This past month you may have seen some yellow ribbons being worn and some events such as the Million Women March for “the invisible disease”. This particular yellow ribbon campaign is conducted to promote awareness for Endometriosis, the disease commonly referred to as “the invisible disease” or “Eve’s curse”. It is a condition that affects as many as 1 in 10 women of reproductive age, is present in 50% of women experiencing infertility and is now the leading cause of chronic pelvic pain in women.
The month of March has been reserved to raise awareness about Endometriosis and to call for investment into research so that the disease can be better understood and treated. This year, the campaign stretched globally and provided a much broader opportunity to raise awareness. The Be Endo Aware campaign in Jamaica received a lot of international buzz on Twitter and Instagram with their #beendoaware tag line. There was a public forum on Endometriosis held at one of their university campuses. The global effort this year was far larger than any previous years. Some events even continued past the end of March, in the UK there was quite a lot of support for Team Endo running the Brighton marathon.
The disease is caused by the growth of endometrial cells outside of the uterus. These cells form growths or plaques which adhere to tissues inside the abdomen (commonly the fallopian tubes, peritoneal lining, and intestines, however the cells can travel as far as the lungs) and continue to respond to hormonal signals to grow and shed just as the endometrial lining does inside the uterus. The most common symptoms associated with endometriosis include chronic lower abdominal and pelvic pain, painful menstruation, discomfort during intercourse, abnormal uterine bleeding, and infertility. Symptoms typically have a relationship to the menstrual cycle and are generally worse around menstruation.
The evaluation and treatment of Endometriosis are considered difficult because there is no standard method to measure pain; the mechanisms by which Endometriosis causes pain are not completely understood; comparisons of the success of medical versus surgical treatments or placebo are difficult; Endometriosis and associated pain may involve nearby organ systems beyond the reproductive tract; and pain attributed to Endometriosis may have a true origin elsewhere in the body. It was only recently that a diagnosis for Endometriosis could be made on symptoms and medical history alone, prior to that laparoscopic surgery was required to confirm the existence of endometriotic growths outside of the uterus.
Common treatments for Endometriosis are aimed at reducing pain and inflammation such as analgesics (ibuprofen – Advil, Motrin), suppressing hormonal fluctuations such as oral contraceptives, surgical removal of the endometriotic growths, or if more severe, complete removal of the reproductive organs (hysterectomy and bilateral salpingo-oophorectomy).
This year’s campaign also proved to be a step forward in recognition for Acupuncture and Traditional Chinese medicine. The American Society for Reproductive Medicine (ASRM) issued a new report on endometriosis. The report included information on the treatment, incidence and the mechanism of the associated pelvic pain in those that suffer with Endometriosis. The report explores the appropriateness and effectiveness of different surgical and medical therapies which take into account a woman’s reproductive plans, age and disease state. Additional treatments such as physical therapy, acupuncture, and counseling were reviewed for their effectiveness with controlling pain associated with Endometriosis as well as the stress and depression that may be associated with extended suffering from pain.
The practice committee outlined that “Acupuncture can also be considered an adjunct therapy for pelvic pain associated with Endometriosis. Two randomized studies evaluated specific versus sham acupuncture for Endometriosis pain and both reported significantly better pain relief with true acupuncture (non-sham)” In addition to acupuncture, it was also found that there were randomized clinical trials comparing Chinese herbal medicine treatment to Gestrinone and Danazol which concluded that “Chinese herbal medicine had comparable results with fewer side effects”.
This is some very promising news for those that suffer from pelvic pain associated with Endometriosis. Acupuncture and Chinese herbal medicine are now viable options that should be considered prior to surgery and certainly as options for support in women undergoing assisted reproductive therapies where surgery, hormone or hormone blocking pharmaceutical interventions, or anti-inflammatories are contraindicated. The awareness around Endometriosis will continue to grow each year and advances in treatment options will continue. It is great to be recognized in this way and I look forward to working with more women to relieve their symptoms.
The 12th annual International Conference on Endometriosis will be held at the end of April in Brazil. We will see if there is more talk about adjunct therapies and their role worldwide.
Treatment of pelvic pain associated with Endometriosis: a committee opinion
The Practice Committee of the American Society for Reproductive Medicine
Received 7 February 2014; accepted 7 February 2014. published online 14 March 2014.
The World Endometriosis Research Foundation (WERF)
a global charity which fosters research into endometriosis to improve knowledge and treatment(s).
12th World Congress on Endometriosis
Dates: April 30 – May 3, 2014
Location: Sao Paulo, BRAZIL
Introductory Letter: The largest world event in endometriosis
The Endometriosis Network Canada
a volunteer-run, incorporated, not-for-profit organization