Our expert answers questions about the painful condition experienced by 10 per cent of the world female population.
Endometriosis is a condition that affects approximately 1 million people of reproductive age in Canada, and is present in one in 10 individuals. It occurs when tissue similar to the lining of the uterus is present outside of the uterus, and can form lesions, cysts and other growths. These growths can cause significant pain in addition to having other long-term medical complications. Vancouver Coastal Health Research Institute researcher Dr. Paul Yong explains what to be aware of and what research is still needed to address this often debilitating condition.
Q: I have experienced frequent menstrual pain throughout my life. When should I be concerned that I have endometriosis?
A: While there are different causes of menstrual pain, endometriosis may be a possibility if the pain cannot be controlled with pain medications or if there are also other types of pain, including pain with sexual activity, gastrointestinal discomfort, pain with urinating or chronic pelvic pain. It may also be a concern if these pains are affecting your ability to engage in day-to-day activities.
Q: What are the root causes of endometriosis and why does it cause pain during menstruation?
A: There are different theories about what causes endometriosis. Some theories suggest that endometriosis derives from endometrial cells within the uterus, and others suggest endometriosis begins elsewhere in the body. Endometriosis-associated pain is complex, and can develop from endometriosis lesion invasion, inflammation and irritation in the surrounding tissue, pain coming from the uterus or sensitivity in other pelvic organs, and nociplastic pain — pain related to changes in the central nervous system.
Q: What are the risk factors for endometriosis?
A: There are both genetic and environmental risk factors to developing endometriosis. While certain epidemiologic risk factors are well known, such as those that affect menstrual cycle characteristics and body mass index, people with endometriosis may have one, some or none of these risk factors. Because endometriosis is so common, it is important to still consider getting assessed even when traditional risk factors are absent.
Q: What are lifestyle changes I can make to reduce the risk or symptoms of endometriosis?
A: This is an area that needs much more research — clinical trials in particular — to evaluate the effectiveness of lifestyle changes for endometriosis symptoms. Sometimes people find certain changes are helpful (such as changes in diet), but it is difficult to make strong general recommendations in the absence of more studies.
Q: How is endometriosis treated?
A: Treatment options depend on your personal symptoms, goals and life plans. These options can involve laparoscopic surgery to remove endometriosis lesions, as well as hormonal medications or pain relievers. In addition, there is increasing recognition of the importance of multidisciplinary care, which combines surgical and hormonal treatments with psychological and physical therapies. A limitation of hormonal medications is that they generally cannot be used by people who have infertility, those who are trying to conceive or anyone who experiences medication side effects. A major goal of our research program is to identify novel non-hormonal medications for the treatment of endometriosis.
Q: I have heard it can take many years for a woman to receive a diagnosis for endometriosis. What are the most common conditions for which it is mistaken, and why?
A: In Canada, the most recent figure shows that it can take five to six years before confirming a diagnosis of endometriosis. There are multiple reasons for this, but I will highlight one underappreciated point: endometriosis can co-exist with other gynecologic conditions such as fibroids, or with pain conditions such as those related to the bladder, bowel or pelvic muscles. This means that while a patient may have one of these other conditions, endometriosis can still be present, and may even be a predisposing factor for the other conditions.
Q: Why is it important for people to talk about endometriosis and know their options for testing and treatment?
A: I think our society needs to do better in addressing the complexities of pain, including its biological, emotional, social and spiritual aspects. Talking about pain is important so that it can be diagnosed and treated, but also so that people know they are not alone. By creating an open dialogue, we can reduce the stigma associated with chronic pain and find better ways to treat it in the future.