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Best pain relief for endometriosis: The request could not be satisfied


Unexpected Ways to Ease Endometriosis Pain


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Endometriosis.org: “Painkillers,” “Five things that pelvic health physical therapy can do to improve your endometriosis-related pain,” “Dietary modification to alleviate endometriosis symptoms.”

Journal of Physical Therapy Science: “Efficacy of exercise on pelvic pain and posture associated with endometriosis: within subject design.”

Einstein: “Patients with endometriosis using positive coping strategies have less depression, stress and pelvic pain

Patients with endometriosis using positive coping strategies have less depression, stress and pelvic painPatients with endometriosis using positive coping strategies have less depression, stress and pelvic pain.”

Journal of Behavioral Medicine: “The association of coping to physical and psychological health outcomes: a meta-analytic review.”

Molecules: “Cannabinoid Delivery Systems for Pain and Inflammation Treatment.”

Cleveland Clinic: “Transcutaneous Electrical Nerve Stimulation (TENS).”

European Journal of Obstetrics, Gynecology and Reproductive Biology: “Effectiveness of complementary pain treatment for women with deep endometriosis through Transcutaneous Electrical Nerve Stimulation (TENS): randomized controlled trial.”

Iranian Journal of Nursing and Midwifery Research: “The effects of massage therapy on dysmenorrhea caused by endometriosis.”

Autonomic Neuroscience: “Physiological responses to touch massage in healthy volunteers.”

Mayo Clinic: “Acupuncture,” “Botox injections.

PLOS ONE: “Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis.”

Pharmaceutical Biology: “Anti-inflammatory activities of essential oils and their constituents from different provenances of indigenous cinnamon (Cinnamomum osmophloeum) leaves.”

International Research Journal of Pharmacy: “Complementary and Alternative Medicine (CAM) Therapies for Management of Pain Related to Endometriosis.”

Patients with endometriosis using positive coping strategies have less depression, stress and pelvic pain
Journal of Clinical and Diagnostic Research: “Comparative Effect of Cinnamon and Ibuprofen for Treatment of Primary Dysmenorrhea: A Randomized Double-Blind Clinical Trial.

Neurology: “Botulinum Toxin Treatment of Chronic Pelvic Pain in Women with Endometriosis.”

European Journal of Nutrition: “Coffee and caffeine intake and risk of endometriosis: a meta-analysis.”

Nutrients: “Caffeinated Coffee, Decaffeinated Coffee and Endometrial Cancer Risk: A Prospective Cohort Study among US Postmenopausal Women.”

Human Reproduction: “Fatigue – a symptom in endometriosis.”

Sleep and Biological Rhythms: “Napping during the late‐luteal phase improves sleepiness, alertness, mood and cognitive performance in women with and without premenstrual symptoms.”

Endometriosis Pain Management – Brigham and Women’s Hospital

Management of chronic pelvic pain may require the use of several types of treatment including psychotherapy, medication, and trigger point and nerve injections. These treatments can be used in addition to laparoscopic surgery to help patients successfully manage their pain due to endometriosis.

Medication Treatment Options for Pain Symptoms

Muscle relaxing medications

  • These large groups of medications work by decreasing cramping and pain in the muscles in your pelvis and around your bladder that can be caused by irritation from endometriosis.
  • There are different groups of medications in this category. Examples of group names you may hear are “sedatives” or “anti-muscarinics.”
  • Examples of medication names in this group: baclofen, tizanidine (Zanaflex), cyclobenzaprine (Flexeril) hyoscyamine, oxybutynin, or diazepam


  • These medications can be helpful to many people with chronic pain, including nerve injury or irritation from endometriosis.
  • The doses of these medications that are given to treat pain are smaller than the doses given to treat depression.
  • Examples: desipramine, amitriptyline

Anti-convulsant medications

  • These medications are another important category that can help women with endometriosis pain.
  • The doses of these medications are much smaller than those given to prevent seizures.
  • Examples: gabapentin (Neurontin), pregabalin (Lyrica), topiramate (Topamax)
  • One medication in this group, topiramate (Topamax), has an extra benefit of helping with weight loss.

Interventional Therapy

Upon the discretion of a pain specialist, patients may be offered more interventional therapeutic options such as: injections to different nerves and muscles which may be diagnosed as a cause of pain. Most of these types of injections are performed in a pain clinic under direct X-ray visualization.

Nerve Blockade

This procedure may be performed for diagnostic reasons and therapeutic benefit. Results from the nerve block can be difficult to interpret thus, only a trained specialist should perform this procedure. Improvement in pain is temporary however, if the specialist feels that a patient has a good initial response, a nerve block may be considered.

Muscle injections

Patients with endometriosis tend to develop spasms in the pelvic floor, lower back and/or abdominal wall. Persistent muscle hyperactivity can lead to the development of painful trigger points which can be a secondary source of pain. Trigger points can be blocked by local anesthetic injections with or without corticosteroids. Muscle injections are also considered both a diagnostic and therapeutic procedure.

Physical Therapy

For women with pain from endometriosis, physical therapy may make up half of their treatment plan. Physical therapy is especially useful in training the muscles that line the bottom of the pelvis. This can help women learn to better control these muscles, relax them and decrease their pain.

Behavioral Therapy

Many people with endometriosis benefit from therapy to help them manage the stress, frustration and pain and that occur with this disorder. A trained therapist can be an important part of the treatment team.


Some women experience significantly decreased pain with acupuncture. Often, this requires regular appointments with an acupuncturist to get longer-lasting benefit.

How to Relieve Endometriosis Pain

3. See a physical therapist to strengthen your pelvic floor.

If you think of physical therapy as a place that only treats athletes with knee and shoulder injuries, it may seem strange at first that pelvic floor physical therapy can be hugely effective. Sara Till, MD, an obstetrician-gynecologist who specializes in minimally invasive gynecological surgery at the University of Michigan in Ann Arbor, says that that’s because pelvic floor dysfunction, when the pelvic floor muscles don’t coordinate well, can be a factor in many types of pain women with endometriosis experience: pain in the back and hips, pain during urination, painful bowel movements, painful sex, and even pain while wearing tampons.

4. Try Chinese medicine.

Janet Lee, L.Ac., DACM, an acupuncturist based in Kansas City, Missouri, and a fellow of the American Board of Oriental Reproductive Medicine, says that endometriosis affects as many as a quarter of her female patients, many of whom are also struggling with fertility problems. “Acupuncture triggers the body’s own endogenous opioids, so it’s really good at managing pain,” she says. Lee also uses various Chinese herbs thought to have blood-moving properties, anti-inflammatory effects, and even calming effects, since stress can further aggravate pelvic pain from endometriosis.

While studies on acupuncture and endometriosis pain are limited, a review published in October 2017 in PLOS One concluded that acupuncture does seem to be effective at increasing pain thresholds, possibly by activating pain-relieving mechanisms in the brain.

Just be sure to check with your doctor first before trying a complementary therapy like acupuncture.

5. Practice yoga.

Yoga involves a mix of gentle stretching, mindfulness, and breathwork — which, when combined, can help loosen pelvic floor muscles, relax tight hip connective tissue, and reduce stress. And relaxing your mind and body can help endometriosis symptoms like cramping and pelvic pain feel less intense.

If you’ve never done yoga before, consider trying gentle approaches, like hatha yoga, yin yoga, or restorative yoga. In fact, a study published in a January 2017 issue of Journal of Alternative and Complementary Medicine found that women with endometriosis who practiced hatha yoga twice a week over the course of two months experienced less daily pain and an improved sense of well-being compared to women with endometriosis who did not practice yoga.

Related: 5 Simple Yoga Moves For Endometriosis and Pelvic Pain

6. Consider your diet.

While little scientific research exists on a connection between diet and endometriosis symptoms, there are plenty of proponents of certain food choices thought to affect symptoms. For example, given that endometriosis is an inflammatory condition, and that much of the pain involved can be linked to inflammation surrounding growths of endometrial tissue, an anti-inflammatory diet could be beneficial. Such a diet involves eating plenty of antioxidant-rich fruits and vegetables, as well as fish or other healthy sources of omega-3 fatty acids. Also, following a temporary elimination diet might help you find out whether dairy, gluten, or added sugars affect your symptoms.

But before you ditch dairy, consider that research from the Nurses’ Health Study, which has tracked over 116,000 women for nearly 30 years, found that women with a higher intake of dairy foods had a lower incidence of endometriosis. Those who ate foods with more calcium, vitamin D, and magnesium were less likely to have endometriosis.

7. Ask for a referral.

When it comes to endometriosis pain, your ob-gyn isn’t always a one-stop shop. “[Treating endometriosis is] a multidisciplinary program,” explains Levy. If you’re fortunate enough to live near an academic medical center, there’s a good chance that a network of providers is already in place, but if you live in a more rural area, you’ll need a doctor who’s willing and able to work with others in the medical community who manage chronic pain. “Sometimes it’s a neurologist who works with people with migraines, sometimes a rheumatologist who deals with fibromyalgia,” Levy continues. Bladder or bowel pain may warrant a referral to a urologist or gastrointestinal specialist. “What you need is a partner,” Levy says, “and you need someone to help manage the different things that cause the pain to happen.”

Note: An earlier version of this story included a reference to a study which has been retracted.  The study reference was removed on 4-17-19.

8 Ways People With Endometriosis Deal With the Pain

Dr. Dassel says that very hot baths can be effective for endometriosis pain because they immerse all of the affected areas in heat at once, such as the pelvic floor, the abdominal walls, and the lower back.

3. Take your heat therapy to go.

Sometimes you can’t stay at home in a hot bath or with a heating pad resting on your abdomen. Lindsey C., 27, tells SELF that she swears by Therma Care heat wraps for those situations. “They are the best for when you’re in pain but you still have to be able to function normally away from a wired heating pad,” she says. “They wrap around your body…and they last for eight hours.”

Lindsey recommends the variety that’s made for your back and shoulders, which cover more surface area than the stomach ones. “I keep one in my desk at work, just in case I ever need it,” she says. Abby is also a huge fan of Therma Care heat wraps when she’s on the move.

4. Consider seeing a pelvic floor physical therapist.

Nora N., 27, has undergone laparoscopic surgery for her endometriosis. She is also on hormone therapy and medication to help with the pelvic nerve damage caused by the condition. When these measures didn’t help her pain subside enough, a specialist referred Nora to pelvic floor physical therapy. Nora tells SELF that this has been a “lifesaver” in managing her endometriosis.

While various medical treatments can work wonders with endometriosis pain, they often don’t address what doctors are coming to understand as one of the most common secondary sources of this discomfort, Dr. Dassel says: a form of chronic pelvic pain called high tone pelvic floor dysfunction.

This is best understood as the result of your pelvic floor’s self-defensive mechanism in response to endometriosis, Dr. Dassel says. It’s kind of like your pelvic floor’s attempt to protect the underlying structures that are being more or less pummeled with pain and inflammation.

“If you imagine someone punching you in your thigh or ribs, you might react by kind of bending over into a defensive posture,” Dr. Dassel explains. “It’s essentially your body saying, ‘Hey, this area hurts, don’t use it.’ ”

This continuous tension (called hypertonicity) can result in chronic pain that is often described as a dull, achy cramping that radiates into the back or down into the legs or vagina, Dr. Dassel says. It can be aggravated by your period and activities like vaginal intercourse, bowel movements, urination, and exercise. Nora, for instance, didn’t have sex with her partner for two years.

Pelvic floor physical therapy helps people learn how to relax those muscles through various methods like stretching, breathing exercises, and activating trigger points via intervaginal pressure applied by the physical therapist or a therapeutic wand that the patient is taught to use on themselves. (Not unlike the way a massage therapist will manipulate knots in your back muscles, Dr. Dassel says.)

Nora credits this combination of medication plus pelvic floor physical therapy with relieving pain in her pelvis, lower back, and butt, as well as letting her regain intimacy with her partner. “I don’t [know] what’s doing what. But I’m certain I needed both therapy and meds to get to where I am today,” Nora says. “It helped me ease my way into trying sex again, and over the course of having sex more often, it [became] easier and less painful.

Of course, finding a specialist in pelvic floor physical therapy, making it to those appointments, and paying for the treatment isn’t feasible for a lot of people. But if you’re curious, consider asking your doctor to help you find a specialist or look for options near you through the American Physical Therapy Association.

5. Experiment with yoga.

We absolutely are not suggesting that you force yourself to move when all you want to do is lie down and try to breathe through endometriosis pain. But some people with endometriosis have used yoga to ease their discomfort when they feel up to it.

Painkillers « Endometriosis.org

by Ros Wood and Ellen T Johnson
Most of us with endometriosis know quite a bit about having pain. Unfortunately, we know a lot less about how to manage that pain. In our attempts to deal with pain, many of us have used various medications such as aspirin, Paracetamol, Panadol, or Tylenol. These drugs alleviate pain by reducing the body’s sensitivity to pain.

Fewer of us are familiar with the use of the non-steroidal anti-inflammatory drugs (NSAIDs) for managing pain. Some of the more common NSAIDs include ibuprofen (ACT-3, Advil, Brufen, Motrin, Nurofen), naproxen sodium (Aleve, Naprogesic, Naprosyn, Naproxen), ketoprofen (Orudis KT), and mefenamic acid (Ponstan). These drugs can be effective in alleviating pain and inflammation, but to do so, they must be used correctly. Too often, women are prescribed NSAIDs without clear instructions about their use, so they use them the same way they use analgesic drugs. However, when used incorrectly, NSAIDs don’t work.

It is thought that much of the pain of endometriosis, especially menstrual pain, is due to inflammation that may be caused in part by high levels of “bad prostaglandins.” Prostaglandins are hormone-like chemicals that can be found in every cell of the body. Prostaglandins have beneficial effects (enhance immune function, block inflammation, relax muscles, maintain the integrity of the stomach lining, dilate blood vessels, etc.), as well as detrimental effects (produce inflammation, decrease oxygen flow, contract muscles, induce pain, etc.). The bad news is that women with endometriosis have been shown to produce an excess of a prostaglandin called PGE2, which causes inflammation, pain, and uterine contractions.

Theoretically, NSAIDs would seem to be a good choice for relieving menstrual pain because most of them work by blocking the production of all prostaglandins. The result is less pain, swelling, and inflammation. However, since NSAIDs work by stopping the production of the pain-causing prostaglandins, they must be taken before any of these chemicals are produced. In other words, you must start taking NSAIDs at least 24 hours before you expect to experience pain. If you delay taking them until after you feel pain, the medication cannot block the pain-producing chemicals that have already been released, so they will not alleviate pain.

If you are using NSAIDs for ovulation pain or menstrual pain, it is recommended that you start taking them as directed at least 24 hours before you expect to ovulate or 24 hours before you expect to start bleeding. If you have an unpredictable menstrual cycle, you may want to take them for a week or more before you expect menstruation to begin. To be effective, it is important to take NSAIDs regularly every six hours so that no pain-producing chemicals are produced during ovulation or menstruation. Another advantage of taking certain NSAIDs is that they decrease the amount of menstrual bleeding (1, 2).

There are many different brands of the NSAIDs available. Some are available over-the-counter at your local pharmacy, while some are available by prescription only. It is difficult to predict which type of NSAID will be effective for a particular individual, so you may need to try two or three brands before finding one that relieves your pain. Talk to your pharmacist or doctor about suitable brands to try. If you’ve already tried an NSAID without success, you may want to try again. If you were using them incorrectly before, try starting them well in advance of your pain so that no pain-producing prostaglandins are produced.

The most important thing to remember is that unlike analgesics, NSAIDs do not block existing pain. Instead, they block the production of prostaglandins that produce the pain. Therefore, they must be taken before you feel any pain. And they must be taken every six hours around the clock if they are to work effectively.

Like many drugs, NSAIDs can have side effects – some quite serious. Because NSAIDs block all prostaglandin production, they also block the good prostaglandins responsible for maintaining the integrity of the stomach lining. That’s why the most common side effects of NSAIDs include nausea, vomiting, diarrhoea, irritation of the stomach, and stomach ulcers. To help reduce stomach irritation, NSAIDs should be taken with food. Newer NSAIDs called selective COX-2 inhibitors (Vioxx, Celebrex, Bextra) were originally thought to cause less bleeding and fewer ulcers than traditional NSAIDs. However, follow-up studies on these drugs have shown there is no clinically meaningful safety advantage over traditional NSAIDs. Therefore, COX-2 inhibitors should be used with the same caution as any other NSAID. If you are considering taking any type of NSAID, be sure to ask for a complete list of potential side effects, warnings, and possible drug interactions from your pharmacist or healthcare practitioner. Also be sure to inquire about the types of side effects that should be reported to your doctor immediately.

Finally, it’s important for you to know that the effects of “bad prostaglandins” can also be moderated in part by diet and supplements. As we’ve discussed in prior articles and interviews with Dian Shepperson Mills, reducing animal fats, caffeine, and alcohol, and adding flax oil, fish oil, and olive oil to your diet can increase the production of “good prostaglandins” and decrease the production of “bad prostaglandins.” If you cannot take NSAIDs (or choose not to), dietary changes may be a good option to try.

  1. Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev 2000;(2):CD000400, ISSN: 1469-493X, Lethaby A; Augood C; Duckitt K; Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
  2. Medical management of dysfunctional uterine bleeding, Baillieres Best Pract Res Clin Obstet Gynaecol 1999 Jun;13(2):189-202, ISSN: 1521-6934, Irvine GA; Cameron IT Ayshire Central Hospital, Irvine, UK

ORILISSA® (elagolix) to Manage Moderate to Severe Endometriosis Pain


What is the most important information I should know about ORILISSA?

ORILISSA may cause serious side effects, including bone loss and effects on pregnancy:

  • Bone Loss (decreased Bone Mineral Density [BMD])
    While you are taking ORILISSA, your estrogen levels will be low. This can lead to BMD loss. If you have bone loss on ORILISSA, your BMD may improve after stopping ORILISSA, but may not recover completely. It is unknown if these bone changes could increase your risk for broken bones as you age. For this reason, your healthcare provider (HCP) may limit the length of time you take ORILISSA. Your HCP may order a DXA scan to check your BMD.
  • Effects on Pregnancy
    Do not take 
    ORILISSA if you are trying to become or are pregnant, as your risk for early pregnancy loss may increase. If you think you are pregnant, stop taking ORILISSA right away and call your HCP. ORILISSA may change your menstrual periods (irregular bleeding or spotting, a decrease in menstrual bleeding, or no bleeding at all), making it hard to know if you are pregnant. Watch for other signs of pregnancy, such as breast tenderness, weight gain, and nausea. ORILISSA does not prevent pregnancy. You will need to use effective hormone-free birth control (such as condoms or spermicide) while taking ORILISSA and for 28 days after stopping ORILISSA. Birth control pills that contain estrogen may make ORILISSA less effective. It is unknown how well ORILISSA works while on progestin-only birth control.
Do not take ORILISSA if you:
  • Are pregnant, have osteoporosis, have severe liver disease, are taking medicines called organic anion transporting polypeptide (OATP) 1B1 inhibitors that are known or expected to significantly increase the blood levels of elagolix, the active ingredient in ORILISSA (ask your HCP if you are not sure if you are taking one of these medicines), or have had a serious allergic reaction to ORILISSA or any of the ingredients in ORILISSA. See the end of the Medication Guide for a complete list of ingredients in ORILISSA. Ask your HCP if you are not sure.
What should I tell my HCP before taking ORILISSA?

Tell your HCP about all of your medical conditions, including if you:

  • Have or have had broken bones or other conditions that may cause bone problems; have or have had depression, mood problems, or suicidal thoughts or behavior; have liver problems; think you may be pregnant; or are breastfeeding or plan to be. It is unknown if ORILISSA passes into breast milk. Talk to your HCP about the best way to feed your baby if you take ORILISSA.

Tell your HCP about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Especially tell your HCP if you take birth control that contains hormones. Your HCP may advise you to change your method of birth control.

What are the possible side effects of ORILISSA?

ORILISSA can cause serious side effects including:

  • Suicidal thoughts, actions, or behavior, and worsening of mood. Call your HCP or get emergency medical help right away if you have any of these symptoms, especially if they are new, worse, or bother you: thoughts about suicide or dying, attempts to commit suicide, new or worse depression or anxiety, or other unusual changes in behavior or mood. You or your caregiver should pay attention to any changes, especially sudden changes in your mood, behaviors, thoughts, or feelings.
  • Abnormal liver tests. Call your HCP right away if you have any of these signs and symptoms of liver problems: yellowing of the skin or the whites of the eyes (jaundice), dark amber-colored urine, feeling tired, nausea and vomiting, generalized swelling, right upper stomach area pain, or bruising easily.

The most common side effects of ORILISSA include: hot flashes and night sweats, headache, nausea, difficulty sleeping, absence of periods, anxiety, joint pain, depression, and mood changes.

These are not all of the possible side effects of ORILISSA. This is the most important information to know about ORILISSA. For more information, talk to your HCP.

Take ORILISSA exactly as your HCP tells you. Tell your HCP if you have any side effect that bothers you or that does not go away. Call your doctor for medical advice about side effects.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1‑800‑FDA‑1088.

If you are having difficulty paying for your medicine, AbbVie may be able to help. Visit AbbVie.com/myAbbVieAssist to learn more.


Endometriosis – Treatment – NHS

Deciding which treatment

Your gynaecologist will discuss the treatment options with you, and outline the risks and benefits of each.

When deciding which treatment is right for you, there are several things to consider.

These include:

  • your age
  • what your main symptoms are, such as pain or difficulty getting pregnant
  • whether you want to become pregnant – some treatments may stop you getting pregnant
  • how you feel about surgery
  • whether you have tried any of the treatments before

Treatment may not be necessary if your symptoms are mild, you have no fertility problems, or you’re nearing the menopause, when symptoms may get better without treatment.

Endometriosis sometimes gets better by itself, but it can get worse if it’s not treated. One option is to keep an eye on symptoms and decide to have treatment if they get worse.

Support from self-help groups, such as Endometriosis UK, can be very useful if you’re learning how to manage the condition.

Hormone treatment

The aim of hormone treatment is to limit or stop the production of oestrogen in your body, as oestrogen encourages endometriosis tissue to grow and shed. 

Limiting oestrogen can reduce the amount of tissue in the body.

But hormone treatment has no effect on adhesions (“sticky” areas of tissue that can cause organs to fuse together) and cannot improve fertility.

Find out more about adhesions and other complications of endometriosis

Some of the main hormone-based treatments for endometriosis include:

Evidence suggests these hormone treatments are equally effective at treating endometriosis, but they have different side effects.

You can discuss the different options and their side effects.

Most hormone treatments reduce your chance of pregnancy while using them, but not all of them are licensed as contraceptives.

None of the hormone treatments have a permanent effect on your fertility.

The combined oral contraceptive pill

The combined contraceptive pill contains the hormones oestrogen and progestogen. 

They can help relieve milder symptoms, and can be used over long periods of time.

They stop eggs being released (ovulation) and make periods lighter and less painful.

These contraceptives can have side effects, but you can try different brands until you find one that suits you.

Your doctor may recommend taking 3 packs of the pill in a row without a break to minimise the bleeding and improve any symptoms related to the bleeding.


Progestogens are synthetic hormones that behave like the natural hormone progesterone.

They work by preventing the lining of your womb and any endometriosis tissue growing quickly.

But they can have side effects, such as:

  • bloating
  • mood changes
  • irregular bleeding
  • weight gain

Progestogens used to treat endometriosis include:


Surgery can be used to remove or destroy areas of endometriosis tissue, which can help improve symptoms and fertility.

The kind of surgery you have will depend on where the tissue is.

The main options are:

  • laparoscopy – the most commonly used technique
  • hysterectomy

Any surgical procedure carries risks. It’s important to discuss these with your surgeon before undergoing treatment.


During laparoscopy, also known as keyhole surgery, small cuts (incisions) are made in your tummy so the endometriosis tissue can be destroyed or cut out.

Large incisions are avoided because the surgeon uses an instrument called a laparoscope.

This is a small tube with a light source and a camera, which sends images of the inside of your tummy or pelvis to a television monitor.

During laparoscopy, fine instruments are used to apply heat, a laser, an electric current, or a beam of special gas to the patches of tissue to destroy or remove them.

Ovarian cysts, or endometriomas, which are formed as a result of endometriosis, can also be removed using this technique.

The procedure is carried out under general anaesthetic, so you’ll be asleep and will not feel any pain as it’s carried out.

Although this kind of surgery can relieve your symptoms and sometimes help improve fertility, problems can recur, especially if some endometriosis tissue is left behind.

You may need to take hormone treatment before and after surgery to help avoid this.


If keyhole surgery and other treatments have not worked and you have decided not to have any more children, removal of the womb (a hysterectomy) can be an option.

A hysterectomy is a major operation that will have a significant impact on your body.

Deciding to have a hysterectomy is a big decision you should discuss with your GP or gynaecologist.

Hysterectomies cannot be reversed and, though unlikely, endometriosis symptoms could return after the operation.

If the ovaries are left in place, the endometriosis is more likely to return.

If your ovaries are removed during a hysterectomy, the possibility of needing HRT afterwards should be discussed with you. 

But it’s not clear what course of HRT is best for women who have endometriosis.

For example, oestrogen-only HRT may cause your symptoms to return if any endometriosis patches remain after the operation.

This risk is reduced by the use of a combined course of HRT (oestrogen and progesterone), but can increase your risk of developing breast cancer.

But the risk of breast cancer is not significantly increased until you have reached the normal age for the menopause. Talk to your doctor about the best treatment for you.

Complications of surgery

All types of surgery carry a risk of complications.

If surgery is recommended for you, speak to your surgeon about the possible risks before agreeing to treatment.

Read about the complications of endometriosis for more information about the risks of surgery.

Gonadotrophin-releasing hormone (GnRH) analogues

GnRH analogues are synthetic hormones that bring on a temporary menopause by reducing the production of oestrogen.

They’re sometimes given before surgery to help reduce the amount of endometrial tissue. You would normally take them for 3 months before your surgery.

GnRH analogues are not licensed as a form of contraception, so you should still use contraception while using them.

90,000 Nonsteroidal anti-inflammatory drugs for pain relief in women with endometriosis

What is the problem?

Endometriosis is a gynecological condition that commonly affects women of childbearing age. This can lead to painful symptoms, including painful periods, pain during or after intercourse, pelvic pain and pain in the lower abdomen, and infertility. This can significantly affect the quality of life of women, their careers, daily activities, sexual and non-sexual relationships, and fertility.Non-steroidal anti-inflammatory drugs (NSAIDs) are most commonly used as first-line therapy in women with endometriosis because they have few side effects and many are available over the counter.

Why is this important?

Endometriosis is a very common condition but can be difficult to diagnose. In 2015, 1.8 billion women (ages 15 to 49) worldwide were diagnosed with endometriosis. An estimated 60% of women experience endometriosis with painful symptoms.Endometriosis can significantly affect the quality of life of women, affecting their careers, daily activities, sexual and non-sexual relationships and fertility. An unpublished study by patient support organization in the United Kingdom – Endometriosis UK (www.endometriosis-uk.org/) found that 65% of women with endometriosis reported that their condition negatively affects their work. Ten percent of women were forced to reduce their hours of work, and 30% were unable to continue the same work.As many as 16% of women were unable to continue doing any kind of work, and 6% had to claim government benefits; in addition to feelings of loss of contribution to society, they became dependent on others. This further lowers their low self-esteem. Endometriosis is considered to be a significant public health issue as it affects a large number of women and the conditions associated with this disease are important.

Nonsteroidal anti-inflammatory drugs are available without a prescription and are used to relieve pain.They work by preventing or slowing down the production of prostaglandins, which helps relieve painful cramps associated with endometriosis. However, a Cochrane Review of NSAID use for painful periods found that NSAIDs increase the risk of indigestion (eg, nausea, diarrhea) or other side effects (eg, headache, drowsiness, dizziness, dry mouth). We conducted this review to compare all NSAIDs used to treat women with painful symptoms caused by endometriosis versus placebo, other pain medications, or no treatment to assess their effectiveness and safety.

What evidence have we found?

We searched for new evidence in October 2016 and found no new randomized controlled trials.

Based on previous updates, this review found limited evidence of the effectiveness of NSAIDs (in particular naproxen) in the treatment of pain caused by endometriosis. This review is also limited in that it includes only one study with data suitable for analysis, and this study included only 20 women.The available evidence is of very low quality, mainly due to poor presentation of methods, inadequate conclusions on overall pain relief, unintended side effects of treatment, and the need for additional pain relief. The included clinical trials did not report quality of life, impact on daily activities, absence from work or school, or participants’ satisfaction with treatment.

What does this mean?

The available evidence does not allow concluding whether NSAIDs are effective for the treatment of pain caused by endometriosis, or whether certain NSAIDs are more effective than others.As shown in other Cochrane Reviews, women who use NSAIDs should be aware that NSAIDs can cause side effects such as nausea, vomiting, headache, and drowsiness. Unless we identify new evidence in the future, we will not update this review again.

Quality of evidence

The evidence was of very low quality due to the risk of bias and inaccuracies (results were based on one small clinical trial).

Endometriosis: why so little is known about this disease

  • Aime Grant Cumberbatch
  • BBC Future

This disease, which is accompanied by unbearable pain, is found in about one in ten women. But despite the prevalence of endometriosis, the causes of its occurrence and methods of treatment are still poorly understood.

Painful periods began when I was 14 years old.To get through the day at school, I put on an anesthetic patch. But this did not always help. Quite often I found myself in the nurse’s office, where I writhed in pain on the couch, and the doctors did not know what to think, because my appendicitis had already been cut out.

After ten years of struggling with unbearable pain, I finally heard the diagnosis – endometriosis. But that didn’t make things much easier. The disease has been little studied, and diagnosis and treatment are complex and can last a lifetime.

Endometriosis is a gynecological disease associated with menstruation in which tissue of the endometrium (the inner layer of the uterus) grows on other parts of the body, such as the fallopian tubes, intestines, and vagina.In rare cases, it even manifests itself in the lungs, eyes, spine and brain. The only place in the body where uterine endometrial cells have never been found is the spleen.

Symptoms of the disease – severe, sometimes simply unbearable, pain in the lower abdomen, fatigue and heavy periods.

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Endometriosis affects one in 10 women of reproductive age

There are many diseases, research of which does not receive sufficient funding, and which remain poorly understood.But none is as common as endometriosis, which affects about 176 million women worldwide.

In the United States, where, as in other countries, endometriosis is found in one in 10 women of reproductive age, $ 6 million is allocated for the study of this disease. In comparison, research on sleep disorders receives 50 times more.

The Health Gap series focuses on gender inequalities in health and medicine. Other articles in this series:

Pain is not the only consequence of endometriosis.A recent study in 10 countries found that endometriosis costs each patient an average of € 9,579 annually (in terms of health, productivity and quality of life), which is more than € 26 per day.

It can also result in infertility. And severe pain makes patients vulnerable to other ailments.

“Severe pain has been shown to alter the central nervous system as well as the patient’s response to pain in the future, which increases the risk of other chronic pain conditions,” explains Katie Vincent, Senior Research Fellow at the University of Oxford.

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The primary symptom is acute pain in the lower abdomen for no apparent physiological cause , is acute pelvic pain without obvious physiological causes.

This is one of the reasons for the mystery of this disease. However, the main reason that so little is known about such a common disease is that only women suffer from endometriosis, and it is associated with menstruation.

Ancient origins

It is believed that endometriosis was discovered using a microscope by the Czech scientist Karl von Rokytansky in 1860. Although there is evidence of earlier studies. However, the symptoms of the disease have been described since antiquity.

Endometriosis has often been attributed to “hysteria” – for example, one analysis of descriptions of pelvic pain in the medical literature indicated that many cases attributed to hysteria could be endometriosis.

“What was called hysterical convulsions in ancient times was often described as a condition where a woman falls to the ground, writhing in a fetal position,” the study says.“But this is very reminiscent of a reaction to severe pain.”

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Many cases, which in ancient times were attributed to “hysteria”, have symptoms similar to endometriosis

Underestimation and misunderstanding of endometriosis of steel the reason that modern medicine knows very little about it. The causes of the disease are unknown, there is no treatment. An accurate diagnosis can take up to ten years, and the only way to definitively make a diagnosis is surgical intervention – laparoscopy.

I spoke with three women in their 20s and 30s who have been diagnosed with endometriosis. Until the women were finally diagnosed with endometriosis, they were given several false diagnoses, and the symptoms were often overlooked.

“I don’t remember a single doctor who would say the diagnosis of endometriosis, or at least ask the right questions,” says 31-year-old Alice Bodenham. “Everything I heard was“ this is normal ”or“ you are exaggerating

The problem of false diagnoses is partly due to the general tendency of doctors to ignore women’s complaints of pain, when pain is the most common symptom of endometriosis.

So it was with me. Once, during an ultrasound scan, I felt a sharp pain and reported this to the doctor. Later in the results of the analysis, I read the note “during the study, the patient felt slight discomfort.”

Complicating the situation is the fact that there is no direct correlation between the intensity of pain and the severity of the patient’s condition.

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Women often face the fact that their complaints of pain are not taken seriously

There are no non-invasive means to make a definitive diagnosis, but in order to send a patient for laparoscopy, the doctor must treat the described symptoms in all seriousness.And this is not always the case, the verdict “it’s all in your head” is still very common.

Therefore, it is probably not surprising that out of 2600 women with endometriosis, almost half consulted a family doctor 10 or more times before being referred to a specialist.

Both Bodenham and Cristal Rodriguez (31) passed out several times from pain before their complaints were taken seriously.

24-year-old Caitlin Koners, who now runs the My Endometriosis Diary blog, practically diagnosed herself.Studying the medical literature, the girl began to suspect that she had endometriosis, but the doctor strongly rejected her assumptions.

“I explained that I have very severe recurrent pains and pain in the lower abdomen, but the doctors said that it was definitely not endometriosis.”

Katie Vincent of Oxford University believes that gender inequality plays a significant role in the situation.

“If any 14-year-old boy went to the doctor, noting that he misses two days of school every month for severe pain, doctors would pay attention to his words,” says the researcher.

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Even on ultrasound, doctors cannot always identify foci of endometriosis

Even during ultrasound, doctors cannot always identify lesions at the initial stage of the disease. Endometriosis forums are inundated with stories of false negative ultrasound results.

Lack of patient awareness, taboos that still surround female physiology, often delay the diagnosis. The women I spoke with said that in the family or in sex education classes, they constantly heard that periods can be uncomfortable or painful.

But how painful, and what is no longer the norm, they did not know.

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The taboos that still surround menstruation are the reason women do not know which pain is normal and which is not

Charities and campaigns in support of patients endometriosis is actively working to disseminate information about the disease, and their efforts are already having results.

In 2017, the Australian government adopted the National Endometriosis Plan to improve treatment and awareness, and increased research funding to $ 4.5 million.

Amendments were made to the treatment protocol of actions, and most importantly, endometriosis was introduced into the training program for primary health care specialists.

Although this is an important step, family doctors still have to bypass a lot of instructions, and the lack of specialized centers is another problem around the world.

There is no panacea

However, even if the diagnosis is determined correctly, the doctor can also make a mistake during treatment.

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Some doctors still tell their patients that pregnancy is an effective remedy for endometriosis.

Some doctors still tell their patients that pregnancy is an effective remedy for endometriosis.

“Nothing can be done about endometriosis, the only thing that will help you is pregnancy,” the doctor told me.

Considering that the disease can cause infertility, this advice is at least illogical. But he is also mistaken, since the symptoms will disappear only during the pregnancy.

Others, such as the writer Lena Dunham, suggest solving the problem with a hysterectomy (removal of the uterus) – she wrote about her decision to have the operation in Vogue earlier this year.

But even such a radical method is controversial, since endometriosis affects the tissues outside the uterus, and not inside it, therefore, after removal of the uterus, relapses are not excluded.

Since endometriosis is primarily affected by estrogen, hormonal treatment is most common. However, hormones help control the disease, but do not cure it, and besides, they can have their own side effects.

For example, women who use hormonal contraceptives are more likely to develop depression, according to a recent study by Danish scientists.

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Hysterectomy is not a reliable cure for endometriosis

Medical menopause (artificial cessation of menstruation) could be a possible treatment.However, in the long term, it has a negative effect on bone density, especially in young women, and one potential, albeit rare, side effect is complete menopause.

There is no consensus among experts about this method, but the number of women who end up resorting to artificial menopause without realizing its side effects is quite large.

“Medical treatment of endometriosis is completely focused on hormone therapy, but so far we know that many patients are not getting the desired effect,” says Creen Zondervan, professor of reproductive and genomic epidemiology at the University of Oxford.

“Plus, it has many side effects that women would not want to experience in the long term,” adds the specialist.

Another option is pain relievers, although they only relieve symptoms, they do not cure the disease.

But they also have quite negative consequences. As Bodenham said, her use of opioid pain relievers over the past three years has provoked a host of side effects in her, in particular anemia and hypertension.

“I used to run 5 km every week, but now sometimes I go down the stairs for a glass of water with the feeling that I ran a marathon,” the girl says.

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Although painkillers help to get rid of the symptoms of the disease, they have many side effects.

However, there is hope. Awareness of the disease is growing at a noticeable rate, and general practitioners are being taught to be more attentive to patients’ complaints of lower abdominal pain.

After finding out that hormonal contraception negatively affects my mental health, I had to decide on the following actions. One option is the use of the Mirena intrauterine device, it has a low dose of hormones, the other is laparoscopy for the final diagnosis.

However, recovery from laparoscopy takes several weeks, and I am a freelancer and cannot afford not to work for so long. This requires savings, which I do not have yet.

And this is another example of difficult choices that face women with chronic pelvic pain syndrome.

To read the original of this article in English you can visit the website BBC Future .

What is endometriosis and how to treat it

What is endometriosis and how is it dangerous

Let’s start with the basic concepts.The endometrium is the lining of the uterus. Sometimes it happens that it (to be absolutely precise, a tissue very, very similar to it) begins to grow where it should not be. For example, in the ovaries and fallopian tubes. Or (which happens less often, but still) in the intestines, bladder, pelvic cavity.

This condition in which the endometrium extends beyond the uterus is called endometriosis .

And everything would be fine, but the endometrium is a hormone-sensitive tissue.During ovulation, when the production of hormones estrogen and progesterone increases, it swells, becomes thicker and friable. In the uterus, this is necessary for the fertilized egg, if any, to find something to cling to for subsequent development.

If the egg is not fertilized, the body gets rid of it. It is for this purpose that menstruation serves. The thickened endometrium also becomes unnecessary, and the body seeks to destroy it and wash it out with the onset of bleeding. But from the ovaries, fallopian tubes, and even more from the abdominal cavity, it is not so easy to remove the tissue that has become unnecessary.

Dead endometrium causes inflammation and swelling of the organ on which it has grown. Later, this can lead to the formation of scar tissue at the site of inflammation. Scars can, in particular, disrupt the patency of the fallopian tubes and make it impossible to conceive.

Endometriosis affects every tenth women aged 15 to 49 years.

But this is not all the troubles that the disease manifests itself in.

What are the signs of endometriosis

Due to the overgrowth of the wrong endometrial tissue, women most often experience the following symptoms.

  • Painful periods (dysmenorrhea) . Pelvic pain and cramping during menstruation occurs earlier and lasts longer than usual.
  • Pain during menstruation, radiating to the lower back .
  • Pain during sex .
  • Discomfort when going to the toilet . Painful symptoms intensify during menstruation.
  • Heavy menstrual bleeding .
  • Difficulty conceiving .Often, endometriosis is first diagnosed in women who cannot get pregnant naturally and are looking for ways to cure infertility.
  • Unpleasant sensations similar to digestive problems . Bloating, constipation, diarrhea, nausea during menstruation.

What is important: the severity of sensations has nothing to do with the degree of the disease. You may have little or no symptoms, but you will have severe endometriosis. Or vice versa: menstrual cramps and other signs are severe, but endometriosis will be minor.

In any case, if you observe at least a couple of symptoms of endometrial tissue overgrowth, go to consult a gynecologist. The doctor will conduct a gynecological examination, suggest you undergo an ultrasound scan and make a diagnosis.

How to treat endometriosis

There is no cure for this condition . Doctors do not know how to guarantee to stop the proliferation of the endometrium. But there are ways to ease the symptoms of the disease.

1. Taking painkillers

To reduce the discomfort during your period, your doctor may recommend that you take pain relievers based on paracetamol or ibuprofen.But it is important to bear in mind that these drugs do not help everyone.

2. Hormone therapy

Taking some hormones slows down the growth of the endometrium and prevents it from thickening and breaking down during menstruation. The gynecologist can advise you:

  • Hormonal contraceptives. Birth control pills, patches, vaginal rings can all help control hormone levels and reduce swelling and pain.
  • Agonists and antagonists of gonadotropin-releasing hormone (Gn-RH).These medications block the production of estrogen and thus prevent menstruation altogether.
  • Danazol. Preparations with this active ingredient also help to stop menstruation and reduce the symptoms of endometriosis.

3. Surgery

This is an option for women who want to get pregnant or have severe pain during their period. Most often, the operation is performed by the method of laparoscopy: through a tiny incision in the abdominal cavity, the surgeon inserts an instrument and with its help removes areas of endometrial tissue from the affected organs.Sometimes the same procedure is done with a laser.

This operation has a temporary effect: endometriosis often occurs again. But during this period, a woman can manage to get pregnant. Or at least live without menstrual pain for a while.

In the most advanced cases, if the bleeding and pain of endometriosis are severe and cannot be reduced by other methods, the doctor may suggest a complete removal of the uterus and ovaries. But nowadays this method is rarely used.If the gynecologist still recommends this option, at least consult with another specialist.

How to reduce the risk of developing endometriosis

Unfortunately, no way. Science has not yet fully figured out what causes endometriosis. Therefore, generally accepted methods of prevention have not yet been developed.

However, you can try to develop them yourself. Here are the risk factors that are thought to increase the likelihood of developing endometriosis.If it is possible to avoid any of them, do it.

  • Absence of children. In nulliparous women, endometriosis is much more common.
  • Menses that began at an early age (before 10-11 years).
  • Short menstrual cycle (less than 27 days).
  • Prolonged periods (longer than 7 days).
  • Low body mass index.
  • Heredity. If your mother, aunt, and sisters have endometriosis, your risks are increased.

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Complications of endometriosis


The main complication of endometriosis is impaired fertility. About half of women with endometriosis have difficulty conceiving and carrying a pregnancy.

In order for pregnancy to become possible, the egg must leave the ovary through the fallopian tube, fertilize with a sperm and attach to the wall of the uterus, and begin development.Endometriosis can damage the fallopian tube and thus prevent the egg and sperm from meeting. The disease can also affect the conception and gestation of pregnancy, having an embryotoxic effect on the fetus.

Even so, many women with mild endometriosis are still able to conceive and maintain a pregnancy. Doctors advise women with endometriosis not to delay having babies because the condition can worsen over time.

Ovarian cancer

The probability of degeneration of ovarian endometriosis into a malignant tumor is low, but the risks in this category of patients are higher.

Diagnosis of endometriosis

To diagnose endometriosis and other conditions that can cause chronic pelvic pain, your doctor will ask you to describe your symptoms, including the location and timing of the pain.

Methods for the diagnosis of endometriosis:

Gynecological examination

During a pelvic examination, the doctor palpates the pelvic area for diseases such as fibroids, ovarian cysts, scarring behind the uterus.Often, it is not possible to identify small areas of endometriosis if they have not caused the formation of nodules or cysts.

Ultrasound examination

This study uses high frequency sound waves to create an image of the inside of the body. To capture an image, the machine’s sensor is either pressed against the abdomen or inserted into the vagina (transvaginal ultrasound). In order to get a better image of the internal genital organs, both types of ultrasound examination can be done.An ultrasound scan can help identify cysts associated with endometriosis (endometriomas). The study is preferable to conduct on the eve of menstruation. The gold standard for the diagnosis of endometriosis is diagnostic laparoscopy, which states the form of endometriosis and the extent of the spread of the process.

Endometriosis treatment

Treatment of endometriosis, as a rule, is complex: with the help of drugs or surgery. The optimal approach depends on the severity of the symptoms and reproductive plans.Low-symptom forms of the disease are treated with hormonal drugs. Endometriomas and common endometriosis are treated in a complex, including surgical treatment.


Your healthcare provider may recommend over-the-counter pain relievers, such as non-steroidal anti-inflammatory drugs (NSAIDs), to help ease painful periods. However, this does not exclude the need for complex treatment.

Hormone therapy

The use of hormones is effective in reducing or eliminating pain in endometriosis.This is because the rise and fall in hormone levels during the menstrual cycle causes endometriotic lesions to break down and bleed. Hormonal medications can slow growth and prevent new lesions of endometriosis from forming.

However, hormone therapy does not provide a complete solution to the problem of endometriosis. It is possible that symptoms may return after stopping treatment.

Methods of hormonal therapy in the treatment of endometriosis:

  • Hormonal contraceptives.Birth control pills, patches, and vaginal rings help control the levels of hormones responsible for the buildup of endometrial tissue each month. For most women, menstruation is easier and shorter when using hormonal contraceptives. The use of hormonal contraceptives, especially continuous regimens, can reduce or eliminate pain from mild to moderate endometriosis.
  • Gonadotropin-releasing hormone (Gn-RH), agonists and antagonists.These drugs block the production of stimulating hormones by the ovaries, lowering estrogen levels and preventing menstruation. This causes the endometrial tissue to reverse development. Gn-RH agonists and antagonists can bring endometriosis into remission during treatment, and sometimes for months or years thereafter. Because these drugs create a state of artificial menopause, taking small amounts of estrogen or progestin along with Gn-RH agonists and antagonists can reduce the side effects of menopause, such as hot flashes, vaginal dryness, and bone loss.Menses and the ability to get pregnant will return after treatment is complete.
  • Medroxyprogesterone (Depo-Provera) This injectable drug is effective in stopping menstruation and growing endometrial implants, thereby relieving the signs and symptoms of endometriosis.