Endometriosis is a chronic, inflammatory condition where tissue similar to the lining of the uterus is found outside of the womb. It affects around one in ten women of reproductive age, causing pain, infertility and gastrointestinal symptoms.

Women often report difficulty getting their pain and other symptoms under control, despite medication or even surgery.

Our research, published today, found one in ten Australian women with endometriosis reported using cannabis to manage their pain and other symptoms.

What did our study find?

We surveyed 484 women with surgically diagnosed endometriosis about the self-management strategies they used.

Of the respondents, who were aged 18 to 45, 76% reported using self-management techniques in the past six months. This included the use of heat packs (70%), dietary changes (44%), exercise (42%), yoga or pilates (35%) and cannabis (13%).

Out of all of the self-management techniques, cannabis was rated as the most effective for managing pain.

Women who reported higher levels of pain were more likely to use cannabis than those with milder symptoms. This may be because they couldn’t get relief through other measures.

Respondents who used cannabis also reported improvements in other symptoms including gastrointestinal problems, nausea, anxiety, depression and sleep.

One in ten cannabis users reported side effects, which included anxiety, drowsiness and tachycardia (fast heart rate). This is consistent with other research.

How could cannabis help treat endometriosis symptoms?

The endocannabinoid system (ECS) is a complex regulatory system comprised of various receptors, chemicals that bind with these receptors, and enzymes. It helps maintain balance (homeostasis) in our bodies and is important for a wide range of actions, including metabolism, inflammation and immune function.

The ECS is distributed throughout most organs in the human body, but is more abundant in the central nervous, immune and female reproductive systems.

Chemicals from cannabis, including the cannabinoids tetrahydrocannabinol (THC) and cannabidiol (CBD), can interact with the ECS and other receptor types. This suggests a mechanism for how cannabis may alleviate pelvic pain in women with endometriosis.

Emerging research shows medicinal cannabis can help manage a number of conditions, including chronic pain in adults, the spasticity of multiple sclerosis, intractable epilepsy (where seizures can’t be controlled with medication) and chemotherapy-induced nausea and vomiting.

Research is still in its infancy in women with pelvic pain, but one study found women with pelvic pain may benefit from using medicinal cannabis. It may also allow them to reduce their opioid pain-killer intake.

Is it legal?

Medical practitioners in Australia can legally prescribe medicinal cannabis through regulated pathways such as the Special Access Scheme Category B and the Authorised Prescriber Scheme. These pathways are typically used by doctors for unapproved medicines.

According to discussions with prescribing doctors and patients, approvals for medicinal cannabis for pain associated with endometriosis have been successful through these regulated, legal channels.

However, at the time our survey was administered, in late 2017, it’s likely most women who were using cannabis accessed it illicitly. No Special Access Scheme approvals had been granted for endometriosis at the time. Further, most women we surveyed reported smoking cannabis, which is very rarely prescribed by doctors in Australia.

Despite the perception that “natural” equals safe, cannabis use does come with risks. These should be discussed with and monitored by medical professionals.

Why do women resort to cannabis and self care?

Both surgical and pharmaceutical treatments are commonly used for endometriosis.

Surgery can reduce pain, at least in the short to medium term.

Recent reviews have found hormonal treatment options can be effective at managing pain but these are often discontinued or avoided due to significant side effects, such as headaches, mood swings and depression.

Non-steroidal anti-inflammatories (NSAIDs) like ibuprofen don’t seem to be effective at alleviating pain from endometriosis.

In the US, opioids (oxycodone and codeine) are commonly prescribed for endometriosis. Rates of opioid prescription are much lower in Australia but it’s still relatively common among women. This puts women at risk of dependence and potential overdose.

Women with endometriosis report wide-ranging negative impacts on their daily lives, from having to reduce their social activities to problems going to work or studying. It can also cause poor mental and emotional health and affect their sexual and romantic relationships.

So what needs to happen next?

Our survey data shows Australian women are already using cannabis for endometriosis-associated pain, regardless of legality, and with few reported side effects.

However, these survey responses are self-reported so there may be issues such as recall bias. This can lead to over or underestimation of either benefits or harms.

Given women with endometriosis are often suffering without adequate pain control, well designed clinical trials are urgently needed to determine how effective and safe quality-controlled medicinal cannabis might be in treating the symptoms of endometriosis.

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The average cost for a woman with endometriosis both personally and for society is around A$30,000 a year, according to our research, published today in the journal PLOS ONE.

Most of these costs are not from medication, or doctors’ visits, although these do play a part. Rather, they’re due to lost productivity, as women are unable to work – or work to their usual level of efficiency – while experiencing high levels of pain.

Remind me, what is endometriosis?

Chronic pelvic pain is pain below the belly button that occurs on most days for at least six months. The most common identifiable cause is endometriosis. Endometriosis is the presence and growth of tissue (called lesions) similar to the lining of the uterus that’s found outside the uterus.

Women with the condition have a variety of symptoms, including non-cyclical pelvic pain (which is like period pain but occurs regularly throughout the month), severe period pain, pain during or after sexual intercourse, and severe fatigue. Gastrointestinal problems, such as severe bloating (often called “endo belly” by those who suffer from it) and pain with bowel motions, are also common.

Currently, surgery (a laparoscopy) is the only way to make a formal diagnosis of endometriosis – this is where a small camera is inserted into the pelvic/abdominal cavity to investigate the presence of endometriosis lesions.

Both medical and surgical treatments are commonly used for women with endometriosis. Medical therapies include non-steroidal anti-inflammatories (such as ibuprofen and naproxen), oral contraceptive pills and other forms of hormonal treatments.

While these medications can be effective for some, many women experience side effects and need to stop using them.

Surgery is the current “gold standard” of treatment, but despite successful surgery many women find their pain and symptoms can return within about five years after surgery.

How many women have it?

Around 7% of Australian women aged 25–29 and 11% of women aged 40–44 are likely to have endometriosis, which is similar to the worldwide estimate of one in ten women.

Delays in diagnosis are extremely common, and combined with needing surgery for a diagnosis, means many women suffer for years with chronic pelvic pain before being diagnosed with endometriosis later in life. This contributes to the difficulty in getting exact figures for how many women in Australia have endometriosis.

Worldwide estimates of chronic pelvic pain range from 5% to 26% of women. In New Zealand, it’s around 25% and is likely to be similar in Australia but we are lacking any up-to-date and reliable statistics on this.

What did our study find?

Endometriosis and chronic pelvic pain affect all aspects of women’s lives – social activities, romantic relationships and friendships, education, and work attendance and productivity.

We surveyed more than 400 women aged 18 to 45 who were either diagnosed with endometriosis or experiencing chronic pelvic pain. We asked about health-care costs (both out of pocket and funded), employment-related costs, and other costs related to childcare and household maintenance. We also asked about their pain levels.

We found the average cost for a woman with endometriosis was around A$30,000 per year.

Around one-fifth of this cost was in the health sector, for medications, doctors’ visits, hospital visits, assisted reproductive technology such as IVF, and any transport costs to get to these appointments. Of this, A$1,200 were out-of-pocket costs.

The bulk of the costs (over 80%) were due to lost productivity, either because of absenteeism (being off work) or presenteeism (not being as productive as usual because you’re sick). Women with endometriosis often use up all their sick leave and then often have to work when they are in severe pain.

Overall, if one in ten women aged 18 to 45 do have endometriosis, the total economic burden in Australia may be as high as A$9.7bn per year for endometriosis alone.

Pain scores had a very strong link with productivity costs. Women with the most severe pain had a 12-times greater loss of productivity, in terms of working hours lost, than those with minimal pain.

Overall, taking into account all costs (health sector, out-of-pocket, carers and productivity) women with severe pain have six-times greater costs (A$36,000) a year overall compared to those with minimal pain (A$5,700).

Finally, we also looked at the cost of illness not only of those women with a diagnosis of endometriosis, but also of those that had other causes of chronic pelvic pain, such as vulvodynia (pain, burning or discomfort in the vulva) and adenomyosis (growths in the muscular wall of the uterus).

We found the overall costs between the two groups – those with endometriosis and those with other types of pelvic pain – were very similar.

So what should we be doing?

The economic burden of endometriosis is at least as high as other chronic disease burdens such as diabetes. However, many women are not receiving the support they need.

We also need to prioritise funding for endometriosis research, which until recentlyhas attracted comparatively little research funding.

Plans are underway to increase awareness and education, and improve diagnosis and pain management. Unfortunately, there is no such plan for women with other forms of chronic pelvic pain.

Reducing pain, by even a modest 10-20%, could improve women’s quality of life and potentially save billions of dollars each year.

The post Endometriosis costs women and society $30,000 a year for every sufferer appeared first on MyMedicPlus.

The average cost for a woman with endometriosis both personally and for society is around A$30,000 a year, according to our research, published today in the journal PLOS ONE.

Most of these costs are not from medication, or doctors’ visits, although these do play a part. Rather, they’re due to lost productivity, as women are unable to work – or work to their usual level of efficiency – while experiencing high levels of pain.

Remind me, what is endometriosis?

Chronic pelvic pain is pain below the belly button that occurs on most days for at least six months. The most common identifiable cause is endometriosis. Endometriosis is the presence and growth of tissue (called lesions) similar to the lining of the uterus that’s found outside the uterus.

Women with the condition have a variety of symptoms, including non-cyclical pelvic pain (which is like period pain but occurs regularly throughout the month), severe period pain, pain during or after sexual intercourse, and severe fatigue. Gastrointestinal problems, such as severe bloating (often called “endo belly” by those who suffer from it) and pain with bowel motions, are also common.

Currently, surgery (a laparoscopy) is the only way to make a formal diagnosis of endometriosis – this is where a small camera is inserted into the pelvic/abdominal cavity to investigate the presence of endometriosis lesions.

Both medical and surgical treatments are commonly used for women with endometriosis. Medical therapies include non-steroidal anti-inflammatories (such as ibuprofen and naproxen), oral contraceptive pills and other forms of hormonal treatments.

While these medications can be effective for some, many women experience side effects and need to stop using them.

Surgery is the current “gold standard” of treatment, but despite successful surgery many women find their pain and symptoms can return within about five years after surgery.

How many women have it?

Around 7% of Australian women aged 25–29 and 11% of women aged 40–44 are likely to have endometriosis, which is similar to the worldwide estimate of one in ten women.

Delays in diagnosis are extremely common, and combined with needing surgery for a diagnosis, means many women suffer for years with chronic pelvic pain before being diagnosed with endometriosis later in life. This contributes to the difficulty in getting exact figures for how many women in Australia have endometriosis.

Worldwide estimates of chronic pelvic pain range from 5% to 26% of women. In New Zealand, it’s around 25% and is likely to be similar in Australia but we are lacking any up-to-date and reliable statistics on this.

What did our study find?

Endometriosis and chronic pelvic pain affect all aspects of women’s lives – social activities, romantic relationships and friendships, education, and work attendance and productivity.

We surveyed more than 400 women aged 18 to 45 who were either diagnosed with endometriosis or experiencing chronic pelvic pain. We asked about health-care costs (both out of pocket and funded), employment-related costs, and other costs related to childcare and household maintenance. We also asked about their pain levels.

We found the average cost for a woman with endometriosis was around A$30,000 per year.

Around one-fifth of this cost was in the health sector, for medications, doctors’ visits, hospital visits, assisted reproductive technology such as IVF, and any transport costs to get to these appointments. Of this, A$1,200 were out-of-pocket costs.

The bulk of the costs (over 80%) were due to lost productivity, either because of absenteeism (being off work) or presenteeism (not being as productive as usual because you’re sick). Women with endometriosis often use up all their sick leave and then often have to work when they are in severe pain.

Overall, if one in ten women aged 18 to 45 do have endometriosis, the total economic burden in Australia may be as high as A$9.7bn per year for endometriosis alone.

Pain scores had a very strong link with productivity costs. Women with the most severe pain had a 12-times greater loss of productivity, in terms of working hours lost, than those with minimal pain.

Overall, taking into account all costs (health sector, out-of-pocket, carers and productivity) women with severe pain have six-times greater costs (A$36,000) a year overall compared to those with minimal pain (A$5,700).

Finally, we also looked at the cost of illness not only of those women with a diagnosis of endometriosis, but also of those that had other causes of chronic pelvic pain, such as vulvodynia (pain, burning or discomfort in the vulva) and adenomyosis (growths in the muscular wall of the uterus).

We found the overall costs between the two groups – those with endometriosis and those with other types of pelvic pain – were very similar.

So what should we be doing?

The economic burden of endometriosis is at least as high as other chronic disease burdens such as diabetes. However, many women are not receiving the support they need.

We also need to prioritise funding for endometriosis research, which until recentlyhas attracted comparatively little research funding.

Plans are underway to increase awareness and education, and improve diagnosis and pain management. Unfortunately, there is no such plan for women with other forms of chronic pelvic pain.

Reducing pain, by even a modest 10-20%, could improve women’s quality of life and potentially save billions of dollars each year.

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Women with pelvic pain should consider the possibility of endometriosis and discuss it with their doctor, an expert in gynecology says.

While pelvic pain can be a sign of many conditions, endometriosis is among the most common. It occurs when cells from the lining of the uterus grow into other areas of the body.

The condition affects one in 10 women of reproductive age, according to the American College of Obstetricians and Gynecologists.

Women are most likely to develop endometriosis between the ages of 25 and 50, and it may contribute to reduced fertility. Left untreated for years, endometriosis can result in debilitating nerve pain.

Endometriosis can cause chronic pelvic pain during menstrual cycles or sexual intercourse; heavy or irregular menstrual bleeding; sleep problems; and constipation, diarrhea and digestive issues.

Women with pelvic pain should talk to their doctor as soon as possible, advised Dr. Gerald Harkins, a gynecological surgeon at Penn State Health in Hershey, Penn.

“Every woman has a different definition of ‘normal’ pelvic pain. But if women start to avoid the activities they love due to pelvic pain during their period, or if the pain starts affecting their job, family, children or relationships, they should speak up,” he said in a Penn State news release.

The first step is to ask other women in the family if they have ever had it.

“Endometriosis is seven times more likely in women who had a mom, sister, aunt or relative diagnosed with it previously,” Harkins said.

Next, schedule an appointment with your doctor and be as specific as possible about your symptoms.

“In mild cases, endometriosis may not cause a lot of damage,” but more aggressive forms may cause severe pain along with damage to the pelvis, ovaries, vagina, bowel or rectum, Harkins said.

The doctor is likely to ask a woman whether her symptoms worsen during menstrual periods; what steps she’s taken to ease the pain and whether any of them have helped; and about her personal history with certain medications.

Treatment varies depending on symptoms and can include diet changes, medication or surgery.

The post Know the Signs of Endometriosis appeared first on MyMedicPlus.

For some women with endometriosis, the pain doesn’t stop after surgical and hormonal treatments. It can persist, triggered by muscle spasms that ripple through the pelvic floor. Now, a small study suggests that Botox, best known for smoothing wrinkles, could quell those spasms and relieve that pain.

Thirteen women diagnosed with the disorder, in which tissue similar to what lines the uterus grows elsewhere in the body, had the botulinum toxin injected into their pelvic floor, which supports the pelvic organs. The shots targeted areas of muscle spasm that were sites of pain. The women, ages 21 to 51, had been in pain for at least two years.

All reported a reduction in pain four to eight weeks after treatment. Eleven of the 13 rated their post-Botox pain as mild or completely gone, researchers reported online July 8 in Regional Anesthesia & Pain Medicine. Relief lasted from five to 11 months in seven of the 11 women followed for up to a year post injection.

Women in the study “had benefit beyond relief of pain. Some were able to resume having sex without pain. Some were able to function better,” says Barbara Karp, a neurologist at the National Institute of Neurological Disorders and Stroke (NINDS) in Bethesda, Md.

Eight of the 13 women had experienced moderate to very severe disability, according to a questionnaire designed to measure how the pain interferes with day-to-day activities such as walking, standing, sleeping, personal care and sex life. Six of these women’s scores indicated their disability had lessened after the injection.

Endometriosis affects an estimated 5 to 10 percent of reproductive-age women, or 176 million worldwide. Compounding the pain and infertility that accompanies the disorder is the lack of awareness of the condition; past studies have found that women face treatment delays and skepticism that they have a medical issue at all.

Standard treatments include hormone therapies and the surgical removal of tissue lesions located outside of the uterus. But there is no cure. Women who continue to have pain might be reassessed for surgery, change their hormone therapy, try physical therapy or take pain medications like opioids, says gynecologist Pamela Stratton, also at NINDS.

The participants in the study had had surgery and hormone treatments, but their pain persisted. All of the women also had pelvic floor muscle spasms.

Botulinum toxin is produced by the microbe that causes the food poisoning illness botulism. As Botox, it paralyzes certain muscles or blocks nerves. The toxin has been used to smooth wrinkles and to calm overactive muscles in neck spasms and bladder conditions (SN: 4/5/08, p. 213). Karp had experience using botulinum toxin to treat neurological disorders involving overactive muscles. So she, Stratton and their colleagues suspected Botox injections might also diminish the pelvic floor spasms and associated pain.

The results suggest that Botox may be “a promising tool” to treat these spasms, says obstetrician and gynecologist Andrea Rapkin of UCLA’s David Geffen School of Medicine, who was not involved in the study. But she notes the treatment is expensive, and the study size was very small.

Larger studies that compare the treatment to a placebo will be necessary to evaluate how safe and effective the botulinum toxin treatment is for this disorder. Whatever the outcome of those trials, the study “brings to light the fact that there are many aspects to endometriosis pain that have to be evaluated,” Rapkin says, not just that caused by tissue lesions.

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