Stress reduction techniques, such as physical exercise, yoga, or meditation, may improve the ability to cope with endometriosis. Studies confirm that stress has a negative effect on disease. In patients with endometriosis, stress may trigger excess adrenal stress hormones. These hormones have a direct effect on heart rate and blood flow, and high levels can impair the body's ability to limit scarring and inflammation. Fortunately, stress reduction activities like yoga and meditation can help promote a sense of calm, slow heart rate, relax tense muscles (which often contribute to pain), and foster a sense of well-being. Likewise, physical exercise, in addition to reducing the amount of estrogen circulating in the body, can help relieve stress.
Warm baths and heating pads may help relax muscles and provide temporary pain relief. Endometriosis pain is often crampy and located deep in the pelvic muscles. Soaking in warm baths or using heating pads may help to temporarily relieve pain, or at least lessen it for short periods of time. Both of these methods can also help reduce stress.
A diet that is rich in fiber (e.g., whole grains, fruits, and vegetables) is important for good health, and may also reduce the levels of estrogen circulating in the body. Although further study is needed, some evidence suggests that dietary fiber can reduce the amount of estrogen circulating in the body. This may be because fiber binds with estrogen and carries it out of the body through the digestive tract. Therefore, a diet that is rich in fiber may help to reduce symptoms in some women with endometriosis. However, doctors always recommend eating a diet that is rich in whole grains, fruits, and vegetables, and low in saturated fat to maintain overall health.
Your doctor is the best source of information on the drug treatment choices available to you.
Many women with endometriosis find that support groups or psychotherapy help them to cope better with their illness. Seeking out and joining other women who suffer from the pain and frustrations of endometriosis can improve peace of mind and ability to cope. Learning that others have similar feelings and personal struggles often provides some sense of control over a confusing illness, and can help you regain your self-esteem. In addition, there is some evidence that support groups can reduce pain and lessen depression.
The same is true for psychotherapy. A type of therapy called cognitive-behavioral therapy (CBT) is especially useful. CBT looks at the emotions caused by especially distressing symptoms and examines what they can mean to a person. For example, many women with pain blame themselves for possibly delaying childbirth or for avoiding sexual intercourse. This guilt and self-blame can leave them feeling victimized or out of control, and can cause anxiety and depression as well as an increased awareness of pain and emotions. On the other hand, women who recognize these feelings and their effects may develop a more active approach to coping, and find it easier to live with endometriosis.
Surgery is usually reserved for women with severe symptoms that do not respond to medical treatment. If medical treatment fails to relieve severe symptoms, your doctor may recommend surgery. Women with endometriosis may also want to consider surgery if they are unable to become pregnant after one year. Laparoscopy, the most common surgical procedure for treating endometriosis, is the same procedure that is used to confirm the diagnosis. Often, surgeons who perform the procedure for confirmation are able to remove implanted endometrial tissue masses, bands of scar tissue (called adhesions), and tissue lesions at the same time, making a second procedure unnecessary. During surgery, the doctor can also correct any changes in the structure of the reproductive organs that may have been caused by endometriosis.
Laparoscopy is a simple procedure that can be done in the hospital or in an outpatient setting; it involves the use of a thin, lighted, microscope-like tube. The tube is inserted into the abdomen just below the navel. Laparoscopy requires only one to four small incisions (about ¼ to ½ inch long). Recovery may take a few days, but most women who undergo this procedure can return to normal activities within a week.
If there is extensive damage, the surgeon may recommend removal of one or both ovaries or removal of the uterus. He or she may also choose to cut the nerves that lie behind that uterus to help provide pain relief. Each of these procedures has risks and benefits that require thorough discussions with your endometriosis management team.
Your surgeon may suggest an older procedure called laparotomy. Laparotomy is often conducted when a patient has extensive tissue masses, especially in the bowel or abdomen. Unlike laparoscopy, laparotomy is major abdominal surgery, requires a hospital stay of at least three to five days, and involves a recovery time of up to six weeks.
Chinese medicine, including acupuncture and herbs, has been recommended to relieve the pain associated with endometriosis. Although further studies are needed, Chinese medicine techniques reportedly relieve endometriosis-related pain in some women. Acupuncture is one such technique. In acupuncture, needles are placed into energy points located along channels that run vertically up and down the body. The goal is to balance and restore the flow of Qi (pronounced “chee”), or life energy force. Practitioners of Chinese medicine believe that when Qi becomes unbalanced, or its flow is interrupted, illness results. Different combinations of herbs are often used along with acupuncture to further enhance treatment and, at times, to speed recovery.
When seeking any type of complementary medicine practitioner, make certain that he or she has received proper accreditation and training. Most types of complementary practices, including acupuncture, have national associations or organizations that offer such credentials. The National Center for Complementary & Alternative Medicine, a division of the National Institutes of Health, is a good starting point for general information about complementary medicine (http://nccam.nih.gov/nccam/fcp/faq/index.html). In addition, the University of Pittsburgh maintains a complementary medicine home page that includes links to mailing lists, newsgroups, government resources, and practitioner directories (www.pitt.edu/~cbw/altm.html). Information on acupuncture can be obtained from the American Association of Oriental Medicine (http://aaom.org) or from Acupuncture.com (www.acupuncture.com).
If endometriosis has spread to the abdomen, bowels, and distant organs, a more complete physical examination and assessment are necessary. During the history-taking and physical, your provider can often determine whether endometriosis has spread to other organs. If it has, a more detailed investigation may be necessary, including laboratory tests, imaging studies, and surgical diagnosis of a variety of body systems. If endometriosis is extensive, the goal of therapy will be to correct the symptoms related to tissue growth and organ damage in the specific affected areas.
With treatment, most women experience some pain relief. Although there is no cure for endometriosis, medical and surgical treatments can successfully reduce and sometimes eliminate pain and other symptoms. Treatment can also improve the chance of becoming pregnant. However, symptoms tend to recur in roughly 34% to 74% of women, depending on the treatment and the extent of disease. Recurrence of symptoms is possible even if the uterus is surgically removed, although the rates are much lower (approximately 5% to 8%). Fortunately, symptoms tend to disappear once menopause is reached. This is because the growth of endometrial tissue depends on estrogen, which is no longer produced after menopause.
An open doctor-patient relationship is important in endometriosis. Treatment of endometriosis is usually provided for limited periods of time. During this time period, you may be asked to contact your doctor if your symptoms continue, or if they worsen. Likewise, your doctor will want to meet with you at the end of the treatment period to assess your progress and determine whether further steps should be taken. That's why an open relationship is so important. Your doctor and other members of your endometriosis team are partners in your care. They will want to know how treatment is going and if you have any questions or concerns.
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