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Endometriosis - Non-Surgical Management

March is Endometriosis Awareness month. It's a topic close to my heart as I was officially diagnosed with Stage 3 Endometriosis in March 2010, following a self-diagnosis and many visits to my GP to get the referral I needed. I was very lucky to be treated quickly and successfully with Laparscopic excision, but I continue to be aware of non-surgical management options....... I now don't experience any ongoing or menstrual pain.

Endometriosis is a condition where endometrial-like tissue is found implanted in tissues outside of the uterus, most commonly within the pelvic cavity, but it can implant into tissues further around the body. The cause for Endometriosis remains a mystery among researchers but some theories suggest it can be due to genetics, immune system problems, endometrial tissues spreading around the body in the bloodstream/lymphatic system or retrograde menstruation (where womb lining flows in through fallopian tubes instead of leaving the body).

For those who are not aware of Endometriosis, it is often dismissed as period pain. However, it affects 1 in 10 women of childbearing age.

Endometrial tissue is driven by oestrogen, so it grows and sheds through the menstrual cycle. The presence of this tissue outside of the uterus causes internal bleeding which has no way of leaving the body like a regular period. Consequently, this can lead to adhesions, scar tissue, deformity of tissues, and is associated with digestive and bladder issues, and constant pain in the pelvis/low back or referred pain throughout the body.

Symptoms of Endometriosis include;

  • Heavy bleeding

  • Painful periods

  • Can progress to constant pain

  • Pain during sex

  • Difficulty getting pregnant

  • Ovulation pain

  • Fatigue

  • Constipation

Due to the broad nature of the symptoms, the average time it currently takes to diagnose Endometriosis is 5-12 years, and it's only adequately diagnosed by a Laparoscopy, which can be described as abdominal keyhole surgery.

Treatment is primarily based around the management of pain, and in some cases surgery in order to ease the symptoms. Surgery involves removal of endometriosis implants via 'laparoscopic excision' where, during a Laparoscopy, the tissue and any scar tissue is removed. Consequently, surgical treatment can often be performed at the same time as diagnosis.

Medication may also be offered in order to reduce the action of oestrogen, which is the driving force behind Endo. However, side effects of this type of medication include memory loss, pain in muscles and joints, bone mass loss, which can linger even after the medication is stopped. This is ultimately, like putting a plaster on rather than dealing with the problem.

Often women are offered a hysterectomy to ease symptoms, however this is not going to be an option for women who would like to have children, nor should this decision to taken lightly and not before all other non-surgical options and surgical removal options are explored. Hysterectomy increases a woman's risk of cardiovascular disease, reduces bone mass, increases risk of pelvic organ prolapse, and if ovaries are removed as well, will induce menopause.

Non-Surgical Management can include;

  • Exercise

  • Nutritional and Lifestyle Support

  • Reducing exposure to Xenoestrogens

  • Stress Management

  • Soft tissue massage and manual therapy

Even following surgery/removal of endometriosis, pain can still remain. This can be due to some implants or adhesions still being present, or the pain can be due to overactivity/irritability of surrounding connective tissues.

This is an area of Endo, which many women's health professionals feel is not promoted as much as it should.

Typically, exercise is based on muscle shortening, however this approach can lead to further pain and irritability meaning many women will cease exercise. Movement which focuses on lengthening and calming over-excited connective tissues, can help to create space in the pelvis and reduce pain signals. The specific goal of movement should be to 'down-train' and release tension in the pelvic floor, diaphragm, and abdominal wall, which promoting overall cardiovascular health.

Lifestyle and nutritional support should be offered to reduce inflammation in the gut, which could further aggravate surrounding structures. Bloating is a very common side effect of Endo, which is commonly known as "endo belly". Looking at dairy and gluten intake should be a course of action in this case. An elimination diet can be completed for 3 weeks, to see if bloating symptoms subside. Doing this with support from a nutritional professional is advised.

Other nutrition management tips in supporting gut and pelvic health include;

  • Eating more and a variety of fruit and vegetables

  • Increasing intake of Omega-3 fats such as salmon, sardines, mackeral, tuna, nuts, seeds, avocado, olive oil.

  • Avoiding trans fats

  • Reducing red meat

  • Increasing water intake

  • Limiting caffeine and alcohol

  • Reducing processed foods

  • Reduce intake of phytoestrogens, such as flaxseeds, sesame seeds, soy products

  • Consider supplementing with a multi-vitamin, magnesium, calcium and turmeric (for anti-inflammatory qualities) - seek specialist advice from your GP before supplementing.

As endometrial tissue is driven by oestrogen, reducing exposure to xenoestrogens is another must. Xenoestrogens are synthetic or natural chemical compounds which imitate oestrogen. They are not only associated with endometriosis but also breast cancer, obesity, infertility, early-onset puberty, miscarriages and diabetes. Xenoestrogens are found in;

  • Plastics (be aware of foods packaged in plastic and plastic water bottles)

  • Pesticides (be aware of non-organic foods and hormone injected meats and dairy)

  • Environmental pollution

  • Chemicals on the skin such as parabens, phalates (be aware of make up, creams, soaps, nail polish/polish remover, fragrances, household cleaners)

  • Combined oral contraceptive pill

Stress is another factor to consider when managing Endo. The stress hormone cortisol drives abdominal fat storage and this fat we store around the abdomen produces a toxic type of oestrogen. A stress management and appropriate exercise programme is therefore essential in managing abdominal fat.

Manual therapy is another treatment option overlooked in the management of Endo. Massage and manual soft tissues techniques can aid the reduction in scar tissue and adhesion formation, improve the mobility, slide and glide of tissues around the abdomen, pelvis and hips, thus reducing irritability and pain.

Please get in touch if you have any questions. There is also lots of information available on Endo on the Endometriosis UK website.

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