Endometriosis

Description

Alternative Names

Lifestyle Changes

Nonsteroidal Anti-inflammatory Drugs (NSAIDs). Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) may be sufficient for about 75% of women with endometrial pain. NSAIDs block prostaglandins (the substances that increase uterine contractions). They are effective painkillers and also have other properties that act against inflammatory factors. Aspirin is the most common NSAID, but there are dozens of others available over the counter or by prescription. Among the most effective NSAIDs for menstrual disorders are ibuprofen (Advil, Motrin, Midol PMS), naproxen (Aleve, Naprosyn, Naprelan, Anaprox), and mefenamic acid (Ponstel). For maximum benefit, they should be taken seven to 10 days before a period is expected. It should be noted, however, that long-term use of any NSAID, can increase the risk for gastrointestinal bleeding and ulcers. In fact, one 2001 study of women with iron deficiency anemia reported that overuse of NSAIDs for menstrual disorders contributed to the anemia.

COX-2 Inhibitors. Celecoxib (Celebrex), rofecoxib (Vioxx), and valdecoxib (Bextra) are known as cyclooxygenase-2 (COX-2) inhibitors,. Meloxicam (Mobicox) is a related drug known as a COX-2 preferential. These agents are effective painkillers and are being used with some success for menstrual cramps. They have actions that are similar to those of NSAIDs, but theoretically COX-2 inhibitors should be less harmful to the GI tract than standard NSAIDs. Studies to date are somewhat mixed, with most reporting few problems. Still experts urge that studies are needed that are not sponsored by drug manufacturers in order to get a clear picture or their risks and benefits.

Acetaminophen. One study found that acetaminophen (Tylenol) reduces levels of female hormones (gonadotropins and estradiol, an estrogen), which may have some beneficial effect on menstrual disorders. A combination of acetaminophen and pamabrom (Women's Tylenol Menstrual Relief) is specifically aimed at treating menstrual pain and bloating. (Pamabrom is a diuretic, an agent used to reduce fluid build-up and bloating.)

Note on Opioids: Drugs containing codeine should not generally be used for endometriosis pain management. They can cause pelvic congestion and constipation, which could exacerbate symptoms in patients with gastrointestinal distress.

Dietary Factors

Some women report relief by avoiding dairy products and having a diet rich in fiber and low in saturated (animal) fats. Fiber-rich foods (such as fruits and vegetables) along with plenty of fluids (water or juice, not caffeine) are not only healthy but help prevent constipation, which can intensify symptoms. If women choose a diet that limits dairy products, they should be sure to have sufficient calcium from other sources.

Certain fat compounds called omega-3 fatty acids, which are in fish oils, may have specific anti-inflammatory effects. They are found in certain oily fish (sardines, mackerel) and can be obtained in supplements. Supplements may be labeled either omega-3 fatty acids or EPA-DHA (which are the important compounds). Evening primrose oil and black currant oil, found in health food stores, contain similar fatty acids that may be helpful.

Omega-3 fatty acids, found plentifully in oily fish and flaxseed and canola oils, are beneficial to people afflicted with IBD (inflammatory bowel disease).

Some evidence suggests that soy products (e.g., tofu, soy milk) may protect against endometriosis. Soy contains estrogen-like compounds that may actually protect against problems that are triggered by a woman's own estrogen. More research is needed.

People with endometriosis should avoid alcohol, caffeine, and chocolate. Women who drink large amounts of beverages with caffeine appear to have an increased risk for endometriosis, possibly because caffeine contributes to increased levels of the estrogen, estrone. Heavy alcohol use (which also increases estrogen levels) is also associated with endometriosis.

Contrast Sitz Baths

A sitz bath is simply sitting in a basin of water. Some people report relief by alternating between sitting three minutes in a hot water basin and then one minute in a cold water basin. This is repeated three times. The procedure is performed twice a day three to four days a week, except during menstruation.

Kegel Exercise

Kegel exercises are designed to strengthen the muscles of the pelvic floor that both support the bladder and close the sphincters, and some people find they help endometriosis. The exercises consist of tightening and releasing the pelvic muscle. Since the muscle is internal and is sometimes difficult to isolate, doctors often recommend practicing while urinating on the toilet. The patient tries to contract the muscle until the flow of urine is slowed or stopped and then releases it. (It is important to note, however, that, once learned, Kegel exercises should not be regularly performed while urinating; such a practice may eventually weaken the muscles.)

Exercise

Exercise may be very helpful for women with endometriosis. It relieves stress and tension and may reduce hormonal levels that could contribute to endometrial growth.

Alternative Treatments

Certain integrative methods may be helpful for relieving menstrual cramps, especially techniques that ease muscle and joint pain and inflammation throughout the body. It is not clear if these approaches have any benefits for women with endometriosis, however. Patients should always approach alternative treatments that involve untested herbal or so-called natural remedies with caution, however. It is certainly possible that some may be helpful, but patients should always be wary of unproven claims for quick cures.

Applying Heat. A 2001 study found that continuously applying a heated abdominal pad for 12 hours two days in a row was as effective in reducing menstrual cramps as ibuprofen (Advil). A warm bath may also be helpful

Acupuncture and Acupressure. Some studies, including a small well-conducted trial, have reported relief from pelvic pain after acupuncture or acupressure, a technique that applies small pins or pressure to specific points on the body. It is believed to work by exciting nerve receptors in those locations that interact with pain blockers in the brain.

Click the icon to see an image of acupuncture.

Some women report relief with reflexology, an acupuncture technique that uses manual pressure on acupuncture points on the ears, hands, and feet. The Relief Brief is an investigative acupressure panty product. It is made from cotton Lycra and applies specific acupressure points in the abdominal and pelvic area. In one interesting study, 90% of women who wore the Relief Brief reported at least 25% less pain and two thirds reported at least half as much pain. This warrants more research.

Transcutaneous Electrical Nerve Stimulation. Transcutaneous electric nerve stimulation (TENS) applies electrodes to certain parts of the body and administered low-level electrical pulses to those locations. Researchers suggest that it works by altering the body's ability to receive pain signals. The standard approach is to give 80 to 100 pulses per second, for 45 minutes, three times a day; patients are barely aware of the sensation. A major 2002 analysis of a number of small studies suggested that this approach can help some women with dysmenorrhea. There may be some minor side effects.

Yoga and Meditative Techniques. Yoga and meditative techniques that promote relaxation may also be helpful for menstrual cramps.

Chiropractic. Some women with primary dysmenorrhea have sought help from chiropractors trained in spinal manipulation. One study compared a high-force spinal manipulation technique with a low-force maneuver used as a placebo technique. Both showed lower scores on tests that measure pain, perhaps indicating that a simple back rub by a sympathetic partner or friend may be helpful.

Herbal and Other So-Called Natural Remedies for Cramp Relief. Studies have not found herbal or other so-called natural remedies to be any more effective than placebos for reducing menstrual disorders. In addition to possibly being ineffective, these remedies can be expensive.

• Ginger tea is safe and may help in relieving nausea.
• Valerian has been used by some women for menstrual cramps. This herb is listed on the FDA's list of generally safe products. Of note, however, its effects could be dangerously increased if it is used with standard sedatives. Other interactions and long-term side effects are unknown. As with all herbal remedies, the quality, safety, and effectiveness of specific products are not regulated.

Until scientific studies determine actual benefits, proper doses, and side effects of unregulated remedies, the patient is at risk for ineffective and even harmful treatments.