Written by Dr. Seif Sadek

March is Endometriosis Awareness Month so let’s talk endo! Endometriosis (endo, for short) is a disorder where the lining of the uterus (aka the endometrium) grows outside of the uterus, where it doesn’t belong.

Endometriosis is a disorder in which the endometrium grows outside the uterus. 

Despite the amazing research available, there isn’t one best way to manage endo. Most people require different combinations of treatments to improve their symptoms, which we’ll go through below ⏬

But first, how do hormones affect endo?

Just like the lining of your uterus, endo usually responds to your sex hormones, estrogen and progesterone. This is the main theory behind treating endo: either by limiting the amount of estrogen/progesterone that helps it grow or trying to maintain a continuous level of these hormones to prevent the endo overactivity. 

What are the symptoms of endo?

The most common symptom of endo is pelvic pain. This pain can happen at any point during your menstrual cycle, but most commonly occurs during your period. You may also feel pain while pooping or having sex. Endo can also affect your chances of getting pregnant, so treating endo can increase your chances significantly.

So, how can you manage endo?

There are three main ways to help manage the symptoms of endo: non-medical, medical or surgical. Most of the time it requires a combination of all three.

What are the non-medical treatments?

🏃‍♀️ Exercise

There is a great amount of research that shows how exercise can help manage symptoms of endo. There is no exact time, duration or type of exercise that has been best shown to help, but maintaining a moderate activity level for at least 30-45 minutes a day has been shown to significantly reduce pelvic pain intensity compared with people who do not exercise. Why? Exercise potentially increases your progesterone levels, which not only helps reduce the activity of endo, but also dampens the pain associated with endo. Since there are multiple health benefits to exercise and a low risk of harm, it is definitely a great initial approach.

🍽️ Diet

There isn’t a specific diet that seems to help prevent or treat endometriosis, but some studies have shown that a balanced diet can help with decreasing pelvic pain and painful periods. The other good news? Endo symptoms were not associated with either alcohol or coffee intake (but of course, everything in moderation!).

Examples of specific diets/supplements that may help with painful periods are:

• Low fat, vegetarian diet
• Increased dairy intake (milk, cheese, yogurt)
• Vitamin B1 and vitamin B6
• Fish oil supplement
• Vitamin E beginning two days before your period and continuing through the first three days of bleeding
• A single dose of vitamin D3 five days before the expected first day of the menstrual cycle 
• Ginger on days one to three of the menstrual cycle

💆‍♀️ Acupuncture 

There have only been a few studies on whether acupuncture helps with reducing endo pain, but the ones out there have shown a significant improvement in symptoms compared to people who do not undergo acupuncture. There is truly little harm in trying acupuncture, and there may be some benefit to it.

What are the medical treatments?

💊 NSAIDs (Ibuprofen, Tylenol, Advil, Aleve/Naproxen):

NSAIDs are anti-inflammatory meds that mainly target the inflammation proteins created by endo. This is usually the first-line treatment that most doctors will recommend, and you can usually take them whenever you feel pain due to endo. Most of these NSAIDs can be easily bought over the counter; if those don’t work out, your doctor may prescribe some stronger versions.

💊 Hormonal birth control

You can also use birth control that contains both estrogen and progesterone to minimize the overactivity of endo. These pills are usually taken continuously without the withdrawal/placebo week in order to prevent endo flairs. Alternatively, you can also use a progesterone-only birth control, such as Depo-Provera (a birth control shot), to help endo symptoms by decreasing the endo activity and dampening the pain associated with endo.

🚧 Hormone blockers

The hormones produced by the brain that stimulate estrogen and progesterone production are called gonadotropins (LH & FSH). A newly approved medication (Orilissa) helps decrease their effect on the ovaries and lowers the body's estrogen and progesterone, causing the endo to starve and shrink in size. Keep in mind that there may be some side effects that are similar to menopause due to the general lack of estrogen.

What are the surgical treatments?

If all else fails, you also have the option to remove the endo lesions through a surgical process called laparoscopy. About 70-80% of people with uteruses who undergo removal of endo are symptom-free for at least a year. About 40% of those people have a recurrence of their symptoms within 10 years. Surgical removal also increases the chances of getting pregnant by 90% in the first 6 months after surgery. 

You are not alone!

Having endo can not only be a physical burden, but an emotional one too. It’s a chronic problem that can interfere with your life, but you are not alone. Reach out to support groups - they’ve been shown to significantly help with ways to manage pain and the psychological distress of having endo. You can always download our Aavia app for access to free community support groups that can help you with your endo journey ✌️