February 27, 2023 — The Philippine General Hospital has been noting an increased number of women consulting for pelvic pain later diagnosed as endometriosis, a chronic disease where tissue similar to the uterus lining grows outside the uterus, causing pain and/or infertility.

The Stop C.O.V.I.D. Deaths Webinar Series held on January 30, 2023 tackled endometriosis as an increasing health problem that affects about 10% of women and girls of reproductive age. It is associated with severe, life-impacting pain during periods, sexual intercourse, bowel movements and/or urination; chronic pelvic pain; abdominal bloating; nausea; fatigue; and sometimes depression, anxiety, and infertility.

Dr. Angela Aguilar of the PGH Division of Reproductive Endocrinology and Infertility affirmed that there are genes that alter the uterine microenvironment and affect the life of the cells and of hormones such as estrogen. This will change the growth, dissemination, and implantation of the uterine cells, known as the endometrial cells, and will cause inflammation leading to fibrosis. Infertility; pelvic pain; and gastrointestinal, genital, and urinary symptoms are the usual manifestations with pelvic pain as the most common. Since pelvic pain is not conclusive of endometriosis, she recommended a full workup of the cause of pain as opposed to the previously recommended practice of doing surgery to get tissue biopsy specimen.

Dr. Aguilar said that it is important to treat this condition early since unmanaged pain will become unresponsive to pharmacologic treatment. She added that if a woman is not responding to the first-line therapy, hormonal medications are a mainstay, such as the use of combined oral contraceptives. If medical therapy fails after three to six months and a patient still has unmanageable pain, treatment will resort to surgical excision of the lesions through minimally invasive techniques as open surgery may result in greater damage.

Dr. Gladys Tanangonan of the PGH Division of Reproductive Endocrinology and Infertility suggested complementary therapies such as enough sleep, low-intensity exercises like yoga, using hot water bottles and warm baths, and over-the-counter pain relievers.

She recommended eating fibrous foods such as fruits, legumes, and vegetables; iron-rich foods such as broccoli, beans, and nuts; antioxidant-rich foods like oranges, berries, and beets; and fatty acid rich foods such as flax seeds and artichokes.

Consumption of trans fats should be reduced while women with endometriosis are discouraged from taking high-fat dairy products such as whole milk cream and butter and caffeine-laden beverages because they cause contractions.

Charmaine Lingdas | Published in UP Manila Healthscape No. 48 (February 2023)