interstitial cystitis endometriosis

How Do You Deal with the Lasting Effects of Endometriosis?

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living with endo

I had my life all planned out. I was going to graduate high school, go to pharmacy school, graduate in four years, and then find a job working at a pharmacy that I loved. I wanted to date and get married and start a family, too. All that changed when I was diagnosed with endometriosis; even though I did not know it at the time.

Fast forward six years and I am a completely different person than I ever thought I would be. Before being diagnosed, I never really understood what people with health problems go through. Now, I do and I am more sympathetic and empathetic to those that have chronic illnesses. I know what it feels like to not be able to do all the things you want to do and love.

Tough Choices with Endo

I have chosen not to finish pharmacy school because my body just cannot handle the stress. I did not want to make this decision. My body has already been through so much. I do not want to put it through anything that may cause more harm. This is the only body I have and I want to make the most of it.

Am I mad? Yes! Will I be able to move on? Yes, because I know that there is a great life ahead of me even if it is not what I had initially planned. I was given endometriosis for a reason and I am not going to let it win. I am going to use what I have been through to help others who also suffer with this disease, as well as the other diseases that come along with endometriosis.

With Endometriosis Comes Many Other Diseases

I have been diagnosed with interstitial cystitis, polycystic ovary syndrome, and osteoporosis, in addition to the endometriosis. I had a hysterectomy at the age of 23. I know I can adopt, but that is a very challenging process to go through. This will make having a family difficult, but not impossible. It may seem like I am giving up because I am not pursuing a dream I had, but I am not. When I was fighting for pharmacy school and for my health, I realized that I just did not have it in me to keep fighting for both. I had to choose my health, because if I did not, I felt like my quality of life would be worse than it is now. If I were to continue pharmacy school, I felt like I would not be able to enjoy the experience. So instead, I am using everything in my power to gain awareness for endometriosis. I encourage people to talk about this disease so that one day there will be a cure. I do not want anyone to ever go through the agonizing heartache and pain I have been through.

When I was first diagnosed, I never thought I would be dealing with endometriosis for the rest of my life. I was sure there was a pill that would help end my pain, but sadly, I was mistaken. I continue to pray that I will wake up one day and not be in pain anymore. However, I have come to the realization that I will be in some kind of pain for the rest of my life. I have to find a way to be able to cope with that pain. I know some people do not understand this, but I have become closer with God since all of this has happened. Many people do not like to hear the saying “everything happens for a reason”, but that is what gets me through each day.

How do you deal with your symptoms of endometriosis and what has the disease stolen from you? Share your story here on Hormones Matter.  Write for us and together we can end endometriosis.

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Pain After Endometriosis Excision Surgery

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Philippa Bridge-Cook

When an endometriosis patient takes the step of having laparoscopic excision surgery to treat their endometriosis, they have often already been through a long journey with many failed treatments. This journey often includes treatments such as multiple rounds of different types of birth control pills, stronger hormonal medications designed to suppress menstrual cycles (such as Lupron or other GnRH agonsists), multiple cauterization or ablation laparoscopic surgeries, and various different complementary alternative medicine approaches.

Most patients who undertake excision surgery after trying many or most of the above, do so on the basis of their own research, since many gynecologists are misinformed about endometriosis treatment, and are not trained to do excision surgery. A recent worldwide consensus paper on the management of endometriosis states that “there is unanimous consensus over the recommendation to excise lesions where possible, especially deep endometriotic lesions, which is felt by most surgeons to give a more thorough removal of disease.”  Sadly, there are fewer than 100 surgeons in North America currently practicing expert excision of endometriosis.

Patients come to excision surgery with hope that this treatment will finally bring them relief. And when pain persists or recurs after excision surgery, patients may feel disappointed, hopeless, and confused.  However, there are many causes of pelvic pain that are not endometriosis, which can continue to cause pain even after expert excision surgery, and once these other causes are treated, excellent pain relief and relief of other symptoms may be achieved. Although it may be natural after previous surgeries have failed, to assume that endometriosis is still the cause of the pain, if surgery was performed by an expert, it is prudent to rule out other potential causes of pain before assuming that endometriosis continues to be the culprit.

Adhesions After Surgery

Adhesions are a very common occurrence after laparoscopic excision surgery. Adhesions occur in 70 to 90 percent of patients undergoing gynecological surgery. In some cases, adhesions may be present but not cause pain, but adhesions can also cause chronic abdominal or pelvic pain, small bowel obstruction (where the intestines are kinked or twisted, and are partially or completely blocked), female infertility, and more. Adhesions are the primary cause of bowel obstructions and are a common cause of hospital admission for people with a history of abdominal or pelvic surgeries.

Pelvic Floor Dysfunction

Pelvic floor dysfunction is also a common consequence both of endometriosis itself, and of the surgeries used to treat it. The pelvic floor is a group of muscles and other tissues that form a sling from the front to the back of the pelvis. When the muscles are too tight, too relaxed, or a combination of both, it can result in problems with urination or bowel movements, pain with sex, pelvic pain, genital pain, back pain, and/or rectal pain.

Adenomyosis

Adenomyosis is a disease of the uterus, where the inner lining of the uterus (the endometrium) is found within the muscle wall of the uterus. There is no clear association between adenomyosis and endometriosis, but it is possible to have both conditions. Adenomyosis may be underdiagnosed because it is difficult to see using imaging techniques such as ultrasound, and the symptoms overlap with many of other conditions causing pelvic pain.

Interstitial Cystitis

Interstitial cystitis is a disease of the bladder that can cause pelvic pain, bladder pain, urethral and/or vaginal pain, painful sex, urinary frequency and urgency. Some doctors have found a very high association between endometriosis and interstitial cystitis, where many patients have both conditions. This has led to the two diseases being nicknamed “the evil twins.”

Vulvodynia and Pudendal Neuralgia

Endometriosis patients may also be more susceptible to pain syndromes involving nerves in the pelvic area, such as vulvodynia, a condition associated with pain in the opening of the vagina, and pudendal neuralgia, a condition involving pain, burning, and/or numbness in the genital area and rectum. The potential cause and effect relationship between endometriosis and these other conditions is not clear; however, some doctors theorize that chronic inflammation, immune system dysfunction, and neural pathway sensitization may play a role in the development of multiple pelvic pain syndromes.

Not All Pelvic Pain is Endometriosis

Unfortunately, although endometriosis is a painful and often debilitating condition all on its own, in many patients other conditions also contribute to pain and other symptoms. For doctors and patients alike, it can be tempting, once a diagnosis of endometriosis is made, to blame every symptom arising in the pelvic area on endometriosis. However, pain after careful excision surgery can often be caused by one or more of these other pelvic pain conditions, and a correct diagnosis of the underlying cause of the pain is crucial to successful treatment.

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Not Endometriosis. Now What?

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I was functioning under the assumption that I had endometriosis. It seemed the most likely disease based in the information given me by my doctors. I underwent a diagnostic laparoscopy and waited for my surgeon to follow up with me.

It’s Not Endometriosis

As it turns out, I don’t have endometriosis and my internal structures appear normal. I’ve been referred to a pain management specialist. It has been suggested that I might see a neurologist as well. “If we can’t find the cause, we can at least treat the symptoms. You may have a rare form of cystitis, or you may not. Please try to focus on the good news: you don’t have cysts or tumors or scar tissue,” said my surgeon. I admit I was very disappointed in a strange way. It’s the very human need for an explanation. Without a known cause, how can we stop this from returning again?

Four days after surgery, I got food poisoning. I recovered after five days.

However, now I am terribly dizzy and have severe fatigue. Is it related to the endometriosis-like abdominal pain or something else? I can barely stay awake. In fact, I sleep most of the day and night. It’s not sleepiness. I simply cannot stay conscious. I’m always hungry and eating, but I’m losing weight slowly. There is ringing in my ears on and off. I find myself confused by simple tasks. I tried to fry an egg on a good day and found I couldn’t lift the pan. I’ve fainted twice last week: once after a blood draw, and once just in my home after a stressful conversation.

My general practitioner has run blood tests for anemia, vitamin deficiency, diabetes, and thyroid disorders, as well as a comprehensive blood count. He also told me that most of the time, when trying to diagnose fatigue and dizziness, these blood tests come back normal. I should be prepared to search for other answers. Diabetes and thyroid disorders run in my family, and I’m really hoping it’s easily found out so I can find treatment soon. My ears were checked for infection, and they appear fine. He also suggested that it could be severe depression, but I’m not so sure. I’ve had depressive episodes before, and while I was sluggish and slow to make decisions, I wasn’t this dizzy or weak.

Symptoms that Led Us to Suspect Endometriosis

As for the pelvic pain, it started in late November, very sharp and stabbing on the right-hand side over my ovary over the course of two days, growing rapidly more painful. The ER docs said it was a ruptured ovarian cyst, and noted that when pressed, my left ovary was very tender and painful as well.

That pain was supposed to heal in three to five days and just didn’t, growing less stabbing. It was a constant ache, day and night, for four months over my right lower quadrant with intermittent sharp cramping. When pressed, my left lower quadrant was just as painful, but didn’t throb or cramp on its own.

A course of progesterone halved the pain. Birth control dampened it a bit more. Hot baths and heating pads also helped somewhat. Exercise made it much worse, as did standing and walking for even short periods or leaning over. Pelvic exams and ultrasounds also hurt very much. Going to the restroom hurt terribly.

What really helped was removing the benign tumor in my colon. Some of the pain had been very bad intestinal cramping throughout my abdomen. I have most of my mobility back now. Occasionally, it will feel like there are hot, throbbing points in my pelvis for about three to six hours at a time, usually on the right side. Advil, a heating pad or ice pack, and lying very, very still help.

Also, since November, my periods have been dreadful. Terrible cramps like I’ve never had, and the week before and after my period, I’m very tender throughout my pelvis and it feels like I’ve thrown my lower back out. They never used to be this way.

After the laparoscopy, where everything was found normal, I had sharp, hot throbbing for several days over my right ovary again. The surgeon said she has no explanation except for perhaps a very uncommon form of interstitial cystitis, but I don’t have half of those symptoms. Sitting in a moving car and long walks cause a sharp ache on the right side of my pelvis, but it isn’t constant like it was for three months beforehand. The pelvic pain comes and goes, and it’s about one-third of its former intensity. I don’t know what would cause it to come back full force and constantly, but I hope it never does.

After seven months of poor health, I’m baffled by all my tests returning normal. If it’s not endometriosis, then what is it? If these tests come back normal, I’m not sure what other steps to take.

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Is it Endometriosis or Something Else?

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Endometriosis is an often misunderstood disorder affecting an estimated 176 million women and adolescents around the world, during what should be the “prime years of their lives” (Hummelshoj).  Commonly characterized by symptoms that may be so severe as to interrupt one’s daily routine, whether with periods or at any time during the month, endometriosis accounts for the leading cause of pelvic pain in women of all ages.

Girls and women who suffer primarily during menses only may think, “Of course everyone’s periods are super painful – that’s how it’s supposed to be, right?”  This is actually incorrect.  Endometriosis is among the most common of diagnoses in adolescents and women with pelvic pain.  Unfortunately, due to widespread lack of awareness and disease education, early symptoms are often dismissed as pelvic inflammatory disease or infection, ovarian cysts, appendicitis, IBS, Interstitial Cystitis, “normal” pain, or worse, an “in your head” diagnosis.  This contributes to a near-decade delay in proper diagnosis and intervention. The good news is, accurate diagnoses are increasing as doctors and patients alike become better at recognizing the signs of endometriosis, particularly in younger women and girls. Early intervention combining timely diagnosis with proper treatment is essential towards preventing symptom progression and development of infertility (Sanfilippo et al.).

Though many women and girls may experience some discomfort during menstruation, “killer cramps” are NOT normal – despite what the media, friends and even well-intentioned loved ones may tell us.  Pain is the body’s way of saying something is wrong.  Symptoms that get in the way of school, work, sports, extracurricular or social life are an indication something is awry, as are persistent symptoms at any time of the month.

So What’s Normal?

  • minor period discomfort that may even require over the counter medication
  • occasional irregular or absent periods, particularly if athletic
  • “functional” ovarian cysts
  • pain during ovulation

What’s Not Normal?

  • severe and incapacitating period pain or pelvic pain at any time of the cycle that interrupts normal routine
  • GI discomfort, often but not necessarily around the time of menstruation
  • bladder pain or discomfort, during your period or apart from menses
  • chronic heavy bleeding and long cycles
  • if active, pain with sexual activity (especially upon penetration)
  • “chocolate” cysts known as “endometriomas”
  • subsequent allergies, food insensitivities or intolerances, chemical sensitivities, fatigue, or autoimmune conditions like thyroid disease may also be present in some women and girls with the disease

Time to See a Doctor

Any ongoing, worsening pain that has no obvious explanation should be evaluated further. “The younger the patient, the more valuable the early evaluation.” (Robert B. Albee, Jr., MD).

Sound Familiar?

  • you have pelvic pain during your period or at any time of the month that causes you to miss school, work or activities
  • you experience chronic stomach upset such as nausea, diarrhea or constipation
  • you have painful urination in absence of infection
  • if sexually active, intercourse or sexual activity are painful
  • you have family members who have been surgically diagnosed with endometriosis

If you’ve answered yes to any of the above, talk to a trusted nurse or doctor about endometriosis.

Endometriosis is NOT…

  • An infection or sexually transmitted disease (“STD”)
  • Contagious or preventable
  • Caused by abortion
  • Caused by backflow periods and thus cured by hysterectomy
  • Untreatable!

You cannot “catch” endometriosis, and it isn’t an infection of any sort.  You can’t “give” it to anyone else, and there is no absolute prevention.  There are treatments that can help, however; and many women and girls live quite well in spite of the disease and are able to control their symptoms long-term through different options. The cornerstone of any effective treatment regimen is quality surgery; most notably, Laparoendoscopic Excision (LAPEX).

Being aware of signs of endometriosis can help get early diagnosis and treatment – critical to effective management.  Pain – menstrual or otherwise – that interrupts one’s life is never normal – being aware of abdominopelvic pain, GI and/or urinary distress, and/or pain with sexual activity are significant indicators of endometriosis.  The most important step a young woman can take is not trivializing her body’s signals. Pain is a sign that something isn’t right.

Societal taboos and a culture of menstrual misinformation may lead women and girls to think their pain is “in their head”, or they may even be told by others that they are “faking it” to get out of work or class – or that crippling period cramps are “totally normal” and “part of being a female”, but these outdated notions simply aren’t true.  If you are experiencing pain or symptoms that get in the way of your life, see your doctor.

About the Authors: The Center for Endometriosis Care is a COEMIG-Designated Center of Excellence in Minimally Invasive Gynecologic Surgery which was founded over two decades ago by renowned laparoscopic excision (LAPEX) pioneer Robert B. Albee, Jr., MD, FACOG, ACGE.  The Center is run under the leadership of Medical Director Ken R. Sinervo, MD, FRCSC, ACGE along with a caring, compassionate staff.  We continue our efforts as architects of the legacy in gold standard endometriosis care.

Medical Disclaimer: All material on this web site is provided for your information only and may not be construed as, nor should it be a substitute for, professional medical advice. To read more about our health policy see Terms of Use.

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