Endometriosis Pain: New Explanation As to Why You Have No Relief from Your Pain Medication

Endometriosis is common, occurring in 1/10 women.  The average delay has been said to be 7-9 years between the start of symptoms and the diagnosis. Endometriosis is a common condition that causes both pain and infertility. Although the infertility aspect of enometriosis requires some women get treatment, virtually all women with endometriosis need their condition managed because of the pain, and this each year is in a significant number of women. Pain control has been difficult, and new research has now linked poor pain control with poor metabolism of the very medications physicians have been prescribing strictly for pain control.

What is Endometriosis?

Small blue lesion of endometriosis deep in the pelvis behind the uterus
Endometriosis is a condition where menstrual glands from the uterine lining appear in places they do not normally reside. This is usually in the form of implants behind the uterus or the ovary. Sometimes there is a whole cyst of endometriosis called an endometrioma. Adenomyosis, a name of Greek origin, is a condition whereby the glands of the uterus become trapped deep within the wall of the uterus and produce symptoms,, is one part of the endometriosis condition. 

How is Endometriosis Diagnosed?

Endometriosis, however is rarely felt on exam, found on an x ray or an ultrasound, unless a woman has a large ovarian mass. For most, this challenge means that there are significant delays in the diagnosis of endometriosis. In fact only 25% of those women undergoing hysterectomy for chronic pelvic pain have endometriosis actually discovered at the time of surgery! ? For most, this challenge means that there are significant delays in the diagnosis of endometriosis. The average delay has been said to be 7-9 years between the start of symptoms and the diagnosis. This has frustrated physicians and patients alike as the only way to diagnose endometriosis has been surgery. 

 Why Does Endometriosis Cause Pain?

Some women have scaring around the Fallopian tubes, the ovaries or the bowel of the pelvis and it is thought this is part of the pain. Sometimes the implants themselves cause pain. It is possible that the implants are behind the uterus or over the rectum or vagina in a way that there is pain with intercourse. The symptoms of adenomyosis can be variable, but most likely will at least cause heavy painful periods.Shrinking the implants with direct effect, reducing overall inflammation, and directly suppressing the substances that can affect nerves and trigger nerve pain response such as one such substance called plasminogen activator which can be found in implants.

How to manage the Pain of Endometroisis

There are two strategies to pain management. First use of pain pills, second use of hormonal therapies that can resolve the condition or control the condition. Many of these women try to manage their pain with OTC pain medications from the NSAID group including ibuprofen and naproxen. However in a new publication on the National Library of Medicine site they point out that o trials done well have answered the question as to whether NSAIDs are helpful for pain in women with endometriosis.

New Explanation for Poor Pain Control In Women With Endometriosis

When we take pain medications some women with endometriosis get excellent relief, and others either get no relief or very partial relief. This can be true for all of the pain medications. But in particular it is the Cytochrome P450 2C9 variant enzyme (CPY2C9 for short) that will determine whether typical medications such as ibuprofen or naproxen will work for you as this enzyme controls  how these NSAIDs are metabolized. You can get tested for these genes to see if these medications will work for you, or will not work for you. If interested contact Women's Health Practice Clinical Research Division, you do not need to be a current patient to enroll in this study called the RADAR study. . 


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