Painful Periods: Could it be Endometriosis

Endometriosis is a common condition that causes painful periods and decreased fertility. It occurs in 6-10% of women of reproductive age. Endometriosis can range from mild to severe. Occasionally it can be debilitating, resulting in missed school or work. Severe cases can cause bowel obstructions, can be confused with cancer and can even migrate to the diaphragm or lungs. Pain associated with endometriosis can lead to addiction to pain medications and often leads to hysterectomies at a young age. To confuse things, the amount of pain doesn’t always correlate with the severity of endometriosis, and sometimes decreased fertility is the only symptom.

The primary cause of endometriosis is thought to be from retrograde menstruation. This is when menstrual blood flows back through the tubes and enters into the pelvic cavity. Endometrial cells (cells that line the uterus) then implant onto the pelvic lining which is called the peritoneum. Thus, women with endometriosis literally bleed internally every month. Other theories as to the cause of endometriosis include transport through blood or lymph flow, origination through stem cells and coelomic metaplasia (morphing of peritoneal cells into endometrial cells).

Some women are at increased risk for endometriosis. There is a 7-10 fold increased risk in women who have a first-degree relative with endometriosis. There is an association of endometriosis with abnormal hormones. Altered immune function is also thought to contribute to the development of endometriosis.

Endometriosis results in overproduction of prostaglandins and increased local production of estrogen combined with progesterone resistance. In simpler terms, the body produces too many inflammatory cells, and the hormones are imbalanced. As the endometriosis lesions slowly grow they produce an inflammatory reaction within the pelvis. The inflammation is what is thought to decrease fertility. This leads to adhesions (superficial scar tissue or attachments of pelvic organs that distorts the normal anatomy).

Unfortunately, our culture is such that menstrual pain is “normalized”. It is often overlooked, and many women suffer silently. When endometriosis is diagnosed, traditional treatments, such as birth control and Lupron injections, suppress the menstrual cycle and provide symptom relief, but they do not cure the underlying endometriosis. Furthermore, suppressing fertility conflicts with the desire of many who are trying to conceive a pregnancy. Hormonal suppression also has side effects, such as risk of a blood clot and hot flashes. Many women are also ethically opposed to taking these medications.

Surgical treatment, usually performed with minimally-invasive laparoscopy, treats the underlying endometriosis. The most common surgical technique for treating endometriosis is called “fulgeration.” This technique ablates the lesions with cautery (burning). Fulgeration does provide symptom relief; however, there is a high associated recurrence rate and also a risk of adhesion formation.

The NaPro treatment approach to endometriosis seeks to restore women to health AND improve fertility by surgically treating endometriosis. Laser therapy can either be used to excise or to evaporate the lesions of endometriosis. This leaves no (or very minimal) residual deposits of endometriosis and results in a much lower recurrence rate. In NaPro studies, we have seen an approximately 7% recurrence rate with laser excision and 12% with laser evaporization. This compares to an approximate 90% recurrence rate with fulgeration. The other benefit to laser surgery is that there is minimal thermal spread to the surrounding healthy tissue. Thus, the healthy tissue is spared and there is less risk of recurrence. NaPro surgery adds the tedious step of repairing the peritoneal defects after excision surgery by suturing the tissue together. This is referred to as PEARS (pelvic excision and repair surgery). This provides a smooth peritoneal surface so that adhesions are less likely to occur and natural conception is possible.

Robotic surgery is a tool that has contributed to improved treatment of endometriosis. The camera is magnified and 3-dimensional, and the instruments are articulated (wristed) so that fine manipulation of tissue and suturing of tissue in the small spaces deep in the pelvis is possible. There is also less risk of injury to important structures such as the major blood vessels and ureters.

Much research is still needed in the field of endometriosis. There is some evidence that a healthy lifestyle, including an anti-inflammatory diet, moderate exercise and stress reduction, along with some immune-boosting supplements can reduce the recurrence of endometriosis. Hormonal balance with natural progesterone, taken during the luteal phase of the menstrual cycle, may also reduce recurrence. With complementary progesterone supplementation, the chemical structure is identical to the form the body naturally produces. It is important to administer progesterone only during the phase of the cycle when the woman is naturally producing it so as to boost her deficient levels to a normal range and not suppress the cycle. Pregnancy and breastfeeding, which is a natural consequence of successful surgery, reduces and postpones recurrence of endometriosis. Two supplements that appear to aid in the reduction of recurrence are turmeric and transfer factor; however, more studies are needed in this area.

Charting your cycles with a reliable form of Natural Family Planning is extremely important to help with the diagnosis and treatment of endometriosis. There are several signs of endometriosis that present with charting such as abnormal bleeding patterns and shortened luteal phases. If you are suffering from painful periods, consider charting and consulting with a NaPro-trained physician. Since menstrual pain is often overlooked, many patients often comment that they never realized just how much they suffered until after treatment when they experience their first pain-free cycle. Charting can aid in the correct diagnosis and treatment of endometriosis and an improvement in the quality of life.

Julia and Jonathan Keller live in central California where they are active in pro-life and pro-family work. They enjoy spending time with friends, family, and their newborn son, Hudson