Jane Harris

NancysNookEndo Pelvic floor dysfunction Another condition that can have overlapping symptoms with endometriosis is pelvic floor dysfunction (PFD). PFD involves abnormal functioning of the pelvic floor muscles (Grimes & Stratton, 2020). The muscles can be too tight (hypertonia), too lax (hypotonia), or just not coordinate appropriately (Grimes & Stratton, 2020). Fraga et al. (2021) reports that those with deep infiltrating endometriosis (DIE) had higher pelvic floor hypertonia, weaker muscle contraction, and inability to completely relax the pelvic floor muscles. They also noted shortening of the anterior thigh, piriformis, and iliotibial band muscles (Fraga et al., 2021). PFD can be seen frequently in those with endometriosis “even after surgical excision of the endometriosis lesions” (Hunt, 2019). Shrikhande (2020) reports: “The presence of endometriosis in the pelvis can cause a secondary chronic guarding of pelvic floor musculature. This chronic guarding state leads to ...

NancysNookEndo Pelvic Congestion Syndrome- another cause of chronic pelvic pain When talking about endometriosis and chronic pelvic pain, it is important to remember that often endometriosis is not the only pelvic pain generator. Another possible contributor to chronic pelvic pain is pelvic congestion syndrome (PCS). “Pelvic congestion syndrome (PCS) accounts for up to 30% of patients presenting with chronic pelvic pain” (Reardon & Dillavou, 2021). There isn’t a significant amount of data about endometriosis and PCS, but one study found “the prevalence of ovarian varices in patients with endometriosis was 80%, whereas the control group was only 26.1%” (Pacheco & de Oliveira, 2016). PCS is like having varicose veins in the pelvis. Blood pulls in the veins and can cause symptoms such as heaviness, pain with penetration, noncyclical pain, positional lower back pain, pelvic and upper thigh pain, prolonged postcoital discomfort, symptoms that worsen throughout the day and are exa...

NancysNookEndo Fibroids We have been looking at some of the related conditions that can cause overlapping symptoms with endometriosis. This is important because, if you only treat one condition and not the others, this can lead to continued symptoms and a great deal of discouragement. Another condition with overlapping symptoms with endometriosis is uterine fibroids (leiomyomas). Fibroids are benign tumors of the smooth muscle cells of the uterus with symptoms that can range from being asymptomatic to having “abnormal uterine bleeding, specifically in terms of heavy and prolonged bleeding” as well as pain with penetration and non-cyclic pelvic pain (Zimmermann et al., 2012). They can also affect fertility and cause urinary dysfunction (Fortin, Flyckt, & Falcone, 2018). There has not been much research on the correlation between endometriosis and fibroids. One study reports “an incidence of concomitant fibroids and endometriosis ranging between 12 and 20%, based on 2 previously ...

NancysNookEndo Endometrial Polyps The last couple of weeks, we have seen that adenomyosis and interstitial cystitis are found frequently in those with endometriosis and can cause similar symptoms. Another finding noted in those with endometriosis is endometrial (uterine) polyps. One meta-analysis found a significantly higher risk of endometrial polyps (EP) in those with endometriosis (Zheng et al., 2015). These polyps are overgrowths of endometrial glands and stroma (Zheng et al., 2015). While they may not cause any symptoms, they can cause abnormal menstrual bleeding, bleeding between menstrual periods, vaginal bleeding after menopause, and might affect fertility. Zheng et al. (2015) notes that, like in endometriosis, the expression of estrogen receptors and aromatase (an enzyme that converts androgens to estrogens) is altered in endometrial polyps and can increase the local concentration of estrogen. The authors suggest that “it is important to determine whether patients with endo...

NancysNookEndo Interstitial cystitis- “evil twin” of endometriosis Last week, we noted that adenomyosis can frequently coexist in people with endometriosis. Another one of those conditions that can frequently coexist with endometriosis, aptly named the “evil twin” to endometriosis, is interstitial cystitis (IC) (also called painful bladder syndrome). The walls of the bladder become inflamed or irritated, resulting in symptoms similar to a bladder infection, such as urinary urgency and/or frequency, painful urination, and pelvic pain (Al-Shaiji et al., 2021). However, in IC, there is no infection, and the symptoms can often be exacerbated during the time around menses (Al-Shaiji et al., 2021). Endometriosis and IC can both be found in 80% of people with chronic pelvic pain (Al-Shaiji et al., 2021). Like endometriosis, it can take several years for a diagnosis of IC to be made (Al-Shaiji et al., 2021). It is important to consider this condition when looking at treatments for chronic p...

NancysNookEndo Adenomyosis- sister to endometriosis Endometriosis is often found along with other conditions that can cause similar symptoms (see Related Conditions ). One of those conditions is called adenomyosis, where endometrial glands and stroma invade the muscular part of the uterine wall (Gracia et al., 2022). Vannuccini and Petraglia  (2019) report that “adenomyosis and endometriosis share a number of features, so that for many years adenomyosis has been called endometriosis interna,” but the authors go on to point out that “nevertheless, they are considered two different entities.” Adenomyosis is found in those with endometriosis anywhere from 20-80% of the time (Vannuccini & Petraglia, 2019)! Both conditions share similar symptoms, such as painful periods and abnormal uterine bleeding. This is important to keep in mind when looking at treatment options as it has been seen that “after surgical treatment…pelvic pain and abnormal uterine bleeding (AUB) were significan...

NancysNookEndo Teens with endometriosis Endometriosis in adolescents was recently reviewed by Liakopoulou et al. (2022), and they report that “adolescent endometriosis is a challenging diagnosis” and that “the disease can be easily overlooked”- thus the true incidence of endometriosis in teens is not really known. The diagnosis in teens is often delayed which “can lead to suffering for several years.” The authors state that “consequently, early diagnosis appears to be of upmost importance, especially as far as adolescents and young patients are concerned, as it can optimize life quality, relief symptomatology, and decrease the negative impact of the disease on future fertility.” To achieve earlier diagnosis, the authors suggest that “further evaluation should be considered when prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) is reported by the patient, there are relatives diagnosed with endometriosis (in cases of frequent absenteeism from everyday activities during me...

NancysNookEndo Endometriosis and early menopause Is there an association between endometriosis and early menopause? Kulkarni et al. (2022) looked this question and found that there just might be. The authors state that early natural menopause (ENM) is the cessation of ovarian function before age 45 years. They report that endometriomas in particular (and some treatments for them) might affect ovarian reserves which could lead to earlier onset of menopause. The authors also note that the increase in inflammatory markers in the peritoneal fluid of those with endometriosis might affect follicular and ovarian function (thus leading to earlier menopause). The authors report that “in this large, prospective cohort study, we observed that surgically confirmed endometriosis was associated with a significantly greater risk of ENM.” They noted the highest risk for ENM was among those who never used oral contraceptives (OC) or had never given birth (more ovulations throughout the lifetime that...

NancysNookEndo More updates on diet with endometriosis A recent systemic review looked at the effect of dietary changes on pain perception in endometriosis. While the researchers went through 2185 studies, only six studies fulfilled their inclusion criteria (reproductive age; laparoscopically confirmed endometriosis; and intervention including any type of dietary change) (Sverrisdóttir, Hansen, & Rudnicki, 2022). Those six studies showed that dietary changes, such as “high intake of polyunsaturated fatty acids, a gluten-free diet and a low nickel diet,” may improve painful endometriosis (Sverrisdóttir, Hansen, & Rudnicki, 2022). Another study created a short algorithm for dietary suggestions for those with endometriosis. They recommended overall the Mediterranean diet or an antioxidant diet- rich in vitamins, minerals, and polyunsaturated fats (Nirgianakis et al., 2021). For those who have gastrointestinal symptoms, they further recommend a gluten free, low FODMAP, or for a ...

NancysNookEndo Endometriosis and rheumatoid arthritis A couple of recent studies have indicated that those with endometriosis might have a higher risk of rheumatoid arthritis (RA) (Xue et al., 2021; Chen et al., 2021). One study even suggested “in the clinical management of patients with RA, rheumatologists should be especially mindful of the possibility of underlying endometriosis” (Xue et al., 2021). This is echoed by Shigesi et al. (2019) who states that “the observed associations between endometriosis and autoimmune diseases suggest that clinicians need to be aware of the potential coexistence of endometriosis and autoimmune diseases when either is diagnosed.” Harris et al. (2016) cautions that “it remains to be understood whether and how endometriosis itself, or hysterectomy or other factors associated with endometriosis, is related to risk of…RA.” Alpízar-Rodríguez  et al. (2017) found that “laparoscopically confirmed endometriosis was found to be significantly associated ...

NancysNookEndo Endometriosis and Constipation Endometriosis is associated with several “digestive complaints, including abdominal pain, bloating, diarrhea, constipation, rectal bleeding, and dyschezia” (Raimondo et al., 2022). Raimondo et al. (2022) reports that “chronic constipation (CC) in women with endometriosis varies from 12% to 85%” and results from multiple causes such as inflammation, scar tissue, and damage to pelvic autonomic nerves. Raimondo et al. (2022) reports that those “with endometriosis are more likely to have pelvic floor muscle dysfunctions” and found by using ultrasounds that hypertonic (too much muscle tone) pelvic floor muscles were found more in those with chronic constipation than those without it. While treating chronic constipation can be challenging, the study states that “specific interventions targeting the pelvic floor hypertonia, such as physiotherapy” might be beneficial. Another study reports that digestive symptoms such as constipation are due mo...

NancysNookEndo Endometriosis and Heart Disease There is not much literature about endometriosis and heart disease. Marchandot et al. (2022) reports that there are some overlaps in contributors to both heart disease and endometriosis, such as “chronic inflammation, enhanced oxidative stress, endothelial dysfunction, and cellular proliferation.” Some research indicates “increased arterial stiffness and impaired flow-mediated dilation, a surrogate marker of endothelial dysfunction potentially reversible after surgical treatment , were associated with endometriosis” (Marchandot et al., 2022). Some risk factors for heart disease have been found in those with endometriosis, including hypertension, dyslipidemia, and obesity. Research suggests that the link between hypertension and endometriosis may be because of certain treatments for endometriosis, namely from early hysterectomy/oophorectomy and from use of NSAIDs (Marchandot et al., 2022). In fact, “hysterectomy in women aged 50 years or...

NancysNookEndo Fatigue, rest, and pacing During endometriosis awareness month, the most interacted with post on our Facebook page was about fatigue- which points to how significant it impacts those with endometriosis. Fatigue and pain often go hand in hand- with one aggravating the other. One concept to help prevent flares of pain and fatigue is pacing. Pacing is about adjusting your activities to your body’s current needs and finding the balance between activity and rest. Pacing doesn’t mean you accomplish less, rather it helps you accomplish your goals while reducing the chance of a pain/fatigue flare. We are familiar with the concept of pacing in running and other forms of exercise: “Pacing is essentially a strategy that you use to distribute your energy throughout your entire bout of physical activity. Being cognitively aware of how much you are physically exerting yourself will keep you in touch with signs of fatigue and allow better control of performance. Properly controlli...

NancysNookEndo Endometriosis Awareness Week 4 Endometriosis awareness month is still going! As it is our last newsletter for March, we have a bunch of more shareable information, including some myth-busters. Remember, a good link to share is our basic all About Endometriosis that has short and to the point information about endometriosis as well as links for more info. Keep that endo conversation going! Food is important in our lives! There is no one specific diet for endometriosis. No food, diet, or supplement will “cure” endometriosis, but it can help manage symptoms and is great for overall health and well-being. Your diet needs to be individualized to your specific needs, and it can take quite a bit of experimentation to find what works for you. For more info on diet, see: https://nancysnookendo.com/diet-and-nutrition/ With the goal to improve symptom management and to feel better overall, some alternative and complementary therapies can be helpful. For more info, see: https...

NancysNookEndo Endometriosis Awareness Week 3 Endometriosis awareness month is still going! Here is a week’s worth of shareable information. Another good link to share is our basic all About Endometriosis that has short and to the point information about endometriosis as well as links for more info. Keep that endo conversation going! Infertility is strongly associated with endometriosis. https://nancysnookendo.com/learning-library/symptoms/lessons/fertility-issues/ and https://nancysnookendo.com/infertility-links-2/ Endometriosis is often found with other conditions that can have similar symptoms. For more info, see: https://nancysnookendo.com/related-conditions/ Excision is the surgical removal of tissue by cutting out. It differs from ablation/laserization/burning/vaporizing, which are techniques that use a heat source to destroy tissue. Excision allows for a biopsies to be sent to a pathologist for confirmation, and it better ensures that all of the endometriosis lesion is...

NancysNookEndo Endometriosis Awareness Week 2 Endometriosis awareness month has arrived! Here is a week’s worth of shareable information. Another good link to share is our basic all About Endometriosis that has short and to the point information about endometriosis as well as links for more info. Keep that endo conversation going! For more information, see: Ultrasounds: https://nancysnookendo.com/ultrasound-use-with-endometriosis/ MRI’s: https://nancysnookendo.com/magnetic-resonance-imaging-mris-and-endometriosis/ Negative scans do NOT rule out endometriosis: https://nancysnookendo.com/but-your-tests-are-all-negative/ While researchers are working to create a reliable test and there are promising ones in development, at this point there are none widely available. Also, response or no response to hormonal medications has NOT been proven to be reliable to diagnose endometriosis. For more info, see: https://nancysnookendo.com/labwork-and-blood-tests/ and https://nancysnookendo....

NancysNookEndo Endometriosis Awareness Week 1 Endometriosis awareness month has arrived! Here is a week’s worth of shareable information. Another good link to share is our basic all About Endometriosis that has short and to the point information about endometriosis as well as links for more info. Keep that endo conversation going! Endometriosis is found outside of the uterus. It can be on many locations both in the pelvis and outside the pelvis. Find more info on endometriosis locations here: https://nancysnookendo.com/locations-of-endometriosis/ and https://nancysnookendo.com/weird-places-endometriosis-has-been-found/ There are key differences in how endometriosis lesions differ from the lining of the uterus- which affects how it responds to its environment and to medications:. Find more info here: https://nancysnookendo.com/role-of-estrogen-receptor-%ce%b2-in-endometriosis/ and https://nancysnookendo.com/progesterone-resistance-in-endometriosis/ An estimated 11% of women ar...

NancysNookEndo Endo Awareness- Start the Conversation March is endometriosis awareness month, and it is time to start the conversation about endo. Endometriosis can take an average of 10 years before a diagnosis and even longer to find effective treatment. That’s why it is important to start that conversation about endometriosis- with family, with friends, with your healthcare providers. Every day in March we will be sharing a short infograph about endometriosis along with links to more information that you can share. If we all reach out to another, perhaps we can help someone else not have to experience the often long delays in diagnosis and adequate treatment for endometriosis. Time to start the conversation!!! You can start with some of these:   Nancy’s Nook website: https://nancysnookendo.com/   Endometriosis graphics to share: https://nancysnookendo.com/endometriosis-graphics/   Articles and Website Links: https://nancysnookendo.com/articles-and-website-link...

NancysNookEndo Surgery- expertise matters  The gold standard for diagnosis of endometriosis is through laparoscopic surgery. The knowledge and skill of the surgeon can affect the ability to accurately identify endometriosis- in order to not only diagnose it but to also successfully remove all disease (Jose, Fausto, & Antonio, 2018; Fischer et al., 2013). In addition to the appearance of endometriosis, the numerous locations, including lesions not confined to the pelvis, can make surgery more complicated (endometriosis can involve areas such as  ureters ,  bowel , or  diaphragm  that require a higher level of care).  Leibetseder et al. (2022) reports that “in over 60% of diagnosed cases, endometriosis treatment requires multiple surgeries due to unidentified (missed) lesions.” Fattah et al. (2017) also echoes this, pointing out that “the numerical importance of atypical, subtle, non-hemorrhagic disease has recently been shown: at least ...