by PFD.

Retraining of muscles

Pelvic muscles that have been identified as tense and in spasm are then “down trained” by teaching the patient the difference between tensing and relaxing these muscles. This can be achieved with the help of biofeedback sensors placed on the muscles, so that the patient can see her pelvic muscle activity fluctuate on the biofeedback monitor.

Home exercises

To improve flexibility and stretch tightened muscles, the patient will be instructed in stretching exercises, focused on opening the hips. The patient may also be instructed in vaginal dilation exercises to be performed digitally or with a home-dilation kit to further mobilize tissue within the pelvis. Further exercises will focus on core strength, and trunk and spine flexibility. Once pain and mobility improve, the patient will be retrained in basic movements such as walking and standing without tensing the pelvic floor and to improve pelvic-girdle coordination. The patient will be instructed in gentle exercises to restore coordination and mobility, such as basic yoga and Pilates, gradually building up over the course of 6 to 12 weeks.


Pelvic floor physical therapy helps chronic pelvic pain sufferers to retrain and recalibrate their bodies, reversing the harmful effects of ongoing pain on the body. The goal is to improve (sexual, bladder and bowel) function, co-ordination, core strength and to relieve pain.

Adenomyosis is a condition of the uterus in which endometriotic tissue is found within the muscular walls of the uterus. Adenomyosis can be focal or diffuse. Focal adenomyosis also referred to as an adenomyoma, is when a tumorous growth of endometriotic tissue forms inside the muscular uterine walls. More commonly, however, diffuse areas of endometriotic tissue are dispersed through the uterine muscle, most often affecting the posterior (back) wall of the uterus, which can become thickened as a result.

What are the symptoms of adenomyosis?

Adenomyosis can result in abnormal uterine bleeding (typically heavy and prolonged menstrual flows) and/or severe uterine cramping – “killer cramps.” Sometimes adenomyosis may not cause any symptoms at all. Patients who suffer from adenomyosis often report severe centralized cramping pain that worsens during the menstrual flow and may radiate up to the belly button and/or down to the lower back and into the buttocks and thighs. One reason why pain may radiate is because the uterus is innervated by nerves that run along the uterine ligaments, which lead upwards toward the umbilicus and downwards to the lower back. Some patients have such severe uterine pain that over time they develop second-degree burns over their abdominal area from the prolonged use of heating pads in an effort to sooth their debilitating cramps.

Are endometriosis and adenomyosis related?

There does appear to be a strong association between these two conditions. A subset of women who suffer from endometriosis will also, unfortunately, have adenomyosis to varying degrees and often a clinical challenge in resolving a patient’s pain is to successfully differentiate between the symptoms of endometriosis and adenomyosis. This is why it is important that your doctor assesses both the uterus and the tissue around the uterus separately in order to discern the source of your pain.

Can anything be done about adenomyosis?

Several treatments for adenomyosis are available, both conservative (organ-preserving) and radical (organ removal). Conservative treatments include pain management with non-prescription and prescription pain medications and the use of hormone therapies to suppress the menstrual cycle and either shorten or temporarily stop the menstrual flow. Sometimes a surgical procedure called a presacral neurectomy (PSN) will be performed to sever the nerves that innervate the uterus with the aim of alleviating uterine cramping. This procedure may not be especially effective in patients with adenomyosis however as the disease may result in localized inflammation that extends beyond the uterus itself, affecting surrounding extra-uterine tissues. A PSN has no effect on these surrounding tissues and therefore a portion of the patient’s pain may persist despite the procedure. A PSN also has no effect on abnormal uterine bleeding. In those patients who do not have future plans for fertility or who have completed childbearing, a hysterectomy may be considered. Hysterectomy is the only definitive (curative) treatment for diffuse adenomyosis. If a patient has an adenomyoma (focal adenomyosis) it may be possible to surgically remove the adenomyoma, rather like one might remove a fibroid, while preserving the rest of the uterus. This will depend on the size of the adenomyoma, it’s location and on the skill of the surgeon.

How is adenomyosis diagnosed?

The only definitive method of diagnosing adenomyosis is by obtaining a biopsy of the diseased tissue and having a pathologist inspect it under the microscope for the presence of endometriotic tissue. While this may be readily possible if a patient has an adenomyoma, in the case of diffuse adenomyosis, obtaining a biopsy of diseased tissue may not be feasible until after hysterectomy (it would be akin to searching for a needle in a haystack). Endometrial biopsies may confirm a diagnosis of adenomyosis in some cases if the biopsy is sufficiently deep but failing to confirm the diagnosis via this test does not exclude adenomyosis and this is not a routine test for adenomyosis but may be undertaken to exclude other possible causes of abnormal uterine bleeding. In most cases, the diagnosis is suspected based on the patient’s symptoms and on the findings from imaging studies (ultrasounds, CT and/or MRI). Sometimes the uterus may be found to be enlarged and have a “boggy” consistency during laparoscopy, raising a suspicion of possible adenomyosis. If diffuse adenomyosis is subtle, however, it may not be apparent on imaging nor at surgery. The absence of any telltale signs should not exclude adenomyosis as a possible source of uterine pain and the patient’s debilitating uterine symptoms still need to be addressed.

Can adenomyosis affect women of any age?

Adenomyosis is often considered to be a disease that primarily affects middle-aged and older women (30s onwards), especially women who have previously given birth. This bias could, however, be due to the fact that usually only women who have completed their families undergo hysterectomy for the treatment of their uterine pain. Given adenomyosis can almost always only be confirmed via biopsy following hysterectomy, this inevitably leads to the impression that the disease only affects women who have completed childbearing. Furthermore, the symptoms of endometriosis may often overshadow the symptoms of adenomyosis in the early course of the disease, giving the impression that its onset is later. In reality, however, both endometriosis and adenomyosis can affect women of any age, including teenagers.

Endometriosis can cause an array of symptoms that differ from individual to individual and may worsen over time.

What are the common symptoms of endometriosis?

  • Severe pelvic pain: The pain may be cyclical (worsening around the menstrual flow and ovulation) and/or non-cyclical in nature (constant throughout the cycle). Women describe a burning, throbbing, stabbing pain in different parts of their pelvis. This pain can be even more severe than labor pains and post-operative pain.
  • Pain with sex: Endometriosis can cause pain with deep penetration. This is because the area of tissue just beyond the end of the vagina is commonly affected by the disease, making it exquisitely tender and sore.
  • Pain with urination and bladder pain: If disease is present involving or near the bladder this may result in bladder pain/sensitivity and pain on emptying the bladder. Another common cause of bladder symptoms is interstitial cystitis, a condition that frequently co-occurs with endometriosis.
  • Pain with bowel movements: Endometriosis involving the lowest part of the colon (the rectum) may result in pain with bowel movements during menses (or during the whole month long).
  • Pain prior to bowel movements: Endometriosis involving the colon may result in pain just prior to bowel movements.
  • Cyclical rectal bleeding: If bowel disease has invaded into the bowel wall, the patient may experience cyclical rectal bleeding.
  • Bloating: Bloating may result from the inflammatory response to endometriosis involving the pelvis and bowels.
  • Nausea and vomiting: This may be a symptom of severe pain, of the effect of inflammation on the gastrointestinal tract or more specifically could be a symptom of invasive small bowel disease. Acute vomiting can be a symptom of small bowel obstruction, a rare but serious complication of endometriosis demanding emergency medical intervention.
  • Constipation and diarrhea: Endometriosis near or involving the bowel may result in IBS-like symptoms.
  • Fatigue: Severe fatigue is a non-specific symptom of endometriosis. It is a common symptom experienced by sufferers of chronic illness and pain.
  • Infertility: It has been estimated that 40% of women with endometriosis struggle with fertility problems. Around 20% of women in a healthy population will experience infertility, meaning that in those with endometriosis the risk of fertility problems is doubled. Infertility may be due to adhesions that result from the disease process or from the effect of the disease on the intrauterine environment; endometriotic tissue releases chemicals that may hinder conception and implantation.
  • Shoulder tip pain: Less commonly, if a patient has diaphragmatic endometriosis, she may present with cyclical right shoulder tip pain. Diaphragmatic endometriosis is relatively rare.

Importantly, while endometriosis is associated with a range of symptoms the most common symptom is chronic pelvic pain. You do not have to experience all of these symptoms to have endometriosis. If you are experiencing debilitating pelvic pain this is not normal. It is your body’s way of communicating that something is wrong and you should seek the help of a doctor who is familiar with treating endometriosis and pelvic pain.

How do symptoms differ between patients?

While some patients are relatively symptom-free except for certain times of their cycles (menstruation and ovulation), others are debilitated by pain each and every day of the month. Many women experience a gradual worsening of symptoms over time, both in severity and in the duration of symptoms i.e., the number of days per month they are affected. A common myth is that endometriosis only affects a woman during her period – while this may be the case for some women, for most patients the pain affects them both during and outside their period.

Is endometriosis “just” monster cramps?

Endometriosis is not “just” monster cramps. Severe cramping during the menstrual flow is, in fact, more commonly associated with another gynecological condition called adenomyosis. Adenomyosis is where endometriotic tissue is found inside the muscular walls of the uterus and can cause severe cramping and heavy menstrual bleeding. Adenomyosis often co-occurs with endometriosis and for this reason the symptoms of the two conditions are frequently confused with one another.

Endometriosis does not, however, cause uterine cramps nor abnormal bleeding; these symptoms point to a problem with the uterus whereas endometriosis affects tissue outside the uterus.

What is the impact of these symptoms on a woman’s life?

The symptoms of endometriosis can be truly devastating. They can impact upon all areas of a woman’s life rendering her unable to function.

Teenagers with endometriosis may find that they are forced to miss one or more days of school each month while those in employment may find they are struggling to hold down a job due to the need to take leave on a regular basis for severe pelvic pain. Non-prescription pain medications may fail to alleviate the pain and prescription pain medications may only offer partial relief. Maintaining a sexual relationship may be difficult if not impossible due to severe pain during sex. Pelvic pain may interfere with social events and plans and may prevent a woman from partaking in physical exercise. Understandably, over time the symptoms of endometriosis can lead to social isolation, financial difficulties, relationship breakdown and severe emotional distress. Clearly, it is a disease that needs to be taken very seriously and treated effectively as soon as possible to restore a woman’s quality of life.

If you think you may be suffering from endometriosis, don’t suffer in silence. Take your symptoms seriously by talking to your doctor.

It’s a great privilege to be a part of such a dedicated team of professionals. I’m excited at the unique opportunity that Vital Health has to offer with regard to research within the field of endometriosis and chronic pelvic pain.


For those of you who know Libby, it will be easy to understand why we have been working with her since September 2013 to help her obtain a work visa here in the United States and join Vital Health Endometriosis Center. She is in the process of moving all the way from The Netherlands to beautiful Los Gatos, California. Margaret has been tirelessly working on this project for the last year, and Libby’s visa was officially approved this month.

For those of you who do not know Libby, she is a young woman who is incredibly gifted in her ability to gather and synthesize data, particularly relating to endometriosis. She is a young woman who has just completed her masters and has also suffered from endometriosis and pelvic pain. […]

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