March is Endometriosis Awareness Month, and this year, more than ever, we want to ensure the voices of those affected by endometriosis are not forgotten.

Endometriosis affects one in 10 women, with an estimated 200 million worldwide. Endometriosis is not just about painful periods and infertility, it is considered a whole body disease as the associated chronic pain is debilitating.

The financial cost to the world of endometriosis is similar to that of diabetes. It is estimated to be about US$10,762 per woman per year. Two-thirds of that cost is due to lost work productivity and the remaining US$3,497 is in direct healthcare costs.

This illness is challenging for so many reasons:-

1. Nobody knows what causes endometriosis but it is likely that genetics plays a role.

2. There is no cure for endometriosis.

3. According to research published in the Journal of Women’s Health, it takes an average of more than four years for women with endometriosis to get a diagnosis after their symptoms start.

4. Endometriosis is hard to diagnose. The only definitive way to know is via laparoscopy by a skilled specialist who knows what to look for.

5. The severity of endometriosis does not necessarily correlate with the amount of pain or other symptoms the patient experiences.

6. Endometriosis affects every woman differently. That means that there is no one treatment that will work for everyone. You should discuss your full range of symptoms and treatment options with your healthcare provider.

7. Having endometriosis does not mean you are infertile. Between 30% and 40% of women with endometriosis may not be able to have children but many women with endometriosis become pregnant naturally or with reproductive assistance.

8. Pain can become part of everyday life for women with endo but taking over-the-counter or prescription analgesics too often can actually make your pain worse in the long run. If chronic pain is part of your life, you should find a pain clinic or pain psychologist or discuss options with your healthcare provider.

9. The couch is not your friend. Exercise is often difficult for people suffering from chronic pain but endometriosis gets worse when you don’t move. You do not have to go to the gym or run a marathon; walking or swimming may be sufficient.

10. Not all endometriosis surgery is created equal. If you are having surgery, laparoscopic excision is the best treatment but it should only be performed by surgeons with experience in the technique and with a good knowledge of the disease. A lot of people mistakenly believe that hysterectomy is a sure-fire cure for endometriosis. Although removal of the uterus can provide relief for some people with this condition, it’s not a guaranteed cure.

What exactly is Endometriosis?

Endometriosis is the abnormal growth of endometrial tissue like that which lines the interior of the uterus, but in a location outside of the uterus. Endometrial tissue is shed each month during menstruation. The causes of endometriosis are still unknown. One theory suggests that during menstruation, some of the tissue backs up through the fallopian tubes into the abdomen, a sort of “reverse menstruation,” where it attaches and grows. Another theory suggests that endometrial tissue may travel and implant via blood or lymphatic channels, similar to the way cancer cells spread.

A third theory suggests that cells in any location may transform into endometrial cells. These lesions are most found on the ovaries, the Fallopian tubes, the surface of the uterus, the bowel, and on the membrane lining of the pelvic cavity. They are less commonly found to involve the vagina, cervix, and bladder. Rarely, endometriosis can occur outside the pelvis. Endometriosis has been reported in the liver, brain, lung and old surgical scars.

What are the stages of endometriosis?

Endometriosis is classified into one of four stages (I-minimal, II-mild, III-moderate and IV-severe) based upon the exact location, extent and depth of the endometriosis implants as well as the presence and severity of scar tissue and the presence and size of endometrial implants in the ovaries. Most cases of endometriosis are classified as minimal or mild, which means there are superficial implants and mild scarring. Moderate and severe endometriosis typically result in cysts and more severe scarring. The stage of endometriosis is not related to the degree of symptoms a woman experiences, but infertility is common with stage IV endometriosis.

Does endometriosis increase a woman’s risk of getting cancer?

Some studies have postulated that women with endometriosis have an increased risk for development of certain types of ovarian cancer, known as epithelial ovarian cancer (EOC). This risk is highest in women with both endometriosis and primary infertility (those who have never conceived a pregnancy). The use of combination oral contraceptive pills (OCPs), which are sometimes used in the treatment of endometriosis, appears to significantly reduce this risk.

Easing the Pain of Endometriosis

Simple tips that can help ease the pain of endometriosis include:

Rest, relax and meditate.

Take warm baths.

Prevent constipation.

Get regular exercise.

Use a hot water bottle or heating pad on your abdomen.

Endometriosis Treatment Options

Specific treatment for endometriosis will be determined by your healthcare provider based on:

Your overall health and medical history

Current symptoms

Extent of the disease

Your tolerance for specific medications, procedures or therapies

Expectations for the course of the disease

Your opinion or preference

Your desire for pregnancy

In general, treatment for endometriosis may include:

“Watchful waiting” to observe the course of the disease

Pain medication

Hormone therapy

Surgical procedures

Can endometriosis be prevented?

Because the cause of endometriosis is poorly understood, there are no known ways to prevent its development.

Finding a healthcare provider with whom you feel comfortable is crucial in managing and treating endometriosis. You may want to get a second opinion before starting any treatment to be sure you know all of your options and the possible outcomes.