Endometriosis: The Basics
March is Endometriosis Awareness Month and amazingly there are more and more women and professionals sharing, educating and uplifting those in need. Yes! Virtual high-five!
In this part of this blog post, I'll be shedding some light on this condition based on the most recent research and how it is impacting our women and girls, as well as common medical treatments.
** Make sure to check out part 2 for treatment ideas from an integrative therapies perspective including pelvic floor physiotherapy, lifestyle medicine, and functional nutrition.
So let's jump right in:
Endometriosis is the most common cause (57%) of chronic pelvic pain in adolescent girls, and period pain continues to be the leading cause of school absences.
It is also the leading cause of fertility challenges in women (40%) and affects 10% of women of reproductive age.
For those of you who don’t know, endometriosis is the growth of a very similar tissue that typically lines the inside of the uterus, but that is growing somewhere outside the uterus (typically local to the pelvis, but sometimes also elsewhere like the lungs, heart, etc.). Each month during the menstrual cycle, these endometrial & endometrial-like tissues/ growths build up but can’t shed as they naturally do and so they cause inflammation, adhesions and scarring. Endometrial growths are estrogen-dependant which is why they tend to create symptoms post-puberty when there are new hormonal fluctuations. It is important to note that endometriosis is benign and non cancerous. 
While the specific cause of endometriosis is still not known (retrograde flow has been disproven, with most recent theories focused on genetic factors &/or early embryonic development of lesions) , there is a lot that can be done to reduce pain, inflammation and allow women and girls to life their life to the fullest.
It can unfortunately be a long road to that diagnosis (only confirmed via laparoscopy), treatment and management stage, taking 6-12 years (yes, years!) to obtain a diagnosis after presenting with symptoms. During that time girls and women can also experience not only pelvic pain, bladder pain, painful periods (although in young women they can experience non-cyclical pain), and pain with intercourse, but also digestive issues (bloating, constipation, IBS, etc.), urinary urgency & frequency, insulin resistance, polycystic ovarian syndrome , fatigue and exhaustion. Further, they are at increased risk for mental health issues like depression , with endometriosis also being associated with higher risk of diabetes, pelvic inflammatory disease, cardiovascular disease, chronic liver disease, hypertension/ hyperlipidema [4,5], ovarian & breast cancer [6,7].
Medical treatment has focused primarily on three aspects:
hormone suppression (including combined oral contraceptives and others to reduce or dominate estrogen)
pain management (including medications like Lupron, Lurid, Nuserelin, etc.)
While some of these medications have been shown to reduce bowel irritation in approximaltey 2/3rds of patients with bowel endometriosis , and others like Lupron can assist with pain relief, a lot of them come with a myriad of other nasty side effects like loss of bone mineral density [9,10]. There is limited evidence supporting non-steroidal anti-inflammatories (NSAIDs) in reducing pain in this population, however, preliminary support for CBD (cannabidiol) oil to reduce pain via the central nervous system and by reducing inflammation has been shown .
Excision surgery of the endometrial growths is the gold standard of care (when provided by a skilled surgeon) compared to ablation with significant improvements in painful periods, pelvic pain, and pain with bowel movements.  We are lucky here in Ottawa to have a wonderfully skilled excision surgeon, Dr. Sony Singh.
While there are clearly a lot of things physically going on with women who have endometriosis, and medication and surgery can be helpful, being in persistent pain also effects school, work, relationships, activities, family planning, thoughts, beliefs and more. Think about those stats at the beginning of the blog - we need to do more to bring awareness to this issue. Awareness to our young women about the "normalcy" and powerful information tool that is our menstrual cycle. Not cover things up by placing them on birth control the moment they get their period, only to find out years later that they have difficulty conceiving. Knowledge is power and we need to empower ourselves as women and our younger generation of girls so they can be their biggest health asset.
Check out the next segment in this endometriosis series for a more lifestyle medicine, integrative physiotherapy and functional nutrition approach to support you holistically towards symptom free health.
A quick shout out and recognition of Dr. Jessica Drummond, whom I have had the pleasure of learning from on a handful of occasions now, for her work in #integrativephysiotherapy and #functionalnutrition. A lot of the information above has been integrated from my coursework with her over the past 2 years. More info on her and her amazing work in integrative women's health can be found here.
 Kristin J. Holoch, Ricardo F. Savaris, David A. Forstein, Paul B. Miller, H. Lee Higdon, Creighton E. Likes, Bruce A. Lessey Coexistence of polycystic ovary syndrome and endometriosis in women with infertility, Pelvic Pain Disord 2014; 6(2): 79 - 83, DOI:10.5301/je.5000181
 J Psychosom Obstet Gynaecol. 2017 Oct 13:1-6. doi: 10.1080/0167482X.2017.1386171. [Epub ahead of print] Mental health, pain symptoms and systemic comorbidities in women with endometriosis: a cross-sectional study. Vannuccini S1, Lazzeri L1, Orlandini C1, Morgante G1, Bifulco G2, Fagiolini A3, Petraglia F4.
 Kvaskoff, M., Mu, F., Terry, K. L., Harris, H. R., Poole, E. M., Farland, L., & Missmer, S. A. (2015). Endometriosis: a high-risk population for major chronic diseases? Human Reproduction Update, 21(4), 500–516. http://doi.org/10.1093/humupd/dmv013 Endometriosis & Chronic Disease
 Teng SW, Horng HC, Ho CH, Yen MS, Chao HT, Wang PH, et al. Women with endometriosis have higher comorbidities: analysis of domestic data in Taiwan. J Chin Med Assoc. 2016;79:577–582
 Cancer Causes Control. 2017 May;28(5):437-445. doi:10.1007/s10552-017-0856-4. Epub 2017 Mar 15. Endometriosis and risk of ovarian and endometrial cancers in a large prospective cohort of U.S. nurses. Poole EM1, Lin WT2, Kvaskoff M3,4, De Vivo I3,5, Terry KL2,5, Missmer SA
 Wei, J.-J., William, J., & Bulun, S. (2011). Endometriosis and Ovarian Cancer: A Review of Clinical, Pathologic, and Molecular Aspects. International Journal of Gynecological Pathology: Official Journal of the International Society of Gynecological Pathologists, 30(6), 553–568. http://doi.org/10.1097/PGP.0b013e31821f4b85
 Acta Obstet Gynecol Scand. 2018 Feb 12. doi: 10.1111/aogs.13328. [Epub ahead of print] Medical treatment in the management of deep endometriosis infiltrating the proximal rectum and sigmoid colon: a comprehensive literature review. Vercellini P1,2, Buggio L2, Borghi A1, Monti E2, Gattei U2, Frattaruolo MP2
 N Engl J Med. 2017 Jul 6;377(1):28-40. doi: 10.1056/NEJMoa1700089. Epub 2017 May 19.
Treatment of Endometriosis-Associated Pain with Elagolix, an Oral GnRH Antagonist.
Taylor HS1, Giudice LC1, Lessey BA1, Abrao MS1, Kotarski J1, Archer DF1, Diamond MP1,
Surrey E1, Johnson NP1, Watts NB1, Gallagher JC1, Simon JA1, Carr BR1, Dmowski WP1,
Leyland N1, Rowan JP1, Duan WR1, Ng J1, Schwefel B1, Thomas JW1, Jain RI1, Chwalisz K1
 Cho, Y. H., Um, M. J., Kim, S. J., Kim, S. A., & Jung, H. (2016). Raloxifene Administration in Women Treated with Long Term Gonadotropin-releasing Hormone Agonist for Severe Endometriosis: Effects on Bone Mineral Density. Journal of Menopausal Medicine, 22(3), 174–179. http://doi.org/10.6118/jmm.2016.22.3.174
 Dmitrieva, N., Nagabukuro, H., Resuehr, D., Zhang, G., McAllister, S. L., McGinty, K. A.,
... Berkley, K. J. (2010). Endocannabinoid involvement in endometriosis. Pain, 151(3),
 Pubdir, J., Omanwa, K., Kovoor, E., Pundir, E., Lancaster, G., Barton-Smith, P. (2017). Laparoscopic excision versus ablation for eondmetrioso-associated pain: An updated systematic review and meta-anaylsis. J Minim Invasive Gynecol. 24(5):747-756
Disclaimer - Everything shared is for informative purposes only. It is not intended for assessment, diagnosis or treatment purposes. If you feel there needs to be further investigation, please seek out a qualified health care professional for a proper assessment.