“I thought menopause would be my salvation because my doctor said it would put an end to my endometriosis. Well, my periods stopped a few years ago, but I still have terrible pain. Now he says that it’s impossible for the pain to be from endometriosis because I’ve gone through menopause and have no estrogen. Since the pain is deep in my pelvis, he thinks having surgery to take out my uterus might help,” a friend told me.
“Whoa. A hysterectomy alone won’t solve the problem, according to a new book being published this summer,” I told her. I gave her my advance copy of the book, Stop Endometriosis and Pelvic Pain, then phoned the author, Andrew Cook, MD, a gynecologist specializing in reproductive endocrinology, for details.
With endometriosis, tissue from the uterine lining migrates outside the uterus, implanting on other pelvic structures and forming blisterlike lesions. Patients experience stabbing or aching pain in the pelvis…sex may be excruciating. Estrogen fuels the growth of endometriosis, and often symptoms are worst during a woman’s period—but contrary to what many doctors believe, the disease does not always abate at midlife. “To say that endometriosis cannot be present and cause pain after menopause or hysterectomy is scientifically incorrect. In fact, 2% to 5% of postmenopausal women have endometriosis and symptoms can recur even after decades,” Dr. Cook said. Reasons…
- Although estrogen production by the ovaries eases at midlife, small amounts of estrogen are produced in other areas of the body. Also, endometriosis tissue itself produces estrogen, thus promoting its own growth, Dr. Cook said.
- Endometriosis can create adhesions (areas of scar tissue) that shrink over time, tugging painfully on organs, nerves and other internal structures. Pain from adhesions is not affected by decreasing estrogen levels.
- Endometriosis implants (growths) are found not just on the reproductive organs, but also on the bladder, bowel, rectum and elsewhere in the pelvic cavity. Even if you remove the uterus and ovaries, a lot of disease can be left behind—which is why a simple hysterectomy often is not an effective treatment.
For mild symptoms: One or more of the following therapies may provide sufficient relief…
- A nutritionist can help you identify food allergies or sensitivities that exacerbate endometriosis symptoms. For instance, Dr. Cook said, you may feel better if you avoid foods that worsen inflammation, such as alcohol, dairy, red meat, saturated fats, sugar and wheat…and increase your consumption of estrogen-balancing foods, such as apples, berries, broccoli, cauliflower, flax, green beans, nuts, peaches, salmon and turnips.
- Bioidentical progesterone use can help counteract the effects of estrogen on endometriosis tissue for some patients.
- Patients with longstanding pelvic pain often develop spasms of the pelvic floor muscles (like a charley horse), contributing to endometriosis pain. For relief, a specially trained physical therapist can perform manual massage techniques to relax the spasms.
If symptoms are severe: Unfortunately, endometriosis will not just melt away, so when a patient is truly suffering, the best option usually is surgery. But beware of any doctor who recommends burning away the endometriosis with coagulation or cauterization. This removes only the top of layer of diseased tissue—an effect Dr. Cook likened to “pulling the tops off weeds and leaving the roots behind”—so symptoms persist or return quickly.
Instead, look for a surgeon specializing in the treatment of endometriosis who can perform wide-excision laparoscopic surgery. The goal is to remove each and every bit of diseased tissue, plus a rim of normal surrounding tissue—just as is done with cancer—to ensure that no microscopic areas of endometriosis are left behind to grow again. This involves meticulously exploring all the “nooks and crannies” inside the pelvis, Dr. Cook said, and using a surgical laser to vaporize the diseased tissue as well as any scar tissue. Best: Ask your doctor for a referral to an endometriosis specialist…or check the Web site of the support organization Endo Resolved (www.Endo-Resolved.com).