Endometriosis and Polycystic Ovary Syndrome (PCOS)
Many women struggle with reproductive disorders such as endometriosis and polycystic ovary syndrome (PCOS). These diseases often cause symptoms of pain and discomfort that can last long term. At this time, we know of no definitive cure for PCOS, however, research continues and has revealed some treatments that can help relieve the symptoms of this condition. A range of drugs and alternative medicine treatments may help women with endometriosis or PCOS have a better quality of life.
What Is Endometriosis?
Endometriosis is a disease that affects the endometrium – the tissue that lines the inside of the uterus. Normally, the endometrium only grows in the uterus. In people with endometriosis, it grows in other places throughout the body, including the ovaries, fallopian tubes, bladder, or intestines. Endometrial tissue may even grow in places outside of the abdomen, such as the lungs, but this is rare. Patches of endometrial tissue may be called implants or lesions.
About 11% of American women have endometriosis. It is especially common among women in their 30s and 40s.
Symptoms of Endometriosis
The most common symptom of endometriosis is pain. About 3 out of 4 women with endometriosis experience pain in the pelvis, lower abdomen, or lower back. Endometriosis may bring about different types of pain:
- Pain before or during periods
- Pain during urination or bowel movements
- Pain during or after having sex
- Pain that doesn’t go away for many months
Endometriosis can also lead to infertility, heavy or irregular periods, digestive problems, and feelings of tiredness or weakness.
What is Polycystic Ovary Syndrome?
PCOS is a disease that affects hormones. Hormones are molecules that act as messengers. They help tissues in different parts of the body communicate with each other.
In women with PCOS, the hormones that help control the reproductive system are not correctly balanced. PCOS causes the ovaries and adrenal glands to make too much of the male sex hormones. Hormone imbalances can create problems with ovulation – the process during the monthly cycle where the ovary releases an egg. The egg may not form correctly, or it may not be released when it’s supposed to be. When ovulation doesn’t occur as it should, fluid-filled sacs in the ovaries that contain the eggs can grow bigger, forming a cyst.
PCOS affects about 10% of all women. This disease can affect women at any age, but most women discover they have this condition when they are in their 20s and 30s.
Symptoms of PCOS
People with PCOS may develop many different symptoms. These can include:
- Abnormalities in your period, including absent, irregular, or heavy periods
- Too much hair on the face, chest, abdomen, or thighs
- Thinning hair or baldness on the scalp
- Acne or oily skin
- Obesity or weight gain
- Pain in the belly or pelvis
- Patches of darker skin
Many women with PCOS also struggle with infertility. Sometimes, PCOS can increase a woman’s chances of miscarriage.
PCOS and Other Health Conditions
Many women with PCOS are resistant to insulin, a hormone that regulates the body’s metabolism. Insulin resistance often leads to type 2 diabetes. In fact, over 50% of women living with PCOS are diagnosed with diabetes by the time they turn 40.
PCOS can also increase the risk of developing other diseases related to metabolism or heart health:
- High blood pressure
- Unhealthy cholesterol levels
- Heart disease
Many people with PCOS also develop sleep apnea, depression, and anxiety. A woman’s risk of cancer of the uterus may also be increased if she has PCOS.
Medications for Endometriosis and PCOS
Although you can’t cure your endometriosis or PCOS, you can find ways to manage symptoms. Work with your health care team in order to come up with a treatment plan that works well for you. When recommending a particular therapy, your doctor may consider factors like your age, how severe your symptoms are, and whether you hope to have children.
Your treatment plan may change over time if your condition improves or progresses. It’s a good idea to have follow-up appointments with your doctor every 6 to 12 months. This helps your doctor keep an eye on your disease, detect any serious health concerns, and get a better idea of when new treatments may be needed.
Pain is a major symptom of both endometriosis and PCOS. Some women manage this symptom by taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or acetaminophen. Opioids may be an option for women who experience severe pain. However, opioid drugs come with many risks, including addiction and overdose, so your doctor may recommend that you try other pain relievers first.
The FDA has approved a medication for treating pain from endometriosis. It is called Orilissa (elagolix). It is a new medication in pill form that is a GnRH (gonadotropin releasing hormone) medication that stops the release of hormones that cause the growth of endometriosis. This drug is a form of hormone treatment.
Hormone levels affect how severe endometriosis is. Estrogen, a female sex hormone, can spur endometrial lesions to grow and spread. Sometimes, taking medications that contain hormones can even out estrogen levels. Options include:
- Birth control pills: Taking birth control can often reduce symptoms. Your doctor may have you take only the hormone-containing pills and skip the placebo or sugar pills.
- Progesterone or progestin therapy: Taking this hormone through pills, shots, or an intrauterine device (IUD) may shrink endometrial growths.
- Gonadotropin-releasing hormone (GnRH): This treatment makes your body go into temporary menopause and can stop endometriosis lesions from growing. GnRH can also help with pain from endometriosis.
- Gonadotropin-antagonist medicine: This pill stops your ovaries from making estrogen, which may slow down growth of endometrial tissue.
PCOS may also be treated with hormone medications. For example, taking birth control pills can treat PCOS symptoms like irregular periods and acne. Hormonal birth control may also decrease your chances of developing endometrial cancer.
PCOS is sometimes also treated with anti-androgen medicines, which block male sex hormones and reduce their levels. Taking androgens may help reduce body hair, clear acne, and improve hair growth on the scalp. However, anti-androgen medications may not be a good choice for women who may become pregnant.
Hormone treatments generally come with many side effects. Make sure to ask your doctor what to expect from these treatments, both positive and negative, so that you can decide whether the benefits are worth the risks.
Diabetes Drugs for PCOS
Some doctors prescribe Metformin, a diabetes drug, to women with PCOS. Metformin may make periods more regular, help women lose weight, and treat fertility problems. This drug may also treat PCOS symptoms like acne and excess hair growth.
Controlling PCOS Hair Symptoms
PCOS often leads to excess hair growth if the patient’s testosterone level is elevated and this can make you feel self-conscious. Hair removal creams may be an inexpensive way to manage this symptom. Additionally, your doctor may be able to prescribe medication that can make hair grow back more slowly. Procedures like electrolysis or laser hair removal can prevent hair from growing back long-term. However, these procedures may be expensive and need to be performed in a doctor’s office.
Endometriosis or PCOS Surgery
Some women with endometriosis choose to get a hysterectomy. During this procedure, a surgeon removes the uterus and sometimes the ovaries and fallopian tubes. After having a hysterectomy, you will not be able to get pregnant.
Surgery may be an option for women with PCOS who struggle with infertility. If other PCOS treatments don’t work, a surgery called ovarian drilling may help. During this procedure, your doctor makes a few small holes in the ovary in order to remove the tough outer layer. This can help some women get pregnant.
Managing Endometriosis and PCOS With Other Treatments
Before prescribing medication for reproductive health problems, your doctor may first recommend that you make some lifestyle changes, such as eating fewer calories or getting more exercise. These changes can improve symptoms for some women, and they don’t come with the side effects that you may experience when you use medications.
Other alternative health strategies may also help make endometriosis or PCOS easier to deal with. However, it is important to know that many popular supplements, diets, or alternative treatments aren’t actually effective. Sticking with treatments that have been proven in clinical trials helps you have the best chance at reducing symptoms.
The things you eat can impact your endometriosis or PCOS symptoms. Some women with endometriosis have reported eating less dairy, carbohydrates, and gluten, and eating more fish, fruits, and vegetables. These women had fewer endometriosis symptoms and felt better overall.
Some of these same changes may help people with PCOS. In one study, women with PCOS followed a low-dairy, low-carbohydrate diet. The participants lost weight, had a healthier balance of hormones, and could use insulin more effectively.
Nutritional and Herbal Supplements
Some women with reproductive health problems turn to supplements to help manage symptoms. Certain vitamins and minerals may be effective at reducing period cramps:
- Vitamin B1, also known as thiamine
- Vitamin E
- Omega-3 fatty acids
Additionally, one clinical trial showed that antioxidants such as vitamins C and E may help endometriosis patients. Women who took these vitamins had reduced levels of inflammation in their bodies and experienced less pain.
When treating PCOS, other supplements may help. Early research has found that certain nutrients may reduce some PCOS symptoms, especially if one is found to be low in these vitamins and minerals:
- B vitamins, including B6, B12, and folic acid
- Vitamin D
- Vitamin E
- Omega-3 fatty acids
Medical science is still collecting data on these supplements so it is not fully understood or clear how effective they might be. Additionally, supplements can have side effects and can interact with other medications, so it is always a good idea to check with you physician before taking any of those listed here. Always tell your doctor and pharmacist about any supplements you are taking.
Getting exercise may help with weight loss, which can make your periods more regular and treat infertility for people with PCOS. Additionally, physical activity can help reduce your chances of developing conditions related to PCOS. Women who exercise more have better heart health and may reduce the risk of developing mental health disorders. Exercise may also help with endometriosis pain.
Mindfulness meditation can be effective for managing pain, including lower back pain. Many women with endometriosis say that meditation and breathing exercises can be effective pain relievers. Studies have also found that mindfulness can reduce stress and lower blood sugar levels for women with PCOS.
Yoga is a form of physical activity that also incorporates elements of relaxation and mindfulness. Yoga can encourage the body to release pain-fighting endorphins and reduce inflammation. In particular, three different yoga poses have been found to help control pain that comes with periods:
- The cobra pose
- The cat pose
- The fish pose
Studies have found that yoga can help women with endometriosis have a better quality of life and live with less pain. Additionally, PCOS studies have shown that yoga can help balance hormone levels and improve mental health.
Mental Health Help
Chronic illnesses and ongoing pain often come with worse mental health. Many people with endometriosis and PCOS experience depression, anxiety, and stress. Seeing a counselor or therapist may help you discover new ways to deal with your illness. For example, endometriosis patients who use positive coping mechanisms have lower levels of stress, depression, and pain.
How Do Endometriosis and PCOS Affect Fertility?
Both endometriosis and PCOS can lead to infertility, or an inability to get pregnant. About 1 in 2 women with endometriosis struggle with infertility. Surgical endometriosis treatments that remove patches of endometrial tissue may help treat infertility. Some women also use in vitro fertilization (IVF). During IVF, egg and sperm samples are mixed together outside of the body, and resulting embryos are transferred to the womb.
For women, PCOS is one of the most common causes of infertility. People with PCOS can also try treatments like IVF. Often, however, infertility is a result of the ovaries not ovulating when they should. Certain treatments can spur your body into ovulating again. These treatments may include:
- Losing weight
- Medications, such as clomiphene, letrozole, or gonadotropins, that affect certain hormone levels in the body
- Ovarian drilling surgery
Women with PCOS also have a three times greater chance of having a miscarriage. Metformin, a diabetes drug, may possibly help reduce this risk, but additional research needs to be done in order to confirm this.
When dealing with a chronic illness, it can be very helpful to find others who are in the same boat. While doctors can help you better understand how different diseases and treatments work, they don’t always know what day-to-day life is like when living with a chronic health condition. Support groups and forums can help you connect with people who share advice, answer questions, and offer emotional support.
Ask your doctor or local healthcare center about any local in-person support groups. Alternatively, search for online forums, or support groups within social media sites like Facebook or Reddit.
Endometriosis and PCOS have no definitive cure at this time, short of surgery. However, many women have found safe and effective ways to manage these conditions. It may take trying several different medications or lifestyle changes before you find something that works for you. Regular communication with your healthcare team and connecting with other people who have the same health issues can help you find a treatment plan that fits your needs.
If you would like to discuss further, please make an appointment with Dr. Connor.