Endometriosis is when the tissue of the inner lining of the womb (the endometrium) gets out into the pelvis where it is not supposed to be. There are a couple of theories on how this happens, but we don’t know for sure. Each cycle, the lining of the womb or endometrial tissue becomes thicker and more vascular in preparation for a possible pregnancy. And then when a pregnancy does not occur, inflammatory hormones trigger the shedding of the lining of the uterus, and we have a menstrual period. Well, the endometriosis tissue scattered about the pelvis does not know that it is in a place that it shouldn’t be, and so it also will grow, thicken and increase inflammation in the pelvis at the time of the menstrual cycle. In turn, this usually leads to pelvic pain and really horrible periods.
Of note, endometriosis requires surgery for a diagnosis. But for women who do not wish to be pregnant, the management options for heavy periods are the same for those with known endometriosis as those with suspected endometriosis. So I usually recommend starting treatment with scheduled Ibuprofen or Naproxen at the time of a period and with a medication that minimizes menstrual flow.
In women with healthy kidney function and no other medical reason to avoid Ibuprofen products, I recommend Ibuprofen 800 mg every 8 hours, starting 2 days prior to the start of menstrual flow and continuing through 5 days of the period. This has been shown to decrease menstrual blood loss by up to 20%, so Ibuprofen helps with pain, inflammation, and, to a lesser extent, the heavy bleeding.
Progesterone is the hormone that thins the lining of the womb, so progesterone containing products are usually a good place to start with endometriosis therapy. My favorite is the Mirena IUD. This is a device that is inserted into the uterus in the office setting and releases a very small amount of progesterone medicine to the pelvis every day. Not only has Mirena been shown to decrease menstrual blood flow by up to 80% within the first 3 months of use, it has also been validated to improve pelvic pain. The device is good for at least 5 years for the management of heavy periods and is also excellent contraception. It can be used for up to 8 years for reliable contraception.
If these symptoms sound familiar, talk to your doctor about what might be the right therapy for you.
Be encouraged! Be empowered!
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