Expert Talk: Maternal and Fetal Medicine Specialist Dr Hemavathi Srinivasan On The Impact Of Endometriosis On The Health Of Women

No-one knows your body better than you. You’re the one who feels every ache, pain and scratch and the one who knows when something is wrong. Yet women with severe pain just before, during, or after menstruation are often told that “it’s just in their head”. This debilitating pain can be a sign of endometriosis. Endometriosis affects one in 10 women. It takes, on average, seven and a half years to be diagnosed. And this condition has a powerful effect on every part of a woman’s body. Pain, cramps, blood, surgery, incisions, chemically induced menopause; all these things – inconveniences, intrusions, life-altering changes are a part of endometriosis, leaving many in worse conditions.

To shine a light on endometriosis during Endometriosis Awareness Month, TC46 connected with Feto-Maternal Medicine Specialist, Obstetrician & Gynaecologist Dr Hemavathi Srinvasan of Motherhood Hospitals, Bangalore. Here she talks about the correlation between PCOS and endometriosis, ways to manage the symptoms, home remedies and the complications endometriosis can cause.

1. What is endometriosis? How does it affect women?

With endometriosis, the endometrial-like tissue thickens, breaks down, and bleeds with each menstrual cycle, much like endometrial tissue does. However, since this tissue can’t leave the body, it gets stuck. Endometriomas are cysts that develop when endometriosis affects the ovaries. Endometriosis can be excruciatingly painful, particularly during menstruation. Fertility concerns can also occur. Efficient therapies are, thankfully, available.

2. What are its major causes? Who is most at risk for endometriosis? What do the signs and symptoms of endometriosis look like?

Endometriosis has an uncertain cause. Several hypotheses have been proposed, including the following: 

Genetics: The disorder runs in families and affects people of various ethnic groups differently. When some of the womb lining passes up through the fallopian tubes and embeds itself on the pelvic organs rather than leaving the body as a cycle, this is known as retrograde menstruation. endometrium cells spreading through the bloodstream or lymphatic system, a series of tubes and glands that form part of the immune system, a concern with the immune system, which is the human body’s inbuilt protection against disease and infection endometrium cells spreading through the body in the bloodstream or lymphatic system, a series of tubes and glands that form part of the immune system. None of these hypotheses, however, fully clarify why endometriosis exists. The disease is most likely triggered by a combination of factors.

If you’re a woman, you’re more likely to get endometriosis if you:

• Have an endometriosis-affected mother, sister, or daughter?
• They started their periods at a young age (before age 11)
• Have monthly periods that are short (less than 27 days)
• Have a menstrual cycle that lasts longer than 7 days?
• Are you an infertile woman?

Endometriosis is characterised by the following signs and symptoms:

1. Periods of pain (dysmenorrhea): Pelvic pain and cramping can start before a menstrual cycle and last for several days. You can also feel discomfort in your lower back and abdomen.
2. Intercourse causes pain: Endometriosis can cause pain before, during, or after a sexual encounter.
3. Pressure while urinating or bowel movements: These symptoms are more likely to occur during a menstrual cycle.
4. Bleeding that is excessive: You may have heavy menstrual periods or bleeding between periods on occasion (intermenstrual bleeding).
5. Infertility: This is a disorder in which a couple is unable to Endometriosis is often found when seeking treatment for infertility.
6. Other signs and symptoms may be present. During menstrual cycles, you can experience exhaustion, diarrhoea, constipation, bloating, or nausea.

3. What is the correlation between PCOS and endometriosis? How does endometriosis affect pregnancy, fertility and breastfeeding?

Women with polycystic ovary syndrome (PCOS) will develop a number of endometrial diseases as a result of their endocrinologic and metabolic abnormalities. Hyperandrogenism and hyperinsulinemia, both of which can be present in PCOS, can increase E2 levels indirectly, Reduced progesterone secretion and increased expression of growth factors such as vascular endothelial growth factor (VEGF) and insulin-like growth factors (IGFs) can have a significant effect on endometriosis incidence and progression. We assume that there may be a correlation between PCOS and endometriosis.

Breastfeeding their unborn child helps many women with endometriosis prolong their duration of symptom recovery after birth. Breastfeeding suppresses ovulation and the growth and development of endometriosis by inhibiting the release of oestrogen by the ovaries.

4. What are some key ways to manage the symptoms of endometriosis?

1. Monitor your symptoms using an app. Many period monitoring apps, such as Eve, let you rate the severity of your symptoms. Use this test to see how your period can affect your symptoms and pain.
2. Pursue a safe way of life. Taking care of yourself by not smoking, drinking in moderation, and avoiding drugs can keep your body in top shape.
3. Schedule ahead of time. You already know your body, and coping with endometriosis means you’re learning even more about it. On the days of your cycle where you think the symptoms will flare, give yourself extra time to get to activities and get ready for work.
4. Make time for self-care. Taking time to relax, listen to your body, and plan your endometriosis needs will help you feel in control of your condition.
5. Understand that fatty acids are your ally. You can feel better overall if you eat foods high in long-chain omega-3 fatty acids. Omega-3 fatty acids can also help with endometriosis symptoms.

5. Which home remedies can help curb endometriosis?

1. Put a rice sock on your foot. Instead of using a heating pad, some women tend to use a rice sock. A mechanism to distribute heat to your aching muscles can be generated by filling a clean sock with uncooked rice and microwaving it for up to two minutes.
2. Taking baths in warm water. Warm baths can relax the muscles and alleviate cramping pain in the same way as dry heat can.
3. Keep yourself hydrated. Water can assist in the reduction of bloating and cramping. Dehydration may be a concern on extremely rough days.
4. Make use of a TENS computer. TENS (transcutaneous electrical nerve stimulation) units produce sensations that can alleviate pain and relax muscles. A physical therapist can prescribe a TENS unit, or you can buy one online for a fair price.
5. Massage of the pelvis.  Massaging the pelvic region, which included parts of the abdomen, sides, and back, was found to be successful in minimizing endometriosis-related menstrual pain. This form of massage can be more comfortable if performed shortly before the menstrual cycle starts. Massage oil can also be helpful.

6. How does nutrition and diet help with managing endometriosis? What changes and/or tips do you recommend?

Eating a lot of fibre may help to lower estrogen levels. As a result, eating a high-fibre diet could be an excellent technique for endometriosis sufferers. Fruits, vegetables, and whole grains are high in dietary fibre. Antioxidants are also found in these foods, which can aid in the reduction of inflammation.

7. How does endometriosis affect mental health? What are some ways women with this condition can take care of their mental health?

Pelvic pain has been shown to have a major negative impact on women’s mental health and quality of life; in particular, women with pelvic pain experience high levels of anxiety and depression, loss of working capacity, social limitations, and reduced quality of life. Some ways women with this condition can take care of their mental health are:

1. Maintain open lines of contact with loved ones and engage in mind-calming practices.
2. Engage in fun hobbies or carry out new things.
3. Take good care of your physical well-being.
4. Recognize warning signs and take mandatory precautions.

8. What are some pain management techniques and treatment options for endometriosis?

1. Anti-Inflammatories

Non-steroidal anti-inflammatory medications (NSAIDs) are a class of painkillers widely used to treat menstrual pain and endometriosis.

2. Hormone Therapy

Hormone medications may help alleviate pain by stopping the mucous membranes in endometrial implants (endometriosis tissue) from accumulating.

3. Analogues Of GnRH (Agonists)

GnRH (gonadotropin-releasing hormone) analogues and GnRH agonists are hormone medications that can assist with endometriosis symptoms. However, they have more severe side effects than the pill: they inhibit the development of female sex hormones to such an extent that they often result in oestrogen deficiency.

3. The Pill For Birth Control

The majority of contraceptive pills have been shown to help with endometriosis pain. The menstrual-like bleeding at the end of a pill cycle, known as withdrawal bleeding, may be painful if a woman has extreme period pain (dysmenorrhea). Headaches, fluid retention, and breast tenderness are the most common side effects of the pill.

4. Surgical Procedures

In general, endometriosis can be treated surgically with a laparoscopy, which is a relatively gentle procedure. A surgical technique known as laparotomy, which involves cutting through the abdominal (tummy) wall, can be performed instead.

9. What are some of the complications endometriosis can cause and how can one prevent them?

Fertility complications are a severe side effect of endometriosis. Women with milder types of the disease may be able to conceive and bring their children to term. According to the Mayo Clinic, about 30–40% of women with endometriosis have difficulties conceiving. 

Medications have little effect on fertility. Since having endometrial tissue surgically removed, some women have been able to conceive. If this doesn’t work for you, fertility treatments or in vitro fertilization might be a choice to increase your chances of having a baby.

If you’ve been diagnosed with endometriosis and want to start a family, you should start preparing now rather than later. It’s likely that your symptoms will intensify over time, making it more difficult to conceive on your own. Your doctor will continue to test you before and during your pregnancy. Consult your doctor to learn more about your choices.

10. What are some myths and misconceptions about endometriosis you would like to debunk?

Myth: Endometriosis is nothing but just a heavy period.

Endometriosis occurs when hormones cause similar thickening and bleeding outside your uterus, such as on your ovaries or in the tubes that deliver your eggs (the fallopian tubes). This sometimes, but not always, causes you to bleed more during your cycle.

Myth: Extreme pain during your cycle is common.

If pain is interfering with your everyday routines, talk with your doctor. It’s a typical symptom of endometriosis and other conditions. It’s also conceivable that the discomfort isn’t limited to your time. Endometriosis can also cause discomfort in the days leading up to your period when you go to the toilet, or during intercourse.

Myth: It’s impossible to get it when you’re young.

Endometriosis will evolve once your cycle has begun. It becomes more likely when you hit your 30s and 40s.

But your chances also increase if you:

• It has happened to other family members
• You begin your time at a young age
• Your cycles are more than 7 days long
• Pain, heavy bleeding, bad cramps, bloating, and spotting between cycles will take 7-10 years to diagnose

So talk to your doctor if you experience any of these symptoms.

Endometriosis is a chronic disease affecting a large portion of the world’s female population of childbearing age. The quality of life is strongly influenced by this pathology; women suffer from dysmenorrhea as well as chronic pelvic pain and this affects work, leisure, social and love relationships. The pain related to endometriosis also affects the psychological aspect, compromising the quality of sleep, making women anxious and depressed.