Severe pain during your periods and sex could be a signal of endometriosis

Severe pain during your periods and sex could be a signal of endometriosis

The cramps you get during your period can be tough. If you suffer from endometriosis though, the pain could be so strong that it could affect your daily routine. Severe pain during intercourse could also be a sign of endometriosis. In both cases, you should speak to your doctor.

Could endometriosis be the cause?

For many years, women thought that strong pain during their periods or during intercourse is normal, but it is not.

Two of the most common symptoms of endometriosis are:

  • severe pain during your periods (dysmenorrhea)

  • painful intercourse (dyspareunia), meaning persistent or recurrent pain that occurs during or after intercourse.

Endometriosis is notoriously difficult to diagnose. The symptoms of endometriosis are similar to other gynecological conditions.

One in 10 women have endometriosis and many are not diagnosed

One in 10 women are affected by endometriosis and often there is a delay of diagnosis for 7-12 years, as endometriosis’ symptoms are similar to other gynecological conditions. Many women with endometriosis remain undiagnosed.

What is endometriosis?

Endometriosis is a gynecological disorder in which tissue similar to the tissue that normally lines the inside of your uterus (the endometrium) grows outside your uterus. The right tissue at the wrong place.

In endometriosis, the endometrial-like tissue acts as endometrial tissue would. It thickens and then breaks down and bleeds in each menstrual cycle.

The ectopic endometrium has no way to exit your body, so it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form.

Surrounding tissue can become inflamed, eventually developing scar tissue and adhesions (abnormal bands of fibrous tissue that cause the internal organs to stick to each other).

Endometriosis can cause strong pain, especially during menstrual periods and very often during the sexual act. Another common symptom of endometriosis is infertility. Fortunately, effective treatments are available.

Endometriosis or normal menstrual cramps?

Menstrual cramps are common and usually can be treated with over-the-counter medication or home remedies. Endometriosis is associated with pain that women call “killer cramps”. Some women say it feels like “their insides are being pulled down”.

Endometriosis pain often stops young women from going to school or having a social life. In adulthood often the pain gets worse and in many cases, they miss days from work.

Endometriosis or “normal” pain during sex?

Painful intercourse can occur for different reasons, ranging from structural problems to psychological concerns. But is also the cardinal symptom of endometriosis. Especially deep dyspareunia.

If dyspareunia is persistent, you should talk to your doctor.

Other symptoms of endometriosis include:

  • Very long or extremely heavy periods

  • Migraines

  • Bleeding between periods

  • Fatigue

  • Nausea

  • Diarrhea

  • Infertility. Surgery can remove the extra tissue, which may make it easier to get pregnant. You may decide to use assisted reproductive techniques like in vitro fertilization(IVF) to help you conceive

  • Painful bowel movements

  • Leg pain that can make it hard to walk. Endometriosis can affect nerves that connect to your groin, hips, and legs.

  • Severe backache. The uterus and ovaries are near your back and endometriosis pain can affect your back too.

Levels of thyroid hormones affect chronic pain and severity of endometriosis

Levels of thyroid hormones affect chronic pain and severity of endometriosis

Endometriosis patients with thyroid dysfunction may have increased risk of more intense chronic pain and increased disease severity, a study suggests.

The underlying disease mechanism of endometriosis is still unclear.

Autoimmune thyroid disorders are associated with endometriosis, but the mechanism by which the two diseases are linked is unknown.

Each cell in the body carries protein markers called antigens that allow a cell to be identified as “self” or “non-self” by the immune system. In autoimmune thyroid disorders, the body’s own immune system attacks and damages the thyroid gland. These diseases are characterized by the production of autoantibodies against thyroid-specific antigens, including the thyroid itself and the thyroid-stimulating hormone receptor.

Now, researchers at the Université Paris Descartes looked at the relationship between endometriosis and autoimmune thyroid disorders, specifically at how thyroid disorders affect the progression of endometriosis.

They first found that both the levels of RNA and proteins involved in thyroid metabolism were altered in the biopsied endometrium of patients with endometriosis compared to healthy people. RNA molecules act as templates to make proteins, which perform key functions in the cell.

Moreover, in endometriotic cells, the amount of thyroid hormones was altered compared to that of control cells. The thyroid hormone T4 (thyroxine) is converted into T3 (triiodothyronine), which is much more active than T4. In the endometriotic cells, T4 production was increased while that of T3 was reduced.

The thyroid-stimulating hormone regulates the production of T3 and T4. In vitro (lab) studies using cells from the endometrium of endometriotic patients and healthy controls showed that thyroid-stimulating hormone increased cells’ proliferation. But the researchers saw no differences in the increase of proliferation rate between endometriotic cells and control cells.

Mouse studies confirmed the data gained in vitro since endometriotic implants were found to be bigger when thyroid hormones increased. A retrospective analysis of endometriosis patients with or without a thyroid disorder revealed an increased chronic pelvic pain and disease score in endometriotic patients with a thyroid disorder.

The study, “Role of thyroid dysimmunity and thyroid hormones in endometriosis” was published in the journal PNAS

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Laparoscopic surgery especially benefits endometriosis patients with pelvic pain

Laparoscopic surgery especially benefits endometriosis patients with pelvic pain

Patients with severe endometriosis and pelvic pain show the most pronounced improvements in quality of life within one year after undergoing laparoscopic surgery, a new study reports.

Laparoscopic surgery is the current gold standard to treat endometriosis. A small incision is made to allow a tool called a laparoscope, coupled with a small camera, to go inside the abdomen to guide the removal of endometriosis lesions.

Although surgery has the potential to reduce pain and improve patients’ quality of life, it is crucial to evaluate how surgery is affecting physical and mental health as well as patients’ social well-being.

Endometriosis often causes chronic pelvic pain, severe pain during menstruation (dysmenorrhea), and pain during sex (dyspareunia). Other non-gynecologic symptoms include constipation, diarrhea, and rectal bleeding. Together, these symptoms have a significant impact on patients’ quality of life.

In order to investigate which factors led to changes in patients’ quality of life, a team of researchers analyzed 981 patients from five districts in the Auvergne region of France who underwent laparoscopic treatment between 2004 and 2012.

Enrolled participants, ages 15-50, had received laparoscopic surgery or been newly diagnosed with a histological confirmation of endometriosis.

The team compared quality of life prior to surgery and one year after surgery using the 36-Item Short Form (SF-36) questionnaire, data on presence or absence of specific symptoms, and intensity of pain. Improvement in quality of life was measured using effect size method (ES), in which a value of 0.8 or higher corresponds to a significant improvement.

The SF-36 consists of eight sections covering physical functioning, energy/fatigue, bodily pain, role limitations due to physical health, general health perception, social functioning, role limitations due to emotional problems, and emotional well-being. The lower the score in the questionnaire, the greater the disability.

In total, 44% of patients with endometriosis and chronic pelvic pain had an improvement in quality of life equal to or above 0.8 ES compared to 23% of patients without pain who had similar ES scores.

Moreover, 47% of patients with stage 4 endometriosis had an ES score above 0.8, whereas only 26%, 31%, and 27.5% of patients in stage I, II, and III respectively had a similar improvement in quality of life.

Researchers observed that patients with chronic pelvic pain were more likely to improve their quality of life after surgery compared to those without it. Fertile patients also were more likely to improve quality of life compared to infertile patients.

Mental health of patients with chronic pelvic pain was also improved after surgery compared to patients without pain.

Similarly, patients with anxiety also showed better mental score compared to non-anxious patients.

Overall, researchers found that chronic pelvic pain was the most significant factor in predicting patients’ improvement in quality of life after surgery.

Patients presenting with severe endometriosis and who experience higher levels of pain are more likely to show improvement in [quality of life] after surgery,” researchers said.

[Chronic pelvic pain] is the most significant independent predictive factor for changes in QoL scores,” the study concluded.

The study, “Identification of predictive factors in endometriosis for improvement in patient quality of life,” was published in the Journal of Minimally Invasive Gynecology.

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Contraceptive implants reduce endometriosis-associated pain

Contraceptive implants reduce endometriosis-associated pain

By I Soussis MD

 Contraceptive implants Implanon NXT and Mirena significantly curb pelvic pain and menstrual cramping in women with endometriosis, improving their health-related quality of life, researchers from Spain report.

The study, “Control of endometriosis-associated pain with etonogestrel-releasing contraceptive implant and 52-mg levonorgestrel-releasing intrauterine system: randomized clinical trial” was published in the journal Fertility and Sterility.

Pelvic pain and debilitating menstrual cramps (dysmenorrhea) are the most common symptoms of endometriosis. One of the main objectives of endometriosis treatment is pain control. Studies have shown that Mirena is effective in controlling endometriosis-associated pain. However, few studies have focused on etonogestrel implants and on comparing the efficacy of these hormonal treatments.

In this Phase 4 clinical trial, researchers compared the efficacy of two contraceptive implants (Implanon NXT and Mirena) in alleviating pelvic pain and menstrual cramps in women with endometriosis.

Implanon NXT is an etonogestrel-releasing contraceptive implant inserted under the skin in the upper arm. Mirena is a 52-mg levonorgestrel-releasing intrauterine device.

The study included 103 women experiencing endometriosis-associated chronic pelvic pain, menstrual cramps, or both for more than six months. The patients randomly received either Implanon NXT or Mirena. The initial follow-up period of the study was six months, with a checkup every month after implantation. The patients could keep the device after completion of the study.

The women were recruited from the Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, Sao Paolo, Brazil. They were being treated for stage I–IV endometriosis or deep endometriosis.

There were 52 patients (mean age 33.4 years) who received Implanon NXT; 51 patients (mean age 34.7 years) received Mirena.

Researchers used the patient-reported visual analogue scale (VAS; 0-10) to determine the effect of these treatments on curbing noncyclic pelvic pain and menstrual cramps. The lower the VAS score, the lesser the pain. The mean score registered in the month before implant placement was considered the baseline.

Pelvic pain was significantly eased by both treatments, with no statistical difference between the two groups. The mean VAS score for pelvic pain in the Implanon NXT group decreased from 7.6 at baseline to 2 at the six-month evaluation. Similarly, among Minera users, the mean VAS score dropped from 7.4 at baseline to 1.9 during the study period.

Both treatments also markedly alleviated menstrual cramps, the team reported. A significant reduction in the VAS score for menstrual cramps between baseline and the six-month follow-up was observed in Implanon NXT users (7.5 to 2.2) as well as the Minera users (7.3 to 1.9).

The team used the Endometriosis Health Profile-30 (EHP-30 questionnaire) to assess the impact of the treatments on the patients’ health-related quality of life (HRQoL). The patients completed EHP-30 before the start of the study and at the six-month follow-up. A lower score corresponds to a better HRQoL.

The EHP-30 core segment assesses pain, control, and powerlessness, emotional well-being, social support, and self-image. It also has a modular section that covers questions about other areas of health and emotional status that patients may or may not experience. A significant reduction was reported by both groups in the scores for core and modular segments of the EHP-30, indicating a marked improvement in their HRQoL.

Menstrual bleeding pattern disturbances were reported in patients in both groups. In the Mirena group, participants reported infrequent bleeding (30%) and spotting (22.1%), at six months follow-up. In the Implanon NXT group, 28.8% reported a complete absence of bleeding (amenorrhea) and 24.4% infrequent bleeding at the six-month follow-up. However, none of the participants discontinued the study because of these disturbances.

Although further studies with a larger study population are required to assess the efficacy of these contraceptives, “both treatments are long-term feasible options for women with endometriosis-associated pelvic pain, with few side effects,” the study concluded.



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