By Dr. Amy Markese
I like to look at endometriosis treatment as a “trial-and-error” process. Every woman’s symptoms, preferences and goals are different, and the interventions that work best for some are less effective for others.
Endometriosis is when tissue from the lining of the uterus, the endometrium, grows outside the uterus, causing problems ranging from pain to infertility. It is often a life-long condition, so we often focus on managing the symptoms, the primary one being pelvic pain.
While surgery can occasionally be a good option for women who have not responded well to other treatment, it is often not the best long-term solution. Even after surgery to remove the uterus and ovaries, some women still experience endometriosis-related pain. So we often work to manage endometriosis symptoms other ways, including treatment modalities the patient can try on her own.
At CU Medicine OB-GYN, we strive to create nurturing and communicative relationships with our patients to better understand what they are looking to get out of their endometriosis treatments. In most cases, in addition to standard medical options, we may also be able to suggest non medical options to help with endometriosis pain such as mindfulness practice, acupuncture, and massage. Lifestyle and diet changes may also improve the quality of life for chronic pain patients.
Mindfulness as Medicine
We know that mindfulness can be helpful in treating chronic pain conditions. Mindfulness is the practice of paying attention to your thoughts, feelings, behaviors and being present in whatever you’re doing. It boils down to being actively involved in your senses, including the ways in which you sense and experience pain.
While we do not have many studies specific to endometriosis, I encourage interested patients to consider mindfulness in addition to their other treatments. Studies show that mindfulness can help patients to separate the feeling of pain itself from the judgments that we place on it, which are believed to make our perception or experience of pain worse.
Focusing on the actual experience of pain, meaning the way that it makes you think, feel and interact with others, can change the ways those with chronic pain conditions cope with severe pain. And in some cases it can reduce or eliminate that pain altogether.
Stress may also contribute to pain, so therapeutic options such as mindfulness can help to reduce stress related to the condition and improve the way pain is experienced. Patients interested in incorporating mindfulness practices should seek out a mindfulness practitioner who works specifically with patients with chronic pain or other medical conditions.
I also encourage my patients to consider acupuncture treatment for chronic pain. Acupuncture is not a cure-all solution for endometriosis pain, but research suggests that in combination with other treatments it is a safe and effective therapy option for endometriosis pain sufferers of all ages.
This holistic treatment is believed to improve imbalances in the body that can cause severe cramping, pain and other premenstrual symptoms in women and endometriosis sufferers. Acupuncture improves blood flow within treated areas, typically the lower abdomen and pelvic area in endometriosis patients. Needle placement varies based on the patient’s needs, but the increase in blood flow that acupuncture causes is thought to reduce inflammation and pain.
Complications from acupuncture are quite rare, so I recommend my patients who are interested try it in addition to their current treatments to see if it improves their quality of life. Women with endometriosis should look for an acupuncture practitioner who specializes in pelvic pain or chronic pain.
PT + Massage = Dynamic Duo for your Pelvic Floor
When you experience severe tendon, joint or muscle pain, visions of physical therapy likely dance in your head. Now, apply that vision to the collection of muscles that supports and protects your pelvic organs. Over time, these muscles may become overly contracted in response to endometriosis pain, resulting in the symptoms of a pelvic floor disorder.
Pelvic floor physical therapy and general physical therapy are often key components of treatment for endometriosis. Physical therapists, who are specially trained in the female pelvic floor, generally employ a variety of techniques including massage and dry needling to help treat this condition.
Therapeutic massage can help reduce trigger points and other abnormalities in the muscles of the back and abdominal wall, which can all contribute to pelvic pain. There is some evidence to support the use of massage to reduce the amount of menstrual pain experienced by endometriosis patients, making massage a great addition to an endometriosis treatment regimen.
Be Wary of Cannabis Products
We don’t have much research on the effect on endometriosis of CBD (cannabis oil) or THC (the active ingredient in marijuana). While CBD is generally considered safe, it can cause side effects or even interact with other medications. Women should talk with their doctor before starting one of these products for endometriosis pain.
We do not have any evidence that CBD/THC suppositories or tampons are effective or safe. Vaginal medications can affect the pH of the vagina and cause irritation or vaginal discharge, so I encourage women to avoid these products until they’ve consulted with their doctor.
Don’t Forget over-the-counter Medicine Options
Tried and True Lifestyle Changes for Symptom Management
Lifestyle and diet interventions may seem overdone, but they are very important to endometriosis symptom management and can be used in conjunction with medical treatments. A healthy lifestyle – meaning a balanced diet and regular exercise – can help in managing endometriosis pain for some women.
Step 1: Get active!
At least 30 minutes of aerobic exercise, at least five days per week is recommended for a healthy lifestyle. The type of exercise that is most helpful for endometriosis is different from person to person, but lower impact exercises such as yoga, swimming or stationary cycling can sometimes be a more comfortable place to start before introducing higher impact activities like long-distance running, CrossFit or heavy weight lifting.
Step 2: Watch what you eat, food journal style
There are a variety of diets, from gluten free or dairy free to low-FODMAP, that are recommended to women with endometriosis. We do not have good studies that show any one particular diet reduces endometriosis pain in everyone.
Often, trial-and-error works best for women to find which foods might contribute to their endometriosis pain. A good starting point can be to keep a daily food diary that includes a pain rating; this can help find an association between particular foods and pain for that person.
Preventing constipation is also very important to managing endometriosis symptoms, as this can contribute to pelvic pain. Pay close attention to your food diary for foods that may be causing constipation. There are a variety of diet modifications, such as increased intake of dark-colored vegetables, whole grains and beans, as well as over-the-counter medications like fiber supplements that can help treat and prevent constipation.
Dr. Amy Markese is a CU Medicine provider specializing in Obstetrics and Gynecology at UCHealth Women's Care Clinic - Anschutz Medical Campus. She graduated in the top 10 percent of her medical school class at Rush University. She is passionate about providing evidence-based family planning resources and methods.