Nearly 6 million women in the United States live with chronic pelvic pain. It can strike the lower back, or occur during menstruation or intercourse. Many describe it as the most severe pain they have ever experienced.
The source of this pain, which is also responsible for up to 40 percent of infertility cases, is endometriosis—a condition in which the cells lining the uterus grow outside the uterus. The cells’ uncontrollable spread has been likened to cancer, and some women feel their only option against the disease is a hysterectomy.
Gynecologist Nasir Rana, MD, takes a different view. “I’m a fertility doctor, so I keep the uterus there. If I don’t, I am out of business.”
He explains that chronic pelvic pain brought on by endometriosis usually correlates with the menstrual cycle, and that the 28-day cycle of producing eggs “is affected by everything—emotion, stress, medications.”
Yet, that pain can exist even if a woman is not menstruating. The growth of cells can affect all systems around the pelvis, including the bladder, rectum and uterus.
An evaluation to determine the presence of endometriosis involves a physical examination, ultrasound, blood tests, and possibly more intensive imaging tests such as MRI or CT scan. The doctor also will analyze the patient’s quality of life. “If you’re sitting at home and can’t go to work, can’t have a child or exercise, that is not a good life. We want to find the reason and see what you can do to treat it,” Dr. Rana says.
Surgery, he stresses, is never the only option. Doctors may prescribe estrogen, calcium or Vitamin D. However, Dr. Rana says, “As medical doctors, we should understand that there are many things we can’t treat with pain medication.”
He suggests patients try alternative approaches before considering surgery. These include:
- Physical therapy
- Acupuncture: possibly decreases pain by increasing the release of chemicals that block pain, called endorphins. Also helps relieve stress and increase blood flow.
- Mind-body treatments: techniques such as meditation, biofeedback and hypnosis aid in relaxation.
- Chiropractic treatments
- Massage therapy: can reduce stress, relieve tension and increase blood flow.
“(Endometriosis) is not a black woman’s disease, and it is not a white woman’s disease. It affects everybody across the board. It is painful, and the doctor has to be very sympathetic,” says Dr. Rana.
Scientists do not yet know the exact cause of endometriosis. But thanks to robotic imaging tools, physicians can see more detail inside the human body than ever before, allowing them to make earlier diagnoses and begin management.
Those images—and the alternative treatments available—also give the nearly 6 million women in the United States living with endometriosis a better chance at a pain-free life.