In this recurring guest column, Kate White, M.D., of Boston Medical Center, answers your questions on all things gynecology. As the author of the Mayo Clinic Press book Your Sexual Health, she’s ready to dole out wisdom on sex, periods, menopause and more. Submit a question here.
Q: I just had surgery to remove endometriosis because of the severe pain. Can I do anything to keep endo from coming back?
A: Endometriosis, sometimes called endo, is a common gynecological cause of pelvic pain, but it’s underdiagnosed and poorly understood. It results when tissue that’s like the tissue lining the uterus, called the endometrium, grows outside the uterus and implants in areas like the fallopian tubes, ovaries and lining of the pelvis. Throughout the menstrual cycle, these tissue implants are stimulated by hormones in the same way that the uterine tissue is. This stimulation can lead to scar tissue and adhesions, which are bands of fibrous tissue that cause organs and structures to stick together.
The pain from endometriosis comes from these tissue implants being in places where they don’t belong. For many people, endometriosis pain feels like really bad menstrual cramps, and not just in the pelvis but also in the lower back. Endometriosis can cause pain with going to the bathroom — both urinating and having a bowel movement — especially during your period, or pain with intercourse at any time.
The first treatments for endometriosis tend to be anti-inflammatory medications like ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) and hormone therapy.
Hormone therapy tries to slow the growth of endometrial tissue and prevent new implants from forming. The most common medications used are hormonal contraceptive methods that turn off ovulation. These include methods with estrogen and progestin (birth control pills, patches and rings) and those with just progestin (injections, IUDs, an arm implant and pills). Talk with your health care team about the methods you want to try. You can always switch to a new one if you don’t like the first one you try.
When these measures aren’t sufficient, surgery can remove implants and scar tissue, which hopefully provides longer lasting pain relief.
But endometriosis is a sneaky beast. Surgery can clear whatever implants the surgeon can see, but it doesn’t prevent the growth of new ones. So most gynecologists will recommend that their patients take hormone therapy after surgery for endometriosis to help keep it at bay.
If a health care provider prescribes hormone therapy for you, make sure that you’re taking or using it correctly and consistently. That’s your best bet to reduce pain and limit the need for future surgery. If the therapy isn’t working for you, your health care team can work with you to find an alternative therapy.
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