Endometriosis: The Invisible Illness

March is known as the Endometriosis (Endo) Awareness Month, and while to some this may not seem that remarkable, this initiative marks a significant milestone in women’s sexual and reproductive health research. While this chronic and debilitating disease affects 7-10% of women worldwide, report findings of endometriosis in some men highlights that this complex disease is not just a women’s health phenomenon.

So what is Endometriosis and Who Does It Affect?
The presence of tissue that somewhat resembles the endometrial lining of uterus outside the uterus. Most common sites that this tissue may affect include ovaries, anterior and posterior cul-de-sac, fallopian tubes, appendix and sigmoid colon due to proximity of these tissues to uterus, but the implants have been found in vagina, cervix, bladder, ureter, umbilicus, surgical scars, pancreas, breast, bone, central nervous system, and diaphragm. Endometriosis does not discriminate based on age, race or gender.  There have been documented cases of 8-10 year old female patients who presented with endometriosis despite having not reached menarche. Endometriosis can affect women of all ethnicities and even those born without a uterus.

How Do I know if I have Endo?
The cardinal symptom of endometriosis is a stabbing (knife-like), shooting pelvic pain that can be cyclical or chronic (independent of menstrual cycle). That being said, in some individuals, the pain is not limited to the pelvis and is felt anywhere between the ribcage and pelvis. Many patients also suffer from intense pain with bowel movements, riding in a moving vehicle, walking, exercising and during sexual intercourse. Re-occurrence of this type of pain can make normal activities of daily living unbearable, and can significantly impair quality of life in this population.

I think I have Endo, What Are the Next Steps and Who Can Help Me?
Currently, there are no reliable laboratory tests available for diagnosing this chronic condition. The definitive diagnosis is based on the results of laparoscopy performed by a gynaecologist, who with the consent of patient may remove any lesions they discover during the procedure, which is considered the best treatment option conventionally available despite its own risks and flaws. Based on the result of the exploratory laparoscopy, endometriosis will be staged as 1-4 depending on number of implants and whether they are located superficially or deeply as well as presence/absence of adhesions.  Other conventional medical treatments include hormone replacement therapies such as Danazol, which targets the ovaries to produce less Estrogen because it is believed that this hormone exacerbates the condition. While the drug therapy has not shown to reduce the size and/ or number of lesions, it may help with pain reduction in some patients.

Abby Norman, Endo warrior and the author of Ask Me About My Uterus, and Dr. Redwine, gynaecologist and world-renowned expert and advocate for endo, had this advice to share with all physicians who may encounter women or anyone with uterus regardless of their gender identity presenting with chronic pelvic pain:  “You (physicians) must take the chronic pain patients and their symptoms seriously and to consider endometriosis as a strong possibility until proven otherwise.” This reminder reinforces the importance of a good history taking and creating the space for patients to share their concerns as many endo patients have gone years being dismissed or misdiagnosed by other healthcare providers due the apparent invisibility of their concern as most of them want their pain dealt with more than any other symptoms they may also endure.

In addition to living with chronic pain and being dismissed by the health care system, many patients endure having their pain and disability be disregarded or ridiculed by their own families and support network, which can create a tremendous mental emotional insults to these individuals. Not to mention that having endo can significantly impair fertility in those interested in parenthood, and this has its own detrimental toll on these individuals. As a result, it is prudent that management and treatment of endometriosis follows a Mind-Body-Spirit approach to address all aspects of patient’s well-being.
It is interesting to note that the stage of endometriosis doesn’t necessarily correlate with the severity of symptoms experienced by patients.  It seems that the amount of inflammation in the body correlates more with the extent and severity of pain that patients experience than the number of lesions found on laparoscopic examinations.
There is also a strong correlation between having endometriosis and developing some autoimmune conditions such as Rheumatoid Arthritis (RA) and psoriasis as well as Inflammatory Bowel Syndrome (IBS). The risk of having CAD and/or MI event in lifetime is increased in patients with endo. The hypothesized link between all these conditions is the presence of high inflammation due to elevated levels of pro-inflammatory cytokines in the body.
In conclusion, it is important to note that while there is currently no definitive cure for this chronic condition, there is a lot that naturopathic medicine can do to help improve the quality of life for these patients. Various naturopathic interventions can be used in combination to address and reduce chronic pain and inflammation, improve sleep, enhance mental health, improve sex life and optimize fertility and overall quality of life based on individual patient’s health goals.
If you are suffering from endometriosis, you are not alone! We want to hear from you and help you, so please reach out to one of our doctors at: http://www.butterflynaturopathic.com/meet-the-doctors.html