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.

Perimenopause’s negative impact on sexual function

Perimenopause’s negative impact on sexual function

A new study by Italian investigators points to a link between perimenopause and sharp decline in sexual function. The results, published in Menopause, show that vaginal atrophy—a treatable condition—is the factor that has the most impact on the negative trend.

The cross-sectional study enrolled 518 women aged 40 to 55 years at 30 centers across Italy. The authors analyzed relationships between vaginal atrophy and symptoms associated with it and the Female Sexual Function Index (FSFI) score, which is composed of 19 questions around the domains of desire, arousal, orgasm dyspareunia, lubrication, and sexual satisfaction.

Vaginal atrophy was defined as presence of a pH > 5, subjective vaginal dryness, and an objective sign, as assessed by a medical doctor. Mucosal pallor and dryness, thinning of vaginal rugae, mucosal fragility, and presence of petechiae were the signs considered.

Overall, 70.6% of participants had sexual dysfunction, as defined by a FSFI score < 26.55. It was seen in 55% of those aged 40 to 45, compared with 82.8% of those aged 52 to 55 (P < 0.01). From 48 to 51 versus 46 to 48 years, mean FSFI score and sexual dysfunction increased: 23.13 ± 9.76 vs. 19.49 ± 9.88; P < 0.05). A similar trend was seen from ages 48 to 51 vs. 52 to 55: 21.3 ± 8.06 to 17.59 ± 9.11; P < 0.01).

Age, weight, ex-smoking status, sedentary lifestyle, menopausal status, subjective vaginal dryness, dyspareunia, and vaginal atrophy were all inversely related to a woman’s FSFI score. Age, vaginal atrophy, and presence of vaginal dryness were all independent determinants of FSFI (R2 02.08; P = 0.011). The score was independently correlated (R2 0.116) with weight (CR -0.067; 95% confidence interval [CI] -0.126, -0.006; P < 0.032), menopausal status (CR -2.406; 95% CI -4.180, -0.63; P < 0.008), and vaginal dryness (CR -5.647; 95% CI -7.677, -3.618; P < 0.0001).

The only variable that correlated independently with each FSFI domain—including desire, arousal, lubrication, orgasm, satisfaction, and dyspareunia—was vaginal atrophy. The authors concluded that it is the symptom most closely related to all domains of female sexuality. They believe that prospective studies are needed to determine whether selective treatment of vaginal dryness improves female sexual function in perimenopausal women.

Said North American Menopause Society Medical Director Dr. Stephanie Faubion in a press release, “Given the high prevalence of sexual dysfunction in women, identifying an eminently treatable contributing factor such as vaginal dryness may allow women to maintain their sexual function during the menopause transition.”

Read more: https://journals.lww.com/menopausejournal/Citation/publishahead/Female_sexuality_and_vaginal_health_across_the.97274.aspx

Source: https://www.contemporaryobgyn.net/sexual-dysfunction/perimenopauses-negative-impact-sexual-function

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.

Read more: https://www.sciencedirect.com/science/article/pii/S1553465019302274?via%3Dihub


Depression in women with endometriosis linked to chronic pain

Depression in women with endometriosis linked to chronic pain

By I.Soussis MD
The complex relationship between endometriosis and depression in women is largely determined by chronic pelvic pain, a systematic review has found.

According to the researchers, raising awareness among physicians on the nature of this relationship, which “is arguably more complex than a direct cause-effect relationship,” is essential to finding the best course of treatment and improving the quality of life of women with endometriosis.

The review study, “Depressive symptoms among women with endometriosis: a systematic review and meta-analysis,” was published in the American Journal of Obstetrics & Gynecology.

Endometriosis, a chronic disease caused by the abnormal growth of endometrium outside the uterus, is estimated to affect approximately 10 percent of women of reproductive age.

The disorder is mainly associated with infertility and chronic pelvic pain, but patients may also experience painful sexual intercourse (dyspareunia), painful or irregular menstrual cycles (dysmenorrhea), painful bowel movements (dyschezia), psychological issues, and overall low quality of life.

Symptoms of depression are significantly more common among individuals with chronic pain. Therefore, “an association between endometriosis and depression may be reasonably expected,” the researchers say. However, so far, no study explored this potential relationship thoroughly.

In this review study, the authors established two goals: first, to determine if there is a link between endometriosis and depression; and second, to assess whether depression is more common in women with chronic pelvic pain associated with endometriosis than in women with endometriosis but without pelvic pain and women with pelvic pain but without endometriosis.

The review included studies published over the past 30 years focused on comparing the clinical outcomes of women with and without endometriosis, or, among those with endometriosis, women with and without chronic pelvic pain.

A meta-analysis from 24 studies involving a total of 99,614 women revealed that those with endometriosis had significantly higher levels of depression than those not affected by the disease. This effect was even stronger when the researchers performed the same type of analysis on 11 studies (1,070 women) comparing between healthy women and those with endometriosis.

Further analysis showed that women with endometriosis who also experienced chronic pelvic pain had higher levels of depression than those who did not report pain.

However, no significant differences were found between women with endometriosis and chronic pain and those with chronic pain not affected by the disease.

“The findings of our multiple meta-analyses provide converging evidence that chronic pain, rather than endometriosis itself, is the main determinant of depressive symptoms,” the researchers wrote. “Screening for psychiatric symptoms among women with endometriosis has therefore been advocated, and our findings would suggest to particularly direct it to those with chronic pain.”

“Future studies into possible modulators of the association will hopefully provide further insights about how to improve the quality of life of women with endometriosis and/or pelvic pain,” they concluded.


My opinion

In our effort to provide personalized care in patients with endometriosis, the impact of chronic pelvic pain on the quality of life should be taken into consideration. Such patients might benefit from psychological assessment and possibly treatment for depression.

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image credit https://www.medicalnewstoday.com/articles/301822.php

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