A 501(C)3Tax-Exempt, Tax-Deductible Organization
Endometriosis Research Center
© 1997-2013 All rights reserved. Absolutely no duplication or reproduction permitted.
What’s the Big Deal? It’s Just “Killer Cramps,” Right?
This misnomer diminishes and invalidates the suffering of every woman and girl with the disease, and often leads to isolation. Endometriosis is, in fact, a wound so profound and primal in nature it has the potential for pervading and negatively impacting every aspect of a woman or girl’s entire life – and the life of those who care for her; from her ability to go about her normal routine, to intimate engagement in a healthy sex life with her partner, to the ability to control her reproductive choices.
So – What IS Normal??
Minor cramping during menses, often treated with over the counter remedies.
Each month, tissue lining the uterus (endometrium) breaks down, sheds and exits the body resulting in normal menstruation. Inflammatory hormones – particularly those known as prostaglandins – are linked to the minor cramping and discomfort of a normal period. This is called “dysmenorrhea”. Dysmenorrhea is not the same as endometriosis. This is considered “normal”.
CRIPPLING PERIOD PAIN IS NOT! Our culture of menstrual misinformation and societal bias often tells us the following “taboo” symptoms are “part of life” because “we are female”:
Pelvic pain that gets worse after sex or a pelvic exam
Chronically heavy or long periods
Bowel or urinary disorders associated with periods
Painful sexual activity, particularly penetration
Significant lower back pain with menses
Allergies, migraines or fatigue that tends to worsen around menses
Crippling menstrual pain
We are often taught these symptoms are routine or that we shouldn’t talk about them. This is wrong. THESE ARE SIGNS OF ENDOMETRIOSIS.
Endometriosis is a disease characterized by the aberrant presence of endometrial-like glands and stroma located outside the womb - where it doesn't belong. These fragments are biochemically different, and behave differently, from normal endometrium which is shed during a period. With endometriosis, the disease occurs on the surrounding structures, causing severe pain, bowel, bladder or other organ dysfunction, inflammation, scarring and adhesions, and in some cases, infertility. Endometriosis represents a significant clinical challenge commonly associated with reduced quality of life in those affected.
With endometriosis, inflammatory reactions, microscopic internal bleeding, development of painful endometriomas, fibrotic scarring and formation of adhesions are all common, along with marked distortion of pelvic anatomy [Kennedy S, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Human Reprod 2005;20(10):2698-2704]. Symptoms are frequently wide-ranging and often start early in life, but may be underappreciated by medical and lay communities alike. Indeed, symptoms may present even as early as eight years of age, and high rates of disease and symptoms indicative of possible future endometriosis have been noted in adolescents and young women based on data by Missmer et al.
Often dismissed by caregivers, healthcare consumers and clinicians, timely diagnosis combined with effective management cannot be undervalued. Lack of reliable non-invasive detection methods also contribute to the current lengthy delays in diagnosis. The disease remains a leading cause of gynecologic hospitalization and hysterectomy, and presents with symptoms ranging from dyspareunia and chronic pelvic pain to infertility and decreased subjective well-being. Thus, practitioners from all disciplines, especially OB/GYN, must understand not only the medical aspects of this disease, but the tremendous psycho-social and cost burdens as well. School and community nurses in particular may be the first line of defense in the youth population, and should be keenly aware of signs and symptoms of possible endometriosis in their students to facilitate early intervention.
A Growing Crisis: Societal Impact at a Glance
176 million women globally - 775,000 in Canada and 8.5 million in North America overall – are affected [Adamson, Hummelshoj et al., J Endometriosis 2010;2:3–6]
Early symptoms are oft-ignored due to lack of awareness by lay and medical societies alike
Nearly 70% of teens with pelvic pain are later diagnosed with endometriosis yet are routinely dismissed [Yeung P Jr, Sinervo K, Winer W, Albee RB Jr. Complete laparoscopic excision of endometriosis in teenagers: is postoperative hormonal suppression necessary? Fertil Steril. 2011 May;95(6):1909-12, 1912.e1. Epub 2011 Mar 21]
Early intervention can reduce morbidity, infertility and progressive symptomatology
We must alleviate the culture of menstrual misinformation and generational gaps if we are to prevent the daughters of tomorrow from suffering as the women of today have!
“The Perfect Storm?”
Often called a “disease of theories”, the definitive cause(s) of endometriosis remain under debate, though demonstrated association with a number of hereditary, environmental, epigenetic and menstrual characteristics exist. NO SINGLE RESEARCHER HAS FOUND "THE" ANSWER. The chronic, inflammatory reaction, infertility and pain associated with endometriosis may also correspond to a variety of co-morbid conditions ranging from autoimmune disease to food and environmental allergies and intolerances.
Theories of pathophysiology include:
Retrograde menstruation – Sampson’s flawed theory of abnormal backflow; this does NOT explain pathogenesis
Immunologic dysfunction – a “broken” immune system allows for implantation of menstrual debris
Stem Cells – have been demonstrated to populate endometriotic implants, even in absence of menstruation
Genetics – a 7-10 fold risk exists in women and girls whose mother or relative has disease
Environmental Toxins – can cause cell changes which allow for implantation and errant immune response
No single theory explains endometriosis in all patients. Likely, we are born with mechanisms which, when later combined – “the perfect storm - trigger the disease.
What does Endometriosis feel like?
Endometriosis typically develops on the pelvic structures including the rectovaginal septum, bladder, bowels, intestines, ovaries and fallopian tubes, but may also be found in distant regions including diaphragm, lungs, where it can induce Catamenial Pneumothorax, and rarely, areas as far outside the abdominopelvic region as the brain. The ovaries are among the most common of locations, with the gastrointestinal tract, urinary tract, soft tissues, and diaphragm following.
Symptoms vary considerably, sometimes mimicking those of other medical conditions such as pelvic inflammatory disease, adenomyosis, fibroids or ovarian cancer. Few laboratory tests will be valuable in diagnosis, as the CA-125, CCR1mRNA and MCP1 all have low accuracy in the diagnostic approach. CBC with differential may help to eliminate other causes of pelvic pain, such as infection, but is of no use in confirming the presence or absence of the disease. Likewise, urinalysis and urine culture can rule out urinary tract infection, and cervical Gram stain with cultures can confirm or deny presence of sexually transmitted diseases which may lend to pelvic pain and infertility, but do not confirm a diagnosis. Beta HCG can rule out complications of possible pregnancy. Imaging diagnostics may be helpful at detecting masses and deep disease, but anything other than surgical confirmation is considered uncertain.
Classic signs include severe dysmenorrhea, deep dyspareunia, chronic pelvic pain, Middleschmertz (painful ovulation), cyclical or perimenstrual symptoms (i.e. bowel or bladder associated) with or without abnormal bleeding, infertility and chronic fatigue [Kennedy S, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Human Reprod 2005;20(10):2698-2704]. Women with endometriosis also frequently suffer from autoimmune inflammatory diseases, allergies and asthma [Matalliotakis I, Cakmak H, Matalliotakis M, Kappou D, Arici A. High rate of allergies among women with endometriosis. J Obstet Gynaecol. 2012 Apr;32(3):291-3], and endometriosis shares similarities with several autoimmune diseases including elevated levels of cytokines, decreased apoptosis and cell-mediated abnormalities [Eisenberg VH, Zolti M, Soriano D. Is there an association between autoimmunity and endometriosis? Autoimmun Rev. 2012 Feb 4]. Severely compromised quality of life and sexual health are common in endometriosis.
Though laparoscopy is the primary means of definitive diagnosis, a third of patients with pelvic pain may have completely normal pelvic anatomy at the time of surgical evaluation. To some extent, the clinically visualized findings may represent a “tip of the iceberg” phenomenon, in that deep, infiltrating endometriosis lesions may appear on the surface as minute fibrotic implants. In these cases, the extent of the disease cannot be determined by visual inspection [Levy BS; Apgar BS; Surrey ES; Wysocki S. Endometriosis & Chronic Pain: a multispecialty roundtable discussion. Journal of Family Practice. 2007 Mar;56(3 Suppl Diagnosis):S3-13]. Still, minimally invasive laparoscopic excision surgery remains the gold standard for diagnosis and treatment, ideally performed in the specialty treatment setting or performed by an advanced surgeon.
“Staging” or “disease stages” –
Refers to the depth and amount lesions present. Graded on a point system upon surgical evaluation and weighted from 1 (mild) through 4 (severe), staging has no correlation to pain or symptomatic impairment and is used primarily as a predictor of fertility in the presence of advancing disease [Demco. Mapping the source and character of pain due to endometriosis by patient-assisted laparoscopy. J Am Assoc Gynecol Laparosc. Aug 1998;5(3):241-5]. Some people refer to "stage 5", but this is not an actual, accepted stage under the formal classification schedule. Nonetheless, regardless of stage, symptoms may reflect area of involvement and typically include the following:
Lower abdominal or back pain
Dyschezia, often with cycles of diarrhea/constipation
Bloating, nausea and vomiting
Pain & Compounded Symptoms
Women with endometriosis are more likely to report their pain as “throbbing” and experience dyschezia when compared with women with an apparently normal pelvis, and specific menstrual symptoms have been reported to occur more frequently in women with the disease as compared with a control group. Endometriosis is more commonly found on the left side, with at least one study indicating 56% of women having left-sided disease versus 50% having right-sided disease [Ballard, Lane, Hudelist, Banerjee, Wright. Can specific pain symptoms help in the diagnosis of endometriosis? A cohort study of women with chronic pelvic pain. Fertil Steril Volume 94, Issue 1, Pages 20-27, June 2010].
Women may also report hematochezia (rectal bleeding) in association with menses when endometriosis involves the rectosigmoid colon. Similarly, flank pain and/or hematuria may be present if the bladder or ureters are involved. Sexually active women may report dyspareunia, which may be due to scarring of the uterosacral ligaments, nodularity of the rectovaginal septum, cul-de-sac obliteration, and/or uterine retroversion, all of which may also lead to chronic backache. These symptoms are often exaggerated during menses. Women with deep infiltration of the uterosacral ligaments were shown to have the most severe impairment of sexual function [Ferrero, Esposito, Abbamonte, Anserini, Remorgida, Ragni. Quality of sex life in women with endometriosis and deep dyspareunia. Fertil Steril. Mar 2005;83(3):573-9].
Acute exacerbations may be caused by chemical peritonitis due to leakage of old blood from an endometriomas – large, painful cysts filled with menstrual debris and inflammatory fragments (hence the moniker ‘chocolate cyst’). With conscious laparoscopic pain mapping, painful lesions were found to involve peripheral spinal nerves rather than autonomic nerves [Demco. Mapping the source and character of pain due to endometriosis by patient-assisted laparoscopy. J Am Assoc Gynecol Laparosc. Aug 1998;5(3):241-5].
Partial or complete bowel obstruction may occur due to adhesion formation or a circumferential endometriosis lesion. Ureteral obstruction and hydronephrosis can also result from endometrial implants on the ureters or mass effect from an endometriomas [Kapoor, Alderman et al. Endometriosis Treatment & Management. http://emedicine.medscape.com/article/271899-overview]. Depending on the site, endometriosis may present with secondary symptoms including bowel obstruction, melena, hematuria, dysuria, dyspnea and swelling in the soft tissues [Sonavane SK, Kantawala KP, Menias CO. Beyond the boundaries-endometriosis: typical and atypical locations. Curr Probl Diagn Radiol. 2011 Nov-Dec;40(6):219-32]. In cases of pleural (lung/diaphragmatic) endometriosis, catamenial pneumothorax – lung collapse in association with menses – may occur.
Parity and infertility have long been associated with endometriosis, with infertility among the chief clinical findings. As well, associated pain, anatomic distortion, development of adhesions, altered inflammatory response characterized by neovascularization and fibrosis formation, abnormal T- and B-cell functionality, abnormal complement deposition and altered interleukin-6 are among clinical consequences of this disease [Kapoor et al. Endometriosis Treatment & Management. http://emedicine.medscape.com/article/271899-overview]. Endometriosis is also clearly associated with dysmenorrhea, but it is unknown whether this is a cause or a consequence [Koninckx].
Prevention & Cure (??)
There is no known prevention for the disease. Likewise, no single cure has been universally defined. Even in the hands of the best surgical excisionists in the world, there has been recurrence post-surgically in a small group of patients. Related to a number of hereditary, environmental, epigenetic and menstrual characteristics and alterations, some sharing certain common processes with cancer [Kokcu. Gynecologic Oncology: Relationship between endometriosis and cancer from current perspective. Archives of Gynecology & Obstetrics Volume 284, Number 6, 1473-1479], endometriosis remains the third leading cause of gynecologic hospitalization in United States [Mcleod, Retzloff. Epidemiology of Endometriosis: an Assessment of Risk Factors. Clinical Obstetrics & Gynecology: June 2010 - Volume 53 - Issue 2 - pp 389-396] and is considered a leading cause of female primary and secondary infertility, prevalent in 0.5–5% in fertile and 25–40% of infertile women [Ozkan, Murk, Arici. Endometriosis & Infertility: Epidemiology and Evidence-based Treatments. Annals of the New York Academy of Sciences Vol 1127, Assessment of Human Reproductive Function pages 92–100, April 2008]. Endometriosis remains a leading cause of the 600,000 hysterectomies performed in the U.S. annually, with significant associated morbidity [Murphy. Clinical aspects of endometriosis. Ann N Y Acad Sci. 2002 Mar;955:1-10; discussion 34-6, 396-406].
Though no particular demographic, personality trait or ethnic predilection has been defined, certain characteristics have been associated with a diagnosis of endometriosis, including decreased risk with late age at menarche [Treloar, Bell, Nagle et al. Early menstrual characteristics associated with subsequent diagnosis of endometriosis. Am J Obstet Gynecol 2010;202:534.e1-6] and shorter menstrual cycles with longer duration of flow [Mahmood 1991]. Family history cannot be undervalued, with consistent findings illustrating a near tenfold increased risk in those women with first-degree relatives who have endometriosis [Matalliotakis, Arici et al. Familial aggregation of endometriosis in the Yale Series. Archives of Gynecology and Obstetrics Volume 278, Number 6, 507-511]. Further genetic analyses will clarify the role of family in endometriosis risk.
Dioxin pollution has been suggested as causally related to endometriosis based on the observation of increased incidence and severity of endometriosis in primates treated previously with dioxins [Rier et al. Serum levels of TCDD and dioxin-like chemicals in Rhesus monkeys chronically exposed to dioxin: correlation of increased serum PCB levels with endometriosis. Toxicol.Sci. 2001;59:147-59]. Related data suggests plausibility that dioxin exposure of specific timing and dosage may precipitate endometriosis through interaction with estrogen receptors or suppression of progesterone receptors [Giudice, Linda, Johannes Leonardus Henricus Evers, and D. L. Healy. Endometriosis: Science and Practice. Chichester, West Sussex: Wiley-Blackwell, 2012. Print]. Conversely, at least one recent, in-depth study concluded that that dioxin may in fact not contribute to the etiology of endometriosis at all [Matsuzaka et al. Lack of an association human dioxin detoxification gene polymorphisms with endometriosis in Japanese women: results of a pilot study. Environ Health Prev Med. 2012 May 1].
No clear association has been defined between endometriosis prevalence and chronic immunosuppression e.g. in transplant patients, nor with smoking affecting NK (natural killer cell) activity, nor with caffeine or alcohol, nor with any lifestyle variables [Epidemiology of endometriosis. Koninckx. http://www.gynsurgery.org/ols/pdf/030101_Epidemiology%20of%20endometriosis.pdf].
Studies have found that higher body mass index decreases risk of both deep as well as ovarian and pelvic endometriosis, as does parity [Parazzini et. al. Risk factors for deep endometriosis: a comparison with pelvic and ovarian endometriosis. Fertil Steril Volume 90, Issue 1, July 2008, Pages 174-179], though pregnancy is not a cure as once – and still sometimes mistakenly - touted. A recent provocative study by Vercellini et al. determined that women with the most severe form of endometriosis appeared “more attractive to external observers” than those with peritoneal and/or ovarian endometriosis, as well as those without endometriosis. Women with severe rectovaginal disease were judged to have a leaner silhouette, larger breasts and earlier coitarche. Such phenotyping may have future use in conjunction with genetic and environmental data to elucidate the pathogenesis of endometriosis, but authors rightfully caution that further studies are warranted to “exclude a spurious relationship between attractiveness and rectovaginal endometriosis and to rule out the potentially confounding effect of deep dyspareunia on some aspects of sexual behavior” [Vercellini, Buggio, Somigliana, Barbara, Vigano, Fedele. Attractiveness of women with rectovaginal endometriosis: a case-control study. Fertil Steril 17 September 2012].
Frequency of endometriosis in women of higher social class has also previously been reported, but this is likely the result of bias. The same diagnostic bias may explain the higher frequency in white women vs. women of color, and in fact, data on prevalence in different races often do not consider the reason for admission for surgical procedure, which may be selectively associated with a higher or lower likelihood of an endometriosis diagnosis. Few studies have evaluated comparable population and socioeconomic conditions; those that did revealed no substantial differences among women of different races [Giudice, Linda, Johannes Leonardus Henricus Evers, and D. L. Healy. Endometriosis: Science and Practice. Chichester, West Sussex: Wiley-Blackwell, 2012. Print]. Less understood are the factors, if any, of nutrition and exercise, lifestyle, personality traits and other variables, with little evidence regarding these as more than simply modulating roles.
Early intervention and increased awareness of the disease is requisite to reduce morbidity, infertility and progressive symptomatology in patients of all ages.
Laparoendoscopic Excision: The Gold Standard
- A safe, effective option: complications of laparoscopy continue to become increasingly less common; approximately 3.2 per 1000 cases [Nezhat C, Berger GS, Nezhat FR, Buttram, VC, Nezhat C, eds. Operative laparoscopy: preventing and managing complications. In: Nezhat CR, ed. Endometriosis: Advanced Management and Surgical Techniques. Springer-Verlag; 1995. Print; Chapron C, Fauconnier A, Goffinet F, Bréart G, Dubuisson JB. Laparoscopic surgery is not inherently dangerous for patients presenting with benign gynaecologic pathology. Results of a meta-analysis. Hum Reprod. 2002;17:1334–1342]
- Reduced in-patient stays and post-operative morbidity lead to reduced costs and improved outcomes
- Laparoscopy is also highly cost effective in initial management of young women with infertility, particularly when infertility treatment dropout rates exceed 9% per cycle [Moayeri SE, Lee HC, Lathi RB, Westphal LM, Milki AA, Garber AM. Laparoscopy in women with unexplained infertility: a cost-effectiveness analysis. Fertil Steril. 2009 Aug;92(2):471-80. Epub 2008 Aug 22]
- Excisional biopsy and removal is most effective way of both treating superficial and deeply invasive disease and allowing for histological confirmation, and has been shown to confer high rates of relief and symptom suppression at re-evaluation [Redwine, D. Evidence on endometriosis: Elitism about randomised controlled trials is inappropriate. BMJ. 2000 October 28; 321(7268): 1077; CEC unpublished data]
- Laparoscopic excision restores normal anatomic relationships and treats pelvic pain, infertility, or both by sharply dissecting deep fibrotic nodules which may be causing partial or complete cul-de-sac obliteration
- Laparoscopic complete excision of endometriosis offers long-term relief in most patients and should be considered the “Gold Standard” [Slack A, Child T, Lindsey I, Kennedy S, Cunningham C, Mortensen N, Koninckx P, McVeigh E. Urological and colorectal complications following surgery for rectovaginal endometriosis. BJOG 2007;114:1278–1282.]
- Minimally invasive access is generally very well tolerated with reasonable incidence of complication and low recurrence rate. [Camanni et al. Laparoscopic conservative management of ureteral endometriosis: a survey of eighty patients submitted to ureterolysis. Reproductive Biology and Endocrinology 2009, 7:109.]
- Excision should be the Standard of Care. Excision of ALL disease, particularly deep endometriosis, is critical in order to reduce symptoms. Coordinating with a multidisciplinary team can ensure maximum patient outcome, in addition to lowered risks. It is better to plan surgeries with other clinicians or directly refer to a tertiary care center for complete excision, rather than delaying or reducing totality of treatment.
Other Treatment Options:
Medical Suppression – treats only symptoms, not disease, significant side effects
Physical Therapy – non-invasive, very helpful way of managing symptoms; see Dr. Sallie Sarrel's information on PT & Endo
Alternative Therapies – non-invasive way to help with pain (physical therapy, acupuncture, aromatherapy, myofascial release therapy, exercise (see our group here), herbal therapy, Bach Flower, holistic)
Diet/Nutrition – contributes to reduced symptoms and a healthy lifestyle, see our group here
Pain Management – coping mechanisms for chronic pain
Hysterectomy – not a cure and inappropriate for young women!
Temporary Medical Suppressives include:
GnRH agonists, i.e. Lupron®, Synarel®, Zoladex®
Synthetic androgens i.e. Danazol®
Oral contraceptives, i.e. Alesse® or Lo-Ovral®, Seasonale®, Visanne® (Canada), etc.
Injectible contraceptives, i.e. Depo-Provera®
Aromatase Inhibitors i.e. Femara®
Aromatase Inhibitors: estrogen is like fuel to fire for endometriosis, thus current treatments have been designed to stop estrogen secretions from the ovaries of a woman (gonadotropin releasing hormone agonists). Estrogen, however is made not only in the ovaries but also in adipose tissue, and most importantly, within endometriosis lesions themselves. Thus, the tissue acts in a devious manner to make its own estrogen through the abnormal expression of Aromatase enzyme in this tissue. This may explain the high numbers of treatment failures and early recurrences after conventional treatments of endometriosis. In mid 90s, new generation Aromatase inhibitors were introduced to successfully treat breast cancer, another estrogen dependent disease. Dr. Serdar Bulun was the first in the world to use an Aromatase inhibitor to successfully eradicate an unusually aggressive case of postmenopausal endometriosis; the treatment is now readily available.
GnRH (gonadotropin-releasing hormone) agonists: these are drugs that are designed to suppress the endometriosis implants in the following way: during the first phase of treatment, the drugs stimulate the ovaries to produce more estradiol (the most potent form of estrogen). In the second phase, after anywhere from approximately 7 to 21 days of constant stimulation, the drugs shut down the "messenger" hormones sent from the pituitary gland to the ovaries. The result is that the ovaries shut down, estradiol levels drop sharply and rapidly, and the patient ceases to ovulate or menstruate; a condition similar to that of menopause. Some women experience positive results with GnRH treatments, others do not. As with any treatment, each case will vary. Though the medications can shrink the lesions of endometriosis, they will not shrink adhesions or scar tissue, which often play a part in the symptomatic pain of the disease.
Common side effects that have been reported by women undergoing treatment include hot flashes, headaches, insomnia, vaginal dryness, decreased libido, depression, mood swings, fatigue, acne, dizziness, nausea, short term memory loss, diarrhea, hair loss, anxiety, and bruising at injection site. Again, each case is individual in nature and there is no way of knowing in advance how the drug might affect you personally.
Danazol – a dated treatment for endometriosis, this is a synthetic testosterone marketed under the names "Danocrine®" or "Cyclomen®." It is usually given in pill form. Danazol has recently been linked to ovarian cancer.
Contraceptives, such as, but not limited to:
Depo-Provera® (medroxyprogesterone acetate) - injectable form of progestins. In March 2005, Pfizer was granted approval on a new pain-relieving compound for endometriosis, the injectable drug Depo-subQ Provera 104, which contains the same active ingredient as the contraceptive Depo-Provera, but in a new formulation.
Provera® (same as above; administered in pill form). For more information on this topic, please request the informative article on Depo-Provera.
Any forms of oral contraceptives recommended by your doctor: popular ones include Alesse® and Lo-Ovral®, because of their low estrogen/high progesterone combination.
An extended-cycle pill, Seasonale®, is also being used with success by some women and girls with the disease. Seasonale contains 84 days of active pills followed by 7 hormone-free days, allowing a woman to experience only four menstrual cycles per year, versus the normal number of 12.
In the pipeline include potential future options i.e. selective estrogen receptor modulators, new GnRH therapy, anti-angiogenic strategies, new anti-inflammatory drugs, selective progesterone modulators, statins, therapies potentially targeting stem cells and others.
The Miracle Cure: every supplement ever sold on the Internet
TAKE NOTE! No supplement has ever been proven for endometriosis 'cure'!
Vitamins & Minerals are classified as food: no FDA requisite for quality of ingredients or claims as to effectiveness
However - CAN be helpful as part of ‘big picture’ management for some –But…caveat emptor!
Is the product in harmony with Nature? Product should be "concentrated from a quality natural source“ [Bruce Miller, MD, American College of Nutrition]. Tar, coal, etc. have been found "All Natural“ supplements.
Artificial colors/flavors: do you have a deficiency in artificial flavors or coloring? No! Therefore, they are unnecessary and used only as money-saving measures by manufacturer.
Does the company offer published scientific research on the product?
LEARN MORE ABOUT NUTRITION FOR ENDOMETRIOSIS:
Get the Book: Endometriosis-Healing Through Nutrition by Dian Shepperson Mills
Crippling pain is never normal
Endometriosis can affect any girl or woman from any walk of life
Cause may be rooted in immuno-genetic/epigenetic basis
While no absolute cure, many treatments exist including self-controllable lifestyle adaptations
Meticulous surgical treatment combined with lifestyle changes can give most relief!
It is ENTIRELY possible to LIVE WELL in spite of endometriosis! This is NOT a HOPELESS disease.
Join our various social media outposts:
Check out as well this group run by Nancy Petersen, RN ("Nancy's Nook")
Developed in 1999 by the Endometriosis Research Center. Thank you to all those foundations and individuals who adopted it for their own use to help others.
Not sure if you have endometriosis? Pelvic surgery is the only current way to definitively diagnose the disease, but symptoms can lead you and your doctor to suspect it. Review the following and consider if any of these common symptoms apply to you. Review your answers with your gynecologist for further discussion.
Do you experience so much pain during or around your period that you find yourself unable to work, attend school or social functions, or go about your normal routine? YES / NO
Do you have any relatives diagnosed with endometriosis? YES / NO
Do you have a history of painful ovarian endometriomas ("chocolate cysts")? YES / NO
Do you experience gastrointestinal symptoms during your cycle, such as nausea or vomiting and/or painful abdominal cramping accompanied by diarrhea and/or constipation? YES / NO
Do you have a history of fatigue or feeling "sick and tired" all the time? YES / NO
Do you have a history of allergies, which tend to worsen around your periods? YES / NO
If sexually active, do you experience pain during sexual activity? YES / NO
Do you suffer from autoimmune diseases or other conditions e.g. thyroid disease, rheumatoid arthritis, lupus, fibromyalgia, multiple sclerosis, chronic migraines? YES / NO
Have you ever undergone pelvic surgery like a laparoscopy, in which endometriosis was suspected but not definitively diagnosed? YES / NO
If you have answered "yes" to three or more of these questions, you may have endometriosis. Talk to your trusted nurse or doctor about getting an accurate diagnosis and effective treatment today. Dull aching and cramping can occur during menstruation in many women and teens, due to uterine contractions and the release of various hormones, including those known as prostaglandins. However, period pain that becomes so debilitating it renders you unable to go about your normal routine is not ordinary or typical! Pain is your body's way of signaling that something is WRONG. If you are suffering from pelvic pain at any point in your cycle, an endometriosis diagnosis should be considered.
Get help. Join today with others who understand: https://www.facebook.com/EndoResCenter
The above information is excerpted from a much larger presentation on the disease. If you would like the ERC to present to your school, company, support group, hospital or provider, or any local resource, contact us today.