Endometriosis is a disorder in which the tissues normally present inside the uterus, start growing in other parts of the body. Endometriosis most commonly occurs in other organs of the pelvic and reproductive organs — the ovaries, the exterior parts of the uterus, fallopian tubes. During the menstrual cycle, the hormonal changes in your body break down the tissues, which can cause you immense pain. It can also cause long-term painful adhesions or scar tissue during your periods. However, there are some effective methods by which one can minimise menstrual pain owing to endometriosis.

How to ease endometriosis pain?

Physical therapy

Physical therapies are very effective in reducing endometriosis pain. It is observed that endometriosis can affect the way your abdomen and pelvis work, and that can cause more pain. However, a physical therapist can get those areas to work right again.

Regular exercise

It is common to feel pain even if you are just lying down on the couch when suffering from endometriosis. But it is recommended by doctors to still practice regular exercise as it can make you feel better. You should not do extreme exercises, but can opt for walking, stretching, and breathing exercises that can ease your endometriosis pain.

Prefer a gluten-free diet

You might feel less endometrial pain if you follow a gluten-free diet. It is possible that it may not work on everyone, but the majority of women switch to it. You can try cutting wheat-based food and regular pasta from your diet. Instead, try eating corn pasta, rice, buckwheat, and lentils. It is advisable to talk to your doctor before you make any changes to your diet.

Take a nap

Women get tired very soon during endometriosis. Hence, to keep yourself fresh and alert, keep your sleep schedule consistent and listen to your body. It is good if you take short naps throughout the day, whenever you need one. It is observed by medical experts that a short mid-afternoon nap can keep your mood good during periods and make you more alert.

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More than 13,500 women have taken part in research revealing the devastating effect of endometriosis.

Half said they had had suicidal thoughts, and many said they rely on highly addictive painkillers.

Most also said endometriosis – involving painful periods – had badly affected their education, career and relationships.

MPs are to launch an inquiry into women‘s experiences of endometriosis following the research.

Women with the condition answered questions on how the condition has affected them. The charity Endometriosis UK helped gather the responses.

The condition affects one in 10 women and, as well as extremely heavy periods, can cause debilitating pain and sometimes infertility.

Bethany Willis, who lives in Essex, was one of those who took part in the research. She began having endometriosis symptoms aged just nine.

She knew what it was because her mum and grandmother also have the condition.

Now 19, Bethany says: “The pain is like barbed wire wrapped around your insides and someone‘s pulling it while at the same time an animal is trying to eat its way through you.”

At one point she was in so much pain that she took an overdose.

“I texted my boyfriend and said goodbye. I was ready to end my life there and then because of the pain.”

She was finally diagnosed this summer following surgery and – though still in daily pain – she is managing to cope.

“My mind is clearer and I have more energy, but the years of not being treated mean I‘ve had to drop out of veterinary school and my dream career,” she said.

Anna Turley MP, a member of the All-Party Parliamentary Group for Endometriosis which will carry out the inquiry, said: “It wasn‘t until I was hospitalised and had the diagnosis that I realised how little attention endometriosis receives, how limited research funding is, and how many women are misdiagnosed.”

She said the data gave “millions of affected women a voice” and the APPG would be calling on the government to act.

Tayla Marshall, 24, from Northamptonshire, is one of those who relies on pain relief to cope with her symptoms.

She has been through multiple operations and two chemically-induced menopauses and she is now addicted to strong opioid medication.

“I worry every day about my opioid intake. I take 50ml of morphine sulfate, Fentanyl patches, Naproxen and 30mg of amitriptyline and although I‘m not addicted in my mind, my body is physically dependant on this now.

“If I went a day without it, I would start to experience nasty withdrawal symptoms.”

Because her condition is so severe, Tayla is considering having a hysterectomy when she‘s 30.

“I have six years to try for a family,” she said.

“But my last relationship ended due to the impact of endometriosis. I wasn‘t able to be intimate with my partner very often, unless I was dosed up on medication.

“I am also in a position where I have reduced chances of falling pregnant naturally and carrying a baby.

“I have sort of managed to get my head around the idea of not having children but it breaks my heart every day.”

What is endometriosis?

Emma Cox, CEO of the charity Endometriosis UK, which helped gather the women‘s testimonies, said: “It cannot be overstated the devastating impact this condition is clearly having on people‘s physical and mental health.

“Without investment in research, a reduction in diagnosis time – which averages at a shocking 7.5 years – and better access to pain management, women will continue to face huge barriers in accessing the right treatment at the right time.”

Some women choose to undergo a hysterectomy and early menopause in a bid to stop their symptoms.

Michelle Middleton, 42, from West Yorkshire, recently underwent the operation to remove her ovaries, womb, fallopian tubes and cervix.

She says it is her last hope: “I just want rid of everything,” she said.

But she added: “The risk is that I‘m no better and that there‘s damage and it gets worse but you have to have hope.”

Minister for women‘s health, Caroline Dinenage said: “I urge clinicians to play their part in breaking down the ongoing stigma around endometriosis by ensuring they follow NICE guidelines and encourage employers to rise to the challenge by creating supportive and flexible ways to help those living with these conditions.”

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Orilissa (elagolix), an FDA-approved medication for managing endometriosis pain, lowers ovulation rates in a dose-dependent manner but does not seem to affect the amount of developing eggs in the ovaries — which is important for maintaining a woman’s fertility — a Phase 1 trial reports.

The study, “Elagolix suppresses ovulation in a dose-dependent manner: Results from a 3-month, randomized study in ovulatory women,” was published in The Journal of Clinical Endocrinology & Metabolism.

An oral medication, Orilissa was approved in the U.S. in July 2018 for the management of moderate-to-severe endometriosis pain, including painful periods (dysmenorrhea), painful intercourse (dyspareunia), and nonmenstrual chronic pelvic pain. It is sold by AbbVie and is available as 150 mg and 200 mg tablets.

The therapy works by dialing down the signals of gonadotropin-releasing hormone (GnRH), a hormone that stimulates the production of follicle stimulating hormone (FSH) and luteinising hormone (LH). In turn, these hormones stimulate the maturation and release of an egg during ovulation, and the production of estrogen in the ovaries.

Orilissa inhibits GnRH receptors in the brain’s pituitary gland — an organ that produces many of the body’s hormones — preventing FSH and LH production and lowering estrogen. This helps reduce inflammation and relieve pain.

Because estrogen makes endometrial lesions grow, lowering its levels is a common way to manage the symptoms of endometriosis.

Orilissa also is under development for the management of heavy menstrual bleeding associated with uterine fibroids.

In healthy, premenopausal women, a prior trial showed that Orilissa was well-tolerated and quickly brought down estrogen levels. This effect could be rapidly reversed after the women stopped taking the medication.

In a subsequent study, Orilissa doses higher than 100 mg twice daily led to such low levels of progesterone — an ovarian hormone that rises after ovulation to prepare the body for pregnancy — that it suggested ovulation was stopped. However, the study was too short to fully determine whether this really was the case.

To specifically address this question, AbbVie scientists — joined by researchers at the Eastern Virginia Medical School in Norfolk, Va. — conducted a trial in healthy women to characterize the effects on ovulation and sex hormones of different doses and dosing regimens of Orilissa.

The trial was a Phase 1, randomized, open-label study (NCT01403038) that enrolled 205 healthy, premenopausal women, ages 18 to 40 years, in the U.S.and Puerto Rico.

Orilissa pills were given during three 28-day dosing intervals (84 consecutive days) at 100 to 200 mg once daily, 100 to 300 mg twice daily, and 300 mg twice daily plus estradiol/norethindrone acetate (E2/NETA; brand names Activella and others) once daily. E2/NETA therapy consists of lab versions of estrogen and progesterone, and is used to treat menopause symptoms.

Throughout the study, ovulation rates — specifically, how many times each woman ovulated — were measured by transvaginal ultrasound, which uses an ultrasound probe placed inside the vagina, as well as blood levels of several hormones, including estradiol and progesterone. Estradiol is the main estrogen found in women.

The study confirmed that Orilissa suppressed ovulation in a dose-dependent fashion. The percentage of women who ovulated was highest at 100 mg daily (78%), followed by 150 and 200 mg daily, and 100 mg twice a day (47%-57%). It was lowest at 200 mg twice daily (32%) and 300 mg twice daily (27%).

Taking E2/NETA in addition to Orilissa further reduced the ovulation rate by 10%, but did not lower estradiol levels any further. Blood levels of progesterone also confirmed these results.

The treatment also lowered overall levels of LH and FSH, resulting in suppression of estradiol and progesterone in a dose-dependent manner. This supported the prior observations. It also made the uterus wall, called the endometrium, stay thinner throughout the menstrual cycle.

However, Orilissa did not seem to harm the ovaries’ pool of developing eggs than can be fertilized — known as the ovarian reserve. This was indicated by the levels of anti-Müllerian hormone (AMH), a hormone secreted by cells in developing egg sacs, which remained relatively stable throughout the study.

This finding is important for women’s fertility.

It suggests “that there was the continued growth of small follicles [ovarian structures where eggs develop] during the treatment period. Given that endometriosis and uterine fibroids are common in women of reproductive age, the rapid return of ovulatory function may be desirable in this population,” the researchers said.

After stopping treatment with Orilissa, normal menses took a maximum of 42 days to resume.

As for safety, 79% (162 of 205) of women experienced a treatment-related side effect. The most common were headache (25%), hot flush (23%), and nausea (19%).

Overall, the study shows that women with Orilissa have lower ovulation rates but may still ovulate. Thus, women using the medication “should use effective methods of contraception,” the researchers said.

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Too many patients with endometriosis are being prescribed opioids and not enough people are aware. Not even physicians.

It first dawned on doctor Georgine Lamvu at a national conference for gynaecologic surgeons. As a specialist in chronic pelvic pain, she and her colleagues were conversing about the pros and cons of doing multiple repeated surgeries for those with endometriosis. 

‘Endo’, as it’s sometimes shortened, is a little-known, often painful disorder that occurs when endometrial-like cells grow outside the womb. Sometimes referred to as ‘the most common disease you’ve never heard of’, it impacts no less than 1 in 10 women and is one of the top three causes of female infertility worldwide.

Today, there is still no cure or long-term treatment for endometriosis; in many cases, surgeries are repeated with little to no relief. A potential drawback, Lamvu remembers saying at the conference, is that a lot of patients end up taking opioids.

“A surgeon blatantly said to me, ‘oh that’s not true, we don’t use opioids to treat patients with endometriosis’,” Lamvu told ScienceAlert.

“And I said, oh, well, that’s interesting. Why don’t I try and find out.”

It wasn’t so much a hunch, she says. Lamvu knew for a fact that opioids were commonly used to treat chronic pain patients outside her own practice, even though regulations are now stricter.

Over the years, opioids have become one of the most common treatments for chronic pain in the US. And while they might be useful for short and acute cases, their efficacy in the long run is currently under intense scrutiny.

Today, despite scientific evidence suggesting opioids are ineffective at treating chronic pain, 92 percent of physicians and patients believe these drugs help reduce pain, and 57 percent report a better quality of life.

When as many as 19 percent of those who are prescribed long-term opiates abuse the drug or become addicted, it’s no surprise that many chronic pain patients are wrapped up in the opioid crisis.

“It almost seemed inconceivable to me that endometriosis patients with chronic pelvic pain would somehow be spared the opioid epidemic,” Lamvu told ScienceAlert.

“It just didn’t really make sense, even though it’s what this colleague of mine was saying.”

Her deep dive into the issue, published in Obstetrics & Gynecology in June this year, confirmed her worst suspicions: too many people with endometriosis have been taking prolonged opioids for their chronic pain. To her knowledge, it’s the largest sample size to date, drawing on publicly available insurance data from 53,847 endometriosis patients and 107,694 others without the disease.

From 2006 to 2016, Lamvu and colleagues found women with endometriosis were nearly three times as likely to fill an opioid prescription, compared to the control group. And while Lamvu admits she has no evidence any of these patients are addicted or dying from narcotics, she sees the pattern as a big problem.

In the findings, patients with endometriosis were nearly four times as likely to fill a larger dose of opioids, equivalent to some 100 milligrams of morphine or more. According to the US Federal Drug Administration (FDA), that’s a large enough amount to cause an overdose if taken by someone who isn’t regularly taking opioids.

What’s more, the data reveal that these patients, aged anywhere between 18 and 49 years, were also more likely to use opioids for over a month, and at the same time as benzodiazepenes – a combination that is 10 times more likely to lead to a fatal overdose.

Similar results were found even after excluding prescriptions specifically for surgery.

“I was surprised by the magnitude of the numbers, I can’t lie about that,” Lamvu admits. “I thought we would see a difference but I just didn’t think it would be this.”

The problem appears to start straight away. Within seven days of being diagnosed with endometriosis, her team found more than a quarter of endo patients filled an opioid prescription.

The results are consistent with a 2018 survey from the American College of Obstetricians and Gynecologists (ACOG), which found almost a quarter of ob-gyns nationwide were prescribing opioids to patients with endometriosis.

But while there’s some other research out there looking at chronic pelvic pain and opioid rates, Lamvu and her team’s research is one of the first to look at endo specifically.

“Although these well-insured study participants may not represent the entire US female population, their prolonged opioid use despite evidence of little or no therapeutic benefit is astonishing,” writes reproductive endocrinologist Robert Rebar from Michigan State University in a review of the team’s study.

People with endometriosis might very well be hidden figures in the opioid epidemic; we just don’t have the data to say for sure. And much of what we do know is anecdotal.

In his decades of experience treating gynaecologic diseases, Serdar Bulun from Northwestern University told ScienceAlert he has seen at least two or three high-school age teenagers who were addicted to opioids when they came to him, and who had been using these narcotics for a year or more.

He himself does not prescribe opioids for chronic pelvic pain, and he suspects these patients were first given the drugs in an emergency room. A good number, he says, go to the local hospital when they experience intense pelvic pain, usually because they can’t get in to see their gynaecologist right away.

In these urgent situations, doctors might see a narcotic as the only option. Encouraged by the pain relief, patients might later go to their regular doctor and ask for more, he suggests.

“I presume it must be an issue,” Bulun told ScienceAlert. “I don’t know what the magnitude is.”

One young patient, he recalls, was on such strong pain killers, she was finding it hard to concentrate in her high-school class. And yet, in the end, nothing else was helping her cope.

That’s the saddest part for Lamvu: the sheer lack of alternatives for desperate patients and for physicians who desperately want to help. As an expert on pelvic pain, she laments the fact we’ve spent two or three decades on one class of pain medication, at the expense of further research on such a common pain disorder.

Today, for the average patient, arriving at a diagnosis of endometriosis takes more than four years; by that time, all a person wants is some sort of relief.

“We’ve done a disservice to our patients, because we’ve basically said, well, you need a surgery. And then if that doesn’t work, pain management, and if that doesn’t work, then opioids.”

Sawsan As-Sanie, a chronic pelvic pain specialist at the University of Michigan, is now building on Lamvu’s findings. Her research has not yet been published, but she told ScienceAlert that her preliminary results suggest a very high prevalence of opioid prescriptions are being given to patients with endometriosis.

A large portion of these are not related to surgery, and a small but worrying subset of patients are taking prolonged high doses.

“I’m not necessarily surprised because it’s frankly not different to what we see in other chronic pain populations,” As-Sanie told ScienceAlert, “but I think it does bring light to the fact that even amongst patients where we have an identifiable cause for their pain, they are still being prescribed opioids that we know can be very dangerous.”

Few healthcare providers are adequately trained to diagnose or manage endometriosis, she says, and far fewer take the time to properly educate their patients about pain management or set their expectations – even though a recent study by her team has actually shown that such information can decrease opioid use after hysterectomies.

In 2017, ACOG reported that up to “63 percent of general practitioners feel uncomfortable diagnosing and treating patients with endometriosis, and as many as half are unfamiliar with the three main symptoms of the disease.” In another study, published that same year, some clinicians were found to be so ill informed, they thought endometriosis was caused by poor mental health.

As such, As-Sanie urges those with endometriosis to work with their primary care physicians and find a gynaecologist who listens to their concerns and fully understands all the available options, whether medical, surgical or pharmacological.

There’s not just one treatment that fits all, she says. And patients deserve safe, effective, non-addictive strategies to manage their chronic pain.

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Endometriosis, a gynecological condition affecting the lower abdomen or pelvic area, has a reputation for being super painful. You might assume that if you had it, you’d know it.

Or would you? Maybe not. This common condition doesn’t always make itself known with red flags and flashing lights.

We talked to reproductive endocrinologist Marjan Attaran, MD, to find out what women should know about the signs and symptoms of endometriosis.

1. Period pain is the biggest clue

Endometriosis occurs when fragments of the tissue that lines the uterus go rogue, growing in places they don’t belong. Those cells can glom onto the ovaries, fallopian tubes or intestine. During your period, those tissues bleed, which may trigger pain and swelling.

“The classic symptom of endometriosis is terrible period pain that doesn’t go away with birth control pills or anti-inflammatory medications like ibuprofen,” Dr. Attaran says. But not all women with endometriosis have horrible cramps. And not all women with horrible cramps have endometriosis. Intense period pain is a tip-off, not a smoking gun. 

2. Endometriosis pain can be fickle

Most often, endometriosis pain crops up low in the pelvis, Dr. Attaran says. But women can have very different experiences. Some describe the pain as sharp. Others experience a dull ache. Cramps might squeeze just one side of the pelvis, or both, or they might move from side to side. (See what we mean about fickle?)

3. Sex might hurt

Many women with endometriosis experience a “deep” pain during or after sex.

4. Stomach problems are common

If cramping wasn’t enough,women with endometriosis sometimes have digestive problems, too. These can include nausea, diarrhea, constipation or bloating, especially during that (least favorite) time of the month.

4. Some women have no symptoms

Just because you don’t have excruciating cramps during your period doesn’t mean you can rule out endo. Some women with the condition have mild symptoms, or even no symptoms at all, Dr. Attaran says.

The symptoms you experience often get worse over time. You might not see any signs until your late 20s, 30s or even 40s. “People don’t wake up one day with all of these symptoms,” she says. “They usually develop slowly as time goes by.”

5. Trouble getting pregnant

If you’ve tried unsuccessfully to get pregnant, mild endometriosis might be involved.

Diagnosing endometriosis would be a lot easier if there were red flags. But for many women, it’s more of a gray area. “It’s a frustrating disease,” Dr. Attaran says. “But if you have symptoms, it’s worth following through to get the diagnosis so you can be active about managing the disease.” 

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Women with endometriosis in Australia using cannabis on their own to manage their disease report its use helps to ease pain and other symptoms like nausea, with very few side effects, a study based on an online survey reports.

The study, “Cannabis Use, a Self-Management Strategy Among Australian Women With Endometriosis: Results From a National Online Survey,” was published in the Journal of Obstetrics and Gynecology Canada.

Severe chronic pelvic pain that significantly affects quality of life is well-reported in endometriosis.

Non-surgical treatments for this disease include combined oral contraceptives or progestins alone and non-steroidal anti-inflammatory drugs, among other options. However, these therapies are limited in their effectiveness, and discontinuation rates range between 25% and 50% due to side effects.

Opioids are commonly prescribed for pain, but carry a high risk of dependency and a potential for overdose.

Due to these limitations on existing medical treatments, women with endometriosis are increasingly turning to self-care or lifestyle interventions for symptom relief. More research is needed, the study said, into the effectiveness of these self-management strategies.

But preliminary studies suggest that cannabis, which acts via the endocannabinoid system (ECS), can help manage pain in women with this disease.

“Cannabis has a long history of use in the ancient and scientific literature for various conditions such as period pain, however until now nothing has been investigated for cannabis being used for endometriosis,” Justin Sinclair, the study’s lead author, an NICM Health Research Institute Research Fellow and coordinator of the Australian Medicinal Cannabis Research and Education Collaboration, said in a press release.

Researchers designed an online survey targeting Australian women with surgically confirmed endometriosis to determine the prevalence of cannabis use, its cost, tolerability, their opinions of its effectiveness, and possible changes they have made in pharmaceutical treatment use.

“Past research has demonstrated that certain compounds within cannabis known as cannabinoids exert analgesic and anti-inflammatory activity. Our research sought to determine the prevalence, tolerability, and self-reported effectiveness of cannabis in women with endometriosis,” Sinclair said.

A total of 484 responses were analyzed, among which 76% of women reported practicing general self-management strategies in the previous six months.

Among these people, 13% (48 women) reported using cannabis for symptom control, and most likely it was not approved medical cannabis, the study noted.

“Medicinal cannabis regulations in Australia were introduced in December 2016, but few prescriptions of standardized, quality-assured medicinal cannabis in this pathway have been dispensed,” the researchers wrote. “[I]t is likely that most, if not all, of the women in this survey were using illicit cannabis,” and this raises serious concerns as to “quality control and potency.”
Survey responders rated cannabis’ effectiveness on pelvic pain at 7.6, on a zero to 10 numeric rating scale with 10 being most effective. Twenty-seven of these women, 56%, reported its effectiveness allowed them to cut by at least half their pharmaceutical medication use.

Women reported the greatest improvements were in sleep, nausea, and vomiting. Side effects were found to be infrequent (10%) and minor, particularly when compared to adverse event reporting for non-steroidal anti-inflammatory drugs (11%−14%) and opioid-based medications (78%).

“Women report good efficacy of cannabis in reducing pain and other symptoms, with few adverse effects reported,” the researchers wrote.

As studies have found a high number of cannabinoid receptors (which cannabis binds to) in the female reproductive system, it is plausible that cannabis can help biologically alleviate endometriosis symptoms.

But Sinclair cautions that cannabis use is not without risk.

“One in ten women in the study who used cannabis reported an undesirable effect such as drowsiness, rapid heartbeat, or increased anxiety,” he said.

And, again, while Australian women with endometriosis report using cannabis quite commonly, it likely was not via prescription.

“Due to the timing of when the survey was administered, most if not all of the women in the survey would have been using illicit cannabis as access to medicinal cannabis was still in its infancy,” said Mike Amour, MD, with the NICM Health Research Institute and the study’s chief investigator.

“This means we don’t have any information about the different varieties of cannabis that women were using, or what might have been in the cannabis that was being used as it was derived from illicit sources which are not quality assured,” he said. “Also, this was a self-reported survey, which can lead to over or under estimation of the positive or the negative effects.”

The scientists add that further clinical research is warranted to determine the effectiveness of cannabis in managing endometriosis’ symptoms.

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Andrea Long Chu is a writer who has thrown the world of homosexual and transgender activism into disarray with her 2018 essays in n+1 and The New York Times, and now in her new book, “Females,” in which she argues that gender is not who one is but what one wants. Chu is a biological male who identifies as female and has undergone sex reassignment surgery. Chu has outraged feminists (this goes double for lesbian feminists) by embracing so many of the “traditional” (which is to say “stereotypical”) notions of femininity that feminists of all stripes have decried for decades as artificial constructs imposed by the desires of men. In particular, Chu has invited the ire of TERFs (“trans-exclusionary radical feminists”) for suggesting (as a New Republic interview with her is titled), “We are all female now.”

To read Chu’s essays — as well as those of her critics — is to find oneself immersed in a maelstrom of philosophical and political debates about women, women, women. But what’s left unspoken is what all of this obsession with sexual identity and transition says about our society’s view of men.

I am tempted to make a sweeping denunciation of our society’s pathological need to eradicate men and masculinity. Oh, there is definitely a movement afoot to do just that. But in fact, it isn’t “society” as a whole pushing this agenda. It is a small, brittle crust of malcontents who cast themselves as the cultural elite, and who develop theories and spearhead movements as a way of making themselves feel important — or at least validated.

If this were the extent of their impact, they would only warrant our pity. But they have hundreds and thousands of enablers and water carriers throughout academia and the media who refuse to challenge their patent absurdities, who promote and praise the nonsense in order to themselves be thought intellectual and avant-garde.

In academia and literary circles especially, bizarre, counterintuitive, unproven and completely unscientific “theories” like those espoused by Chu and many others enjoy broad acclaim. And it is a much larger problem than just sexual identity politics, as scholars and authors Peter Boghossian, James Lindsay and Helen Pluckrose revealed in the expose they published in Areo magazine last year.

The three authors submitted for publication in peer-reviewed journals a series of deliberately absurd, counterfactual, wholly unresearched articles worded in gobbledygook academe-speak. A shocking number of them were accepted for publication.

Why does this matter?

“(T)here is a problem in our universities, and … it’s spreading rapidly into culture,” say Boghossian, Lindsay and Pluckrose. “Radical constructivism is … a dangerous idea that … we must, on moral grounds, largely reject the belief that access to objective truth exists.”

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Infertile reproductive-aged women with recurrent unilateral endometrioma had adverse outcomes from in vitro fertilization (IVF) compared with results in infertile reproductive-aged women with tubal factor infertility, according to a study in the journal Gynecological Endocrinology.

“A controversial issue is whether endometriosis per se exerts a detrimental effect on IVF outcomes,” wrote the Russian authors.

Objective
The purpose of the study was to assess the quality of embryos and the implantation rate in women with infertility associated with endometriosis. The 120 study patients, all ages 26 to 40, underwent IVF and intracytoplasmic sperm injection (ICSI).

Methods
They were then divided into two groups. Group One (n = 70, average age 33.21) consisted of patients with recurrent unilateral endometriomas, whereas Group Two (n = 50, average age 32.54) represented the control group with tubal factor infertility. 

The quality of the retrieved embryos was evaluated according to the generally accepted classification of Gardner, indicating the rate of implantation in each group. Embryo transfer was performed for high-quality embryos. 

Infertile reproductive-aged women with recurrent unilateral endometrioma had adverse outcomes from in vitro fertilization (IVF) compared with results in infertile reproductive-aged women with tubal factor infertility, according to a study in the journal Gynecological Endocrinology.

“A controversial issue is whether endometriosis per se exerts a detrimental effect on IVF outcomes,” wrote the Russian authors.

Objective
The purpose of the study was to assess the quality of embryos and the implantation rate in women with infertility associated with endometriosis. The 120 study patients, all ages 26 to 40, underwent IVF and intracytoplasmic sperm injection (ICSI).

Methods
They were then divided into two groups. Group One (n = 70, average age 33.21) consisted of patients with recurrent unilateral endometriomas, whereas Group Two (n = 50, average age 32.54) represented the control group with tubal factor infertility. 

The quality of the retrieved embryos was evaluated according to the generally accepted classification of Gardner, indicating the rate of implantation in each group. Embryo transfer was performed for high-quality embryos. 

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Lorena Beatriz was 23 when an ultrasound to check for endometriosis revealed her ovaries were abnormally small.

After her doctor advised her to stop taking the contraceptive pill, her menstrual cycles ceased.

What followed was an onslaught of perimenopausal symptoms; hot flushes involving a burst of intense heat that would start in her face and spread through her body, fatigue, mood swings and vaginal dryness.

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You’ve probably heard of endometriosis, a gynecological condition that can cause women to have debilitating pelvic pain, excessive bleeding, bloating and infertility. But did you know that it has a lesser-known sister condition called adenomyosis?

Adenomyosis likely affects millions of women, but it’s not well understood. The knowledge base is growing, though, and medical experts are coming to better understand how to effectively diagnose it and help women manage it.

“It used to be thought that adenomyosis only occurred in older women, but it’s now being diagnosed earlier,” says Rosanne Kho, MD, Head of the Section of Benign Gynecology and a subspecialist in minimally invasive gynecologic surgery. That’s probably because gynecologists have better tools than ever to diagnose it, she suggests.

There’s still much to learn about this condition. But it’s understood that it can deeply affect a woman’s quality of life — and potentially her fertility.

“Adenomyosis is getting much more attention now,” Dr. Kho says. “Hopefully in the next few years we will be able to understand this condition better.”

Endometriosis and adenomyosis

Endometriosis and adenomyosis can cause some of the same symptoms, but what’s happening inside the body isn’t quite the same. And a woman could actually have both.

In endometriosis, some of the tissue that lines the inside of the uterus travels outside of the uterus, attaches itself to other pelvic organs and continues to bleed monthly. In adenomyosis, that tissue instead embeds itself inside the wall or muscle of the uterus, causing the uterus to swell.

Some women don’t have any symptoms, but many who are eventually diagnosed with adenomyosis are tipped off that something is wrong because of heavy periods and agonizing pain, Dr. Kho says.

Doctors used to only be able to make an adenomyosis diagnosis after a woman had her uterus removed to get rid of her symptoms, and a pathologist could see that there was indeed endometrial tissue inside the walls of her uterus.

But thanks to greater awareness of the condition and improvements in diagnostic tools like transvaginal ultrasound and MRI imaging, gynecologists can now see signs of the disease in women who haven’t had a hysterectomy.

It’s hard to know how many women have this condition, and experts aren’t sure exactly what causes it. But some think that women who have been pregnant or had surgery on their uterus are at higher risk, Dr. Kho says.

Secondary effects

Adenomyosis is not fatal, and symptoms often go away after menopause. However, research has shown that the presence of adenomyosis does elevate a woman’s risk of endometrial and thyroid cancers.

Because it causes changes in the uterus itself, experts also suspect that adenomyosis can make it harder for a woman to get pregnant. But research on this has been limited — and complicated by the fact that adenomyosis often occurs hand-in-hand with other factors that affect a women’s fertility, such as fibroids and endometriosis.

Treatment approaches

Today there are several ways doctors can treat adenomyosis, including options that preserve the uterus for women who still wish to have children.

Which approach is best depends on a woman’s symptoms, whether she wants to have children and the extent of the adenomyosis.

Over-the-counter, anti-inflammatory medicines are the first step in helping with the pain. Beyond that, progestin-only hormonal therapies like an IUD may also ease pain and bleeding — or eliminate periods all together, Dr. Kho says. Other forms of hormonal therapies such as birth control pills, patches or rings, may also be recommended.

If medication isn’t able to decrease symptoms, women may consider other options:

• Endometrial ablation: This minimally invasive procedure that destroys the lining of the uterus may produce good results when the misplaced endometrial tissue occurs in a cluster. When the tissue is spread out or extensive, it may be able to be treated this way if it is not embedded deeply in the walls of the uterus.
• High-intensity focused ultrasound ablation: HIFU is a relatively new treatment that seems to be a promising noninvasive option for patients, Dr. Kho says, but there haven’t been enough comparative studies showing its efficacy, safety and outcomes on pregnancy just yet.
• Surgical removal: A surgeon can remove the affected areas of the uterus, but it’s not going to be perfect. “We would often end up excising healthy tissue and/or leaving some diseased tissue behind,” Dr. Kho explains. “Removing good tissue could put the patient at risk for worse pregnancy outcomes such as uterine rupture.”
• Hysterectomy: Removal of the uterus eliminates adenomyosis but also eliminates the chance for pregnancy.

Steps to take

If you have periods that are heavy or painful, or experience pelvic pain when you’re not on your period, talk with your Ob/Gyn. Any number of things could be going on, so it’s best to get to the bottom of it ASAP.

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