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doctor's orders: how to treat endometriosis

while there isn't a known way to prevent endometriosis, ottawa's dr. sony singh says he can help patients manage symptoms.

by karen hawthorne

jul 6 2023

5 minute read

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treating and managing endometriosis symptoms

the four key symptoms of endometriosis are painful periods, pain with bowel movements, urinating and/or sex. getty

endometriosis is an often painful disease where tissue that is similar to the tissue that lines your uterus grows outside your uterus. the tissue acts as endometrial-like tissue, meaning that it thickens, breaks down and bleeds with your menstrual cycle. the trouble is, this tissue doesn’t exit your body like menstruating, so it becomes trapped and can lead to problematic cysts, scar tissue and adhesions, according to the mayo clinic . the result is often pelvic pain and even infertility .

the journal of obstetrics and gynaecology canada estimates that this complex disease affects about one million canadians.

healthing spoke with dr. sony singh , an ottawa-based gynecologic surgeon, professor and surgical director at the shirley e. greenberg women’s health centre at the ottawa hospital , about this invisible condition and what he finds most rewarding about treating people living with it.

what is endometriosis?

dr. singh : endometriosis is a disease that results from tissue that is like the lining of the uterus. but it can grow anywhere. it can grow anywhere else in the body, most often around the pelvic organs or the reproductive organs. but it can invade or involve the bowel, the bladder, the diaphragm basically it can grow anywhere. the other way to define it is to say that it is a condition that can result in severe pain and infertility, although this isn’t the case for everyone.

what are the signs of endometriosis?

dr. s.: the main symptom is painful periods, but there can also be pain with bowel movements, urinating and sex. those are the four key symptoms. a fifth one is what we call chronic pelvic pain — pain that’s just always there.

dr. sony singh is an ottawa-based gynecologic surgeon, professor and surgical director at the shirley e. greenberg women’s health centre at the ottawa hospital. supplied

how do people develop endometriosis? what are the risk factors?

dr. s.: anybody with ovaries and a uterus — women, transgender men — can potentially be affected, starting as soon as they start their periods to the time of menopause. in rare cases, before and after that as well. the risk factors we know of include a family history of the disease, as well as infertility and those with pelvic pain.

most of the patients we see are probably in their 30s, however, that doesn’t mean they didn’t have symptoms. there’s often a delayed diagnosis of at least seven to 10 years from the time a person experiences symptoms of endometriosis to the time they actually get the care they need. the message i want to communicate is it could happen at any age. and although there is more awareness of the disease, the pandemic has added a two to three-year wait period to surgeries, as well as consultations for diagnosis.

are there lifestyle choices that can help prevent or treat endometriosis?

dr. s.: there really isn’t anything that has been proven to prevent endometriosis. i think that’s very sad. it’s also important to recognize that it’s never anybody’s fault. it’s not a sexually transmitted disease, or something that develops because of poor lifestyle. it is likely genetic and might have some environmental implications that we still don’t understand. that said, there are lifestyle modifications that can help manage the symptoms of endometriosis, like exercise, mindfulness, meditation, and yoga. diet changes can help too, and although there’s no specific diet that’s right for everybody, you can choose foods that don’t exacerbate of symptoms. we also recommend social interactions, support networks, physiotherapy and good sleep.

how is endometriosis diagnosed?

dr. s.: a diagnosis starts with hearing a patient’s history, detailing symptoms and family history. then comes the physical examination to localize the pain and feel for nodules or disease that’s more advanced. there are three different forms of endometriosis: superficial, deep endometriosis, which is the worst form, and then ovarian endometrioma, which affects the ovaries.

image credit: dr. sony singh

to get to a diagnosis, good imaging is essential, and there are only a handful of specialized units in canada that can diagnose the more severe forms. also, having a normal ultrasound doesn’t mean that you don’t have endometriosis. the challenge is that there needs to be a certain knowledge and skill-set to diagnose and treat it. not all providers have the experience to treat this disease. unfortunately, it’s not black and white.

how is endometriosis treated?

dr. s.: there’s pain management like tylenol, ibuprofen or anti-inflammatories. the second line therapy would be hormonal treatment, starting with the birth control pill or progestin that can be taken orally, through an implant or an iud that has progestin. there are also other hormonal treatments that can reduce the amount of estrogen in the body in a pill form or injectables. [the natural fluctuations of hormones estrogen and progestin can increase endometriosis activity and aggravate symptoms, whereas steady doses can help relieve symptoms.]

surgery can be a very good option for those who have deep endometriosis or need surgery to improve pain or fertility. but there’s always a big but: not all surgeons have the experience to do it. and good quality surgery to excise the endometriosis has a high response rate in terms of pain and fertility outcomes. the key tips here are to understand your symptoms, advocate for high-quality imaging, and then find people who have experience managing this disease both medically and surgically.

what’s one piece of advice for someone with endometriosis?

dr. s.: learn about the disease and the options through credible sources. there is a lot of misinformation and confusion on social media, for example. it’s important to find reliable sources like endoact canada , bc centre for pelvic pain and endometriosis , and the mayo clinic . education will lead to a better understanding of what the options are.

what’s most rewarding about the work you do?

dr. s : validating the experience of those who’ve been struggling with this, especially since it’s a relatively invisible disease. giving people hope is also rewarding, letting them know that there are options for care and that we can make them better. those are two of the things that are the most amazing for people after years and years of struggling: we understand the condition, and we actually can help them.

for more information about endometriosis, visit endoact canada and bc centre for pelvic pain and endometriosis .

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karen hawthorne

karen hawthorne worked for six years as a digital editor for the national post, contributing articles on health, business, culture and travel for affiliated newspapers across canada. she now writes from her home office in toronto as a freelancer, and takes breaks to bounce with her son on the backyard trampoline and walk bingo, her bull terrier.

doctor's orders: how to treat endometriosis