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Endometriosis treatment options: What you should know

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3 weeks ago

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If you’ve recently been diagnosed with endometriosis, you’re likely going through a whirlwind of different emotions, and that’s okay. You may be feeling anxious and at the same time, relieved. Now you know why you’ve been dealing with symptoms like severe cramping, discomfort during intercourse, painful urination or infertility. But you might also be wondering: What happens now?

While endometriosis is a chronic condition, there are a range of treatment options to help effectively manage your symptoms and dramatically improve your quality of life. This starts by working with your doctor to create an endometriosis treatment plan that works best for your unique symptoms and preferences.

Treatment options can range from pain management to hormone therapy to surgery, and they’re working for millions of people living with the condition. Here’s what you need to know about endometriosis treatment options and how they can help you manage your symptoms.

What’s the best treatment option for endometriosis? It depends on a few factors.

Every person’s treatment plan will be unique. And while multiple factors will be taken into account as you and your doctor discuss your options, there are three key considerations that will guide your doctor’s recommendations.

What your pregnancy goals are

Endometriosis is often linked to difficulty conceiving, and women with endometriosis may experience infertility. So some of the first questions your doctor will ask when figuring out your treatment plan will be about your pregnancy goals:

  • Are you actively trying to get pregnant?
  • Do you hope to conceive children in the future?
  • How soon in the future do you wish to become pregnant?

Why is this all so important? Endometriosis tissue growth appears to be affected by hormones, and your hormone levels are directly related to your fertility. It’s not uncommon for doctors to recommend hormone therapy and possibly surgery, but some treatments can affect fertility. So your doctor will use your pregnancy goals to give you the best possible care and create a personalized treatment plan.

The severity of your endometriosis symptoms

Getting diagnosed with endometriosis might have been a lengthy process for you that involved some kind of diagnostic imaging test, like an ultrasound. While these are helpful tools, a laparoscopy – a minimally invasive surgical technique – is the only way doctors can confirm endometriosis and determine how advanced it is. During this procedure, doctors make small incisions in the abdomen to see the endometrial growths and possibly remove them.

Treatment options may depend on the severity of your endometriosis. Your doctor can determine this by noticing whether the growths are isolated or clustered, how deep into the tissue the growths exist, and whether scar tissue is present. For example, the most severe case of endometriosis includes large cysts on the ovaries and adhesions that cause organs to stick together, causing sharp pains.

Understanding the severity can help your doctor determine how advanced the endometrial tissue growth is and if more aggressive treatment options should be considered.

Your age

Endometriosis most commonly affects reproductive-age women. When someone goes through menopause, estrogen hormones levels drop and ovulation ends – menopausal women with a history of endometriosis will typically experience symptom relief because of these changes. So, your age and how close you may be to menopause are often key considerations in developing your endometriosis treatment plan.

Endometriosis treatment: Pain management

The first step in treating endometriosis is often pain management. Your doctor may recommend over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) to help with inflammation and cramping.

Managing painful symptoms is an important step, whether or not you’re hoping to get pregnant. Your pregnancy goals, however, will determine what treatment your doctor recommends next.

Endometriosis treatment if you’re hoping to get pregnant

If you’re trying to become pregnant or hope to conceive in the future, endometriosis-related lesions, cysts and scarring can make it more difficult. But there are techniques that can ease your endometriosis symptoms and increase your chances of getting pregnant.

Laparoscopic surgery to remove excess endometrial tissue (and help increase your chances of getting pregnant)

Since the buildup of scar tissue in the uterus from endometriosis may lead to fertility issues, laparoscopy – which is typically used to diagnose endometriosis – can be used to remove lesions and scar tissue. This will not only help increase your chances of getting pregnant, but it will also help protect your uterus and ovaries.

During the procedure, your doctor will make small incisions in your abdomen and then insert a slim instrument (laparoscope) to see and remove the endometrial growths. The goal of this type of endometriosis treatment is to remove endometrial growths without harming the healthy tissue around it. This surgery can also provide pain relief.

Endometriosis treatment if pregnancy is not a goal

If you’re not planning to get pregnant in the future, there are other treatment options available to you. In addition to pain management, other more conservative management methods may be recommended before you consider surgical endometriosis treatment options.

Hormone therapy for endometriosis

Hormone therapy is an effective treatment option that can help manage your pain and symptoms in two ways: It can change your hormone levels or stop your body from producing certain ones altogether. Although doctors don’t know exactly what causes endometriosis, its symptoms are affected by your body’s hormones.

Hormone therapy can affect your ability to get pregnant, which is why this treatment option isn’t recommended for everyone.

Combination birth control: Pills, patches or rings

Hormonal contraceptives like combination birth control pills, patches or rings, can help with endometriosis symptoms because they can make your period shorter, lighter and more regular.

Combination birth control has two hormones – estrogen and progestin – that can help manage endometriosis symptoms by controlling the timing of your menstrual cycle and the severity of related symptoms.

Combination birth control is used in 28-day cycles. For 21 days, birth control hormones help prevent pregnancy and menstruation. During the other seven days (the hormone-free week), your body is triggered to go through menstruation for a controlled amount of time. This minimizes the chances of a long, irregular period, which can make your symptoms worse.

Your doctor might also prescribe using hormonal contraceptives and skipping the hormone-free week, which may cause your period to stop completely, helping to further suppress endometriosis symptoms.

Progestin therapy

Progestin therapy is a treatment option where progestin – a synthetic lab hormone meant to mimic progesterone – is administered in one of four ways: a daily pill, the placement of a hormonal IUD, regular progestin injections or a Nexplanon implant.

Progestin helps prevent pregnancy, and it can also stop your period and prevent endometrial tissue growth, helping to minimize your symptoms. When progestin therapy is administered as a pill, it’s taken daily. Hormonal IUDs are inserted into the uterus and prevent pregnancy by releasing small amounts of progestin. It can potentially stop eggs from leaving your ovaries and makes it harder for sperm to get through by making your cervical mucus thicker. Progestin injections are taken once every three months and usually stop menstruation.

GnRH agonists and antagonists

Gonadotropin-releasing hormone (GnRH) medicines are a treatment option that makes the body imitate menopause and its symptoms. This means you may experience common menopause symptoms like hot flashes and mood changes but the decrease in hormone production can limit new tissue growth that causes your painful and annoying endometriosis symptoms. How?

GnRH medicines stop the body from producing hormones that make it go through ovulation and menstruation – symptom triggers for people with endometriosis. The antagonists work against ovarian hormones by limiting the production of these hormones, while agonists stop them completely.

GnRH medicines come in pills or as an injection, and are often recommended for about six months at a time. These medicines aren’t long-term treatments and won’t be continued forever. If this treatment is to be repeated, your doctor will likely schedule several months between treatments because there is an increased risk for bone loss.

Aromatase inhibitors

Aromatase inhibitors reduce the amount of estrogen in the body. While they don’t stop the ovaries from making estrogen, they stop aromatase – an enzyme found in fat tissue – from changing other hormones into estrogen and promoting endometrial tissue growth. Aromatase inhibitors may be built into your treatment plan alongside other hormone therapy options.

Surgery for endometriosis

If more conservative treatment options are not effective or your endometriosis becomes more advanced, your doctor may recommend a surgical option: a hysterectomy.

During this procedure, your uterus will be removed, which can provide relief for painful cramping and heavy bleeding. And it also prevents you from getting pregnant in the future. Your doctor will determine whether to also remove your ovaries during the procedure – a decision that comes down to a few different factors.

Hysterectomy (without the removal of the ovaries)

Your doctor may recommend a hysterectomy without removal of your ovaries to preserve the low levels of estrogen that your ovaries produce – and prevent you from entering menopause early. If you are premenopausal and not at risk for ovarian cancer, you doctor may recommend an ovary-sparing hysterectomy to prevent other possible health complications later in life.

Hysterectomy (with the removal of the ovaries)

Your doctor may recommend a hysterectomy with the removal of your ovaries (oophorectomy). By removing the ovaries, your body will stop releasing the ovarian hormones that make you ovulate and get your period. It’ll also lower estrogen levels, which can slow and stop endometrial tissue from growing.

Removing your ovaries can be highly effective in treating endometriosis, but it does come with side effects and long-term health risks. An oophorectomy puts your body into menopause, meaning you’ll likely begin experiencing a range of menopause-related symptoms. Additionally, the long-term effects of early ovary removal – before your body reaches natural menopause – include an increased risk of parkinsonism, cognitive impairment or dementia, depression and anxiety.

Relief from endometriosis is possible

Once you have an endometriosis diagnosis, it puts you one step closer to treatment – and saying goodbye to painful cramps and periods. It may also improve your chances of getting pregnant after months or years of trying.

If your symptoms are mild, your primary care doctor or OB-GYN can guide you through a more conservative treatment plan. But if certain hormonal therapies or surgical treatments may be needed, an OB-GYN can provide that more advanced care.

Whether you’re looking for relief from your symptoms or hoping to become pregnant, endometriosis doesn’t have to stop you from living the life you want.



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Health

Experts Watching Bird Flu Carefully in Case It Takes Off

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2 hours ago

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May 14, 2024

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May 14, 2024 – So far, the unexpected jump of bird flu to cattle has not emerged as a new human flu pandemic. Yes, a dairy worker got pink eye this year after being infected, but a larger threat to all of us has not yet materialized.

That doesn’t mean experts are not keeping a close eye on the situation.

“The current risks to the public of this infection is very low,” said Maximo Brito, MD, MPH, a professor of medicine at the University of Illinois College of Medicine in Chicago. “The CDC is conducting surveillance for unusual flu activity in doctor’s offices and emergency rooms. No significant problems have been detected thus far.”

“Just don’t kiss or hug the animals,” recommended Tina Tan, MD, who agreed the risk to U.S. population from bird flu remains low at this point. Tan is a professor of pediatrics at Northwestern University Feinberg School of Medicine, also in Chicago. Both infectious disease experts spoke during a news briefing sponsored by the Infectious Diseases Society of America (IDSA).

Infected cows have been reported at 36 farms in nine U.S. states. The federal government is requiring that cows test negative for bird flu, also known as avian flu, before crossing state lines. But the feds do not have jurisdiction within states. Instead, they are making recommendations to help state leaders, agriculture officials, and others contain the outbreak, and paying affected farmers who suffered losses in recent months. 

The H5N1 virus behind bird flu has been circulating in cows since December 2023. The virus passing from wild birds to cattle was a surprise, said Brito, who is also an IDSA fellow.

How Safe Are Milk, Eggs, and Beef?

The FDA tested retail milk and found parts of the virus in some samples. Further tests confirmed that pasteurization, the heating procedure that most milk goes through before sale to the public, deactivates the virus. 

“Thus, the FDA thinks that the U.S milk supply is currently safe,” Brito said at the briefing on May 9. 

At the same time, drinking raw or unpasteurized milk is risker. “It is very important … to alert the public to refrain from drinking unpasteurized or raw milk, that is milk straight from the cow without processing,” he said. “There are other diseases, not only influenza, that could be transmitted by drinking unpasteurized milk.”

Do not touch surfaces that may be contaminated with raw milk, or with the saliva, mucus, or feces of any potentially infected animals, officials warn. 

In areas where there is bird flu or birds that are sick, cook poultry and eggs to an internal temperature of 165 F. Don’t eat raw eggs. Also, cooking beef to the appropriate temperature prevents transmission of infection. 

“To date, the virus has not been found in beef,” Brito said.

OK for Now?

The H5N1 virus could evolve an ability to move to humans more easily, “but that’s all speculative right now,” Brito said. The virus variant that is circulating among cattle is not an efficient cause of disease in humans. But there can be genetic shifts in these viruses, which has happened before. There may be added concern if H5N1 passes to pigs, he said, because their viral receptors are closer to those in humans. 

If the virus does jump to people, children may be at higher risk. “As you know, kids are very different from adults in that they’re much more likely to hug and kiss an animal,” said Tan, who is also president-elect of the IDSA.

There are elementary schools that have chickens and ducks as school pets. Some families have chickens as pets. “Kids also drink a lot of milk, including some kids that drink unpasteurized raw milk,” she said. 

The Ann & Robert H. Lurie Children’s Hospital of Chicago, where Tan works, is ready if H5N1 starts to cause significant infections in children. “We’re going to treat it very much like pandemic influenza. We have protocols in place for pandemic influenza and for COVID, which can be adjusted toward H5N1 if that were to become a real problem.”

Brito added, “We haven’t implemented any specific emergency protocols, but we are always monitoring what’s happening on the ground.”



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Asperger syndrome: What parents should know – CHOC

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8 hours ago

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May 14, 2024

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Published on: May 14, 2024
Last updated: April 25, 2024

A CHOC expert discusses why Asperger syndrome is not diagnosed anymore, and talks about signs of autism spectrum disorder (ASD).

Link: https://health.choc.org/asperger-syndrome-what-parents-should-know/



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3 Women With Eczema Describe the Ways They Combat Nighttime Flare-Ups

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2 days ago

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May 13, 2024

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If you have eczema, you know what it’s like – that frustrating struggle to catch some ZZZ’s.

The problem is at once physical and emotional. “When my eczema is flared, nighttime often fills me with anxiety,” says Nicola Johnston, a digital content creator who lives in Carlisle, England, near the border of Scotland. “I have experienced nights in so much pain that I cannot sleep, and I’ve scratched so hard that my sheets were covered in blood. This is why I’ve worked to establish a good evening routine that will allow me to have a comfortable night’s sleep and get the rest that my body needs.”

But that rest can be elusive when you’re tormented by “itching, flaky skin, raised red rashes, cuts, skin tightness,” the symptoms listed by Elise Loubatieres, a London-based editor and beauty influencer. In many patients, eczema is itchiest at night, sometimes due to a lack of time for self-care earlier in the day. Natalie Findley, a holistic chef from Whistler, British Columbia, has had a similar experience. “Nighttime flare-ups taught me that something wasn’t working,” she says. “Not getting enough sleep was not doing me any good.”

If you want to turn down eczema flare-ups, finding out what works best for you calls for trial and error. But it also helps to get advice from people who understand firsthand what you’re going through. Here, three women who’ve been there offer tips on how to prepare for bed, get as comfy as possible, deal with symptoms, and reset your emotions in the morning.

When it comes to preparing for bed, Findley favors consistency. “I try to keep my routine the same each night,” she says. Before doing anything, she sets “an intention to sleep better.” From there, Findley likes “to cleanse and moisturize my skin, drink some herbal tea, do some journaling, read, express gratitude, and then I am in bed by 10 p.m.”

An equally firm believer in the step-by-step approach, Johnston focuses first and foremost on comfort. “I start my bedtime routine by having a lukewarm bath to soothe my skin, if my skin is feeling particularly flared,” she says. “I then apply an emollient-based product that is going to lock in moisture and be slowly absorbed through the night. I put on lightweight satin nightwear that keeps me cool. In making up my bed, I personally prefer a silk pillow, as this is gentler on my facial eczema and doesn’t absorb any product I apply to my face like a cotton material would.”

Loubatieres scrupulously preps her skin and takes medication to prevent symptoms later. “I have been prescribed antihistamines to help with the itching,” she explains. “I also make sure that I apply emollients to my skin liberally and frequently in the hour leading up to bedtime.”

To Findley, the choice of bedding fabric is less important than the way it’s washed. “I don’t use any particular kind of sheets to relieve my eczema, but I use natural and clean laundry detergents.” she says. “Even though many regular products claim to be clean, they use a lot of harmful chemicals and ingredients in detergents that aggravate eczema and your overall health. I use detergents that are hypoallergenic and without any fragrances. My favorite laundry detergent is Tru Earth.” Her bedside companion is also natural and gentle: “If I need some relief, I always use calendula and comfrey-based salve, with some shea butter, to calm the itchiness and dry skin.”

Johnston has an unusual trick for dealing with one of eczema’s side effects – a trick that involves a trip to the nail salon. “A great tip I have found is having acrylic gel manicures,” she notes. “It means that your nail itself becomes thicker and doesn’t break your skin when you’re scratching in the night. This has been a great help with healing my eczema.”

Aware that overheating can bring on eczema, Loubatieres takes a proactive approach. “I try to stay cool using a stand-alone fan, and I also use a handheld fan to pinpoint itchy areas for some relief,” she says. “I ensure that my sheets and sleepwear are either 100% cotton or silk to reduce irritation. I also have eczema gloves and Cosi Care [aka “safe scratchers”], which are itching tools that allow you to satisfy an itch without causing damage.”

Whenever she begins to feel itchy, Findley does simple breathing exercises to calm her body. “I close my eyes, breathe in slowly and count to five, and hold for 2 seconds, then breathe out slowly and count to seven. Or I will just breathe in slowly until my chest and belly are full with air, hold for a few seconds, and breathe out slowly all the way. I repeat this multiple times until I’m relaxed. I also imagine myself sinking into my pillow as I breathe out, and it relaxes me and my muscles until I finally fall asleep.”

Johnston tries to nap during the day whenever possible. That way, in the event of a nighttime flare-up, she’s not completely exhausted the next day, And the extra rest is also calming. “By keeping my daytime stress levels to a minimum,” she says, flare-ups become less likely.

As Loubatieres sees it, you’ve lost the battle when you give in to the urge to itch. “At night I tend to get what I call ‘scratch attacks,’ where I uncontrollably and incessantly scratch despite breaking skin and causing myself pain,” she says. “It feels very satisfying in the moment and provides relief from that bone-deep itching sensation. But I try to get up and distract myself in some way. If I stay in bed and don’t keep my hands busy, I’m more likely to indulge in a scratch.” Indeed, taking up a hobby – drawing, knitting, playing guitar, anything that involves using your hands – can be an ideal diversion between a flare-up and the welcome moment when you feel really sleepy.

In the light of day, after successfully dealing with her nighttime flare-ups, Findley developed a fresh philosophy. “I made it a habit to clean up my diet and reduce stress and anxiety with meditation, journaling, and sleep hygiene. To treat the root cause of my issue, I switched to a plant-based diet. I also cut out dairy, as it’s pretty inflammatory. … I drink a lot of water each day. Now my eczema has cleared up! I find that fueling your body with the proper nutrients will support your immune system, therefore improving your eczema.”

Johnston emphasizes the importance of knowing your true self. “Often, it feels like you are your eczema, like it’s a defining characteristic,” she says. “It’s important to learn that your value comes from you and not your skin. I also learned to be kind to my skin. Not looking at it with hatred and resentment, but to see my eczema as a friend that was telling me there is an imbalance somewhere that I need to put right. It’s really important to listen to your body and notice your triggers.”

Whatever strategies you adopt, Loubatieres says, you should treat yourself with compassion. “After a scratch attack, I personally get a huge amount of guilt,” she admits. “I think I’ve caused my skin a lot of harm. However, I have to remind myself that it’s a condition that I cannot control. Skin eventually heals.” Her best advice for getting a good night’s sleep: “Don’t be so hard on yourself.”

 

 



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