Pelvic pain is a big problem. Around 1 in 10 women have endometriosis, with many more troubled by the 'bigger picture' of pelvic pain that can include period pain, an irritable bowel, bloating, painful sex, bladder troubles, anxiety, low mood and fatigue, pain on one side, headaches or nerve pain. It's a major cause of lost days at school, days off work, relationship stress and lost opportunity. Often, women are just 'sick and tired of feeling sick and tired'. With so many symptoms, it's easy to feel lost between many different health care providers and worry if a cause for the pain isn't found.
To help women both in and outside Australia start to become well and learn more about their problems, Dr Susan Evans is releasing a completely revised and updated version of her best-selling book, Endometriosis and Pelvic Pain. With personal stories from women across Australia the book answers common questions such as which symptoms are helped by operation, will ie effect fertility as well as tips on how to help yourself to be well.
Dr Susan Evans highlights common Endometriosis misconceptions and symptoms to watch out for below:
It will all get better once you have a baby. Unfortunately not true. Sometimes pain on the first day of a period is better after a pregnancy, but other pains don't usually improve.
Women with endometriosis are infertile. Women with endometriosis sometimes find it difficult to become pregnant, but many get pregnant easily, especially if the endometriosis is mild. So, it is still really important to use reliable contraception.
The amount of pelvic pain depends on how much endometriosis is in the pelvis. We know that while having a lot of endometriosis can increase the chance of infertility, it doesn't fit with the amount of pain at all. So, you can have a little bit of endometriosis and a lot of pain or a lot of endometriosis and only a little bit of pain. There are many types of pelvic pain you can't see at a laparoscopy.
Symptoms to watch for
Period pain that lasts for more than 1-2 days each month
Period pain that doesn't get better on the pill or with normal period pain medications
Pelvic pain that causes them distress or stops them doing things they enjoy.
Girls or women whose mothers or sisters have had problems with pelvic pain. There is much more that can be done to help now.
Does diet change and exercise help?
Changing diet won't get rid of endometriosis, but it can help pelvic pain a lot. The common problems are bowel pain or bloating after eating wheat products like pasta or bread, or sometimes drinking milk. Her bowel will complain unless she gives it the healthy, low wheat, low fat, low salt diet it wants. The foods that aggravate the bowel are sometimes called FODMAP foods and are explained further in the eBook release detailed below. Exercise is also essential as it releases chemicals in the blood that block pain and also helps muscles work normally. The trouble is that some core-strength exercises can make pelvic muscle pain worse, so one of the best exercises is walking. Even ten minutes a day can make a big difference.
To coincide with the new edition Dr Evans is also offering a free eBook answering common questions that will be available on her website www.drsusanevans.com
Dr Susan Evans is a gynaecologist in Adelaide, Australia specialising in the management of pelvic pain. She has a long held interest in improving the care of women and girls with pelvic pain through improved public awareness, clinical practice, education, and multidisciplinary care. She is terrific media talent and is available to custom-write on the topic.
Endometriosis and Pelvic Pain
Author: Dr Susan Evans
Question: Why did you decide to write Endometriosis and Pelvic Pain?
Dr Susan Evans: Thousands of girls and women in Australia have pelvic pain. It can be a complicated problem for both women and their doctors to work out, and many suffer pain for many years before they find the answers they need. The book 'Endometriosis and Pelvic Pain' was written to help girls, women, partners, parents and families learn more about the pain and what they can do to treat it. The shorter ebook 'pelvic pain' is a free resource available for download from our website, so no-one need miss out on the information they need.
Question: What are the symptoms of endometriosis?
Dr Susan Evans: The commonest symptom is period pain that doesn't go away on the pill or with normal period pain medications. Often there is pain before the period starts, or sometimes (but not always) problems getting pregnant.
What makes it more difficult are the other pains that are common in women with endometriosis. They are what we call the 'bigger picture of endometriosis' and include pains like an irritable bowel, an irritable bladder, painful sex, poor sleep, bloating, sudden pains, a painful uterus, headaches and a low mood. They don't mean there is endometriosis present, and can come even long after endometriosis has been removed, or even after a hysterectomy. These type of pains don't show at an operation, but are still an important part of pelvic pain.
Question: What are the treatment methods for endometriosis?
Dr Susan Evans: Endometriosis can be removed at an operation called a laparoscopy. However, this type of surgery can be quite difficult, especially if the endometriosis is near important things like the bowel or ureter. It takes advanced surgical skills to manage endometriosis.
When endometriosis is removed, period pain often improves. However, while good surgery is an important part of pelvic pain care, it might not be enough for all her pain. The best care might include several different treatments including surgery, pelvic physiotherapy, medications such as amitriptyline, a mirena IUCD, diet, exercise, lifestyle change and others.
Question: Does endometriosis affect fertility?
Dr Susan Evans: Around 3 or 4 in 10 women with endometriosis will have trouble getting pregnant. This means that many get pregnant easily. Endometriosis is just one factor in deciding whether or not a couple become pregnant. Other important factors are whether her partner has normal semen, how regular her periods are, and whether they are over-weight. Women with endometriosis who do not wish to become pregnant need contraception just as other women do.
Question: What tips do you have for woman in dealing with general pelvic pain?
Dr Susan Evans: Our best advice is included in the free ebook 'pelvic pain' that can be downloaded from www.drsusanevans.com or www.nzendo.co.nz.
It includes an introduction to all the different types of pelvic pain. For those who find it useful but would like more information, the full size book has all the information they need to work with their doctor towards being well again.
Interview by Brooke Hunter