Don’t put up with pain

Plagued by severe pain every month? You may be one of the two million women in the UK with endometriosis – but there are ways to manage it

Every month before my period I seemed to have excruciating pain,’ says 25-year-old Laura Wootton. ‘With that came exhaustion, bloating, headaches, tummy upsets, shooting pains through my back and legs, constant hot flushes, skin breakouts and mood swings. I would go to a pharmacy for help, only to end up sliding down the front of the counter, consumed with pain.’
It may sound extreme, but Laura’s endometriosis symptoms aren’t unusual. ‘The condition is caused when cells lining the womb (endometrium) appear in other areas of the body, most commonly the pelvic area, the lining of the abdomen, Fallopian tubes and ovaries,’ explains Bruce Ramsay, consultant gynaecologist and a spokesperson for the Royal College of Obstetricians and Gynaecologists. ‘They can even get into your blood, lungs, eyes and brain.’ During your monthly cycle, the hormone oestrogen stimulates the development of endometrium in preparation for your period – and it has the same effect on endometrial tissue outside the womb. The difference with the patches of endometriosis elsewhere in the body is that there’s nowhere for the blood to be excreted, and it ends up becoming trapped, causing inflammation, pain and formation of scar tissue (adhesions). Sometimes, in extreme cases, the tissue can even stick organs together.
The severity of symptoms varies and that’s why many women put up with the discomfort, thinking it’s just period pain. ‘Endometriosis is underdiagnosed,’ says Diane Hicks from charity Endometriosis UK. ‘It takes approximately three years for a woman to even go to her doctor with her symptoms, and up to eight years to be officially diagnosed. Many accept it as part of being a woman.’ But it’s important to get a diagnosis as, not only can it be extremely debilitating, endometriosis is also linked to infertility, with an estimated 30–40 per cent of women with the condition having trouble conceiving.

What are the symptoms?
Common signs of endometriosis include:
- Painful, heavy or irregular periods
- Pain during or after sex
- Difficulty getting pregnant, or infertility
- Pain on opening bowels, including bleeding and IBS-like symptoms
- Fatigue

‘The difficulty in diagnosis is recognising whether these symptoms are a result of endometriosis, or a problem in their own right,’ says Ramsay. The pain depends more on where the endometriosis is rather than how much of it you have.
We don’t know what causes it for certain, but there are a few theories:
Retrograde menstruation may be a common cause. ‘This is when blood from the uterus during a period flows back into the Fallopian tubes and the abdomen,’ says Ramsay. It probably happens to most of us, but in some women, the endometrial tissue can attach itself to the ovaries and bladder, and travel to other areas of the body.
Genes If your mother was affected, you’re at higher risk.
Immune dysfunction ‘For some, a weak immune system means they can’t fight off the endometriosis,’ says Ramsay.
Environmental toxins Studies in the early 1990s discovered a link with a toxin called dioxin, created when plastics such as PVC are burned and their gases are released into the atmosphere.
Metaplasia is a process where one type of cell morphs into another. ‘This may explain why, in endometriosis, womb lining cells can spontaneously appear in other areas of the body,’ says Ramsay.

What the doctor orders
There’s no guaranteed cure, so treatment is all about managing endometriosis.A doctor will usually start off by prescribing some form of hormone treatment such as the contraceptive pill or Mirena coil, which release hormones and prevent the build-up of lining in the womb,’ says Hicks. But these can cause side effects and aren’t suitable if you’re trying for a baby. The next step may be a laparoscopy: ‘This is a keyhole procedure that allows a surgeon to identify where in the body the endometriosis is, and then use a laser to remove it,’ says Hicks. The final option is a hysterectomy – but only if you don’t want more children.

Explore the natural route
‘As endometriosis is an oestrogen-sensitive condition, controlling levels of the hormone is an important step for helping you lessen your symptoms, and a good place to start is your diet,’ says Helen Heap, a nutritional therapist at the Dr Marilyn Glenville Clinic.
Go organic ‘Xenoestrogens are man-made compounds that mimic the effect of oestrogens. There are high levels in today’s food and water due to increased use of the Pill and HRT (which passes through into the water supply), as well as intensive farming, with livestock being pumped with hormones,’ says Heap. ‘So go organic where possible and avoid too much red meat, caffeine and alcohol, which are all inflammatory and may worsen the condition.’
Up your fruit and veg Getting your five-a-day is important – but load up on tomatoes in particular. A US study found the lycopene they contain cuts chemical activity that leads to endometriosis build-ups by up to 90 per cent.
Get well oiled Essential fatty acids are good for endometriosis as they are anti-inflammatory,’ says Heap. ‘Eat plenty of oily fish, nuts, seeds and avocados, or take a fish oil supplement.’ Bromelain and evening primrose oil supplements are anti-inflammatories, too.
Help for cramps Magnesium is a muscle relaxant and has been shown to have a beneficial effect, so a supplement may help reduce pain.
Detox your liver Your liver is responsible for ridding your body of the excess oestrogen that can encourage endometriosis, so give it a helping hand. ‘Cruciferous vegetables, such as broccoli or cabbage, contain a compound called indole-3-carbinol, which helps detoxify the liver,’ says Heap. ‘The herbal supplement milk thistle may also help.’
Be alternative ‘Two popular alternative therapies for managing endometriosis pain are acupuncture and reflexology,’ says Hicks. ‘Many women like to try natural treatments as opposed to being completely reliant on hormone therapy and traditional pain relief.’

So the good news is, it doesn’t have to take over your life. A combination of conventional and natural treatments is often the most successful way to treat endometriosis – see what works best.
- Visit Endometriosis UK at www.endometriosis-uk.org or call its free helpline on 0808 808 2227.

Famous sufferers
Dame Kelly Holmes has endometriosis, but managed to run her way to double Olympic gold at the Athens games in 2004.
Emma Bunton The ex-Spice girl and Strictly contestant gave birth to baby boy Beau last year despite having endometriosis.
Louise Redknapp beat the condition to give birth to Charley and Beau (yes, really!).

‘Diet and supplements helped my endometriosis’
‘I noticed symptoms after my second pregnancy,’ says Michelle Middleton, 31, from Yorkshire. ‘I’d been on the Pill before my pregnancies, but suddenly I was exhausted, had long, heavy periods, pain during intercourse and bowel problems. I hadn’t even heard of the condition when I was diagnosed in January 2008 after a laparoscopy. My GP prescribed the hormone treatment Zoladex to put me into a pseudo-menopause, but it left me tired, bloated and feeling out of control. ‘I decided to take the natural route and came off the medication. I revamped my diet by cutting out caffeine, reducing my intake of red meat, dairy and alcohol, and upping my oily fish, fruit and vegetables. I also started taking evening primrose oil and multivitamins, which really helped balance my mood. Aromatherapy massages helped release tension. For many sufferers, it’s about educating yourself about the condition, and finding a way to manage the symptoms. I’ve got two small children, so it’s vital I take control of endometriosis as much as I can – I can’t take time off. And I do feel more positive about being able to deal with it in my own way.’

Words: Hannah Fox