Jacqueline Wolf - A Woman's Guide to a Healthy Stomach

Are there any alternative treatments that work for endometriosis?

As any woman with severe endometriosis will tell you, it’s worth trying anything! But there aren’t any solid trials evaluating alternative treatments. In a self-report of 1,160 women responding to an Endometriosis Association survey, many different treatments were highlighted, including whole medical systems and energy medicine (including acupuncture, traditional Chinese medicine, candidiasis treatment, homeopathy and naturopathy, ayerveda reiki), mind-body medicine, biologically based therapies (including ingestion of dietary supplements, diet-based treatment and ingestion of herbs), and manipulative and body-based therapies (including exercise, chiropractic manipulation and massage therapy).

Biologically based therapies (use of substances found in nature) (52 percent) and manipulative and body-based therapies (based on manipulation and movement of one or more parts of the body) (41 percent) were commonly used. The self-reported improvements were 74 percent for therapy with mind-body medicine (techniques to enhance the mind’s capacity to affect bodily function and symptoms) and 53–66 percent for therapy with many of the whole medical systems (complete systems of theory and practice), energy medicine (use of energy fields) and biologically based therapies. The manipulative and body-based therapies overall were reported to be less helpful, with 35 percent of women reporting improvement. However, without good studies, I can’t recommend the alternative therapies just yet.

I have endometriosis. Do I have to worry about getting cancer, too?

If you have symptoms that are unusual or bothersome, certainly get them checked out. You should also have the routine recommended screening tests for cancers, such as PAP smears, mammograms and colonoscopies. There are some differences in cancer rates for women who have had endometriosis. In a very large study from Sweden that looked at the rate of diagnosis of cancer after a hospitalization for endometriosis, the overall rate of cancer was not increased. However, some tumors were slightly more common, and one—cervical cancer—was less common. The cancers that had about a 25–37 percent increase in incidence were ovarian, endocrine, thyroid, brain and kidney cancer, and malignant melanoma. Colorectal cancer was not examined but may be slightly more prevalent. Breast cancer was barely increased, possibly due to the fact that we screen so vigilantly these days.

Lately I’ve been needing to pee—constantly. Judging by my sex life, I’m sure I’m not pregnant. My mother wants me to get tested for ovarian cancer, just in case. I had no idea constant urination was even a symptom! Could I have it?

Probably not. Frequent urination is more often a symptom of other problems. It could be a symptom of a urinary tract infection or diabetes mellitus, or it might be associated with irritable bowel syndrome or interstitial cystitis. Burning with urination also occurs in almost half of all women with endometriosis. It’s important to make sure that you don’t have an infection by getting a culture of your urine and to make sure you don’t have diabetes mellitus by having the sugar checked in your urine or blood. In the United States, females have a 1.4 percent lifetime chance of developing ovarian cancer. More than half of the deaths from ovarian cancer occur in women between the ages of fifty-five and seventy-four years. Still, it’s important to be aware of the symptoms. If something feels unusual for your body, please tell your doctor! Many symptoms overlap with gastrointestinal issues. See your doctor if the following symptoms are constant or worsening:

Bloating throughout the day, especially requiring a larger waist size on your pants

Pelvic or abdominal pain

Difficulty eating, feeling full quickly or weight loss

Urinary symptoms (urgency or frequency)

Frequent pain with intercourse

If I decide to get tested for ovarian cancer, what’s going to happen?

It’s important to remember that we want to rule out the zebras—or more unusual diagnoses—in the hopes of finding what we call horses, or more common ailments. Here’s what you can expect.

Pelvic exam: Your doctor will feel your cervix, uterus and ovaries. She may do a Pap smear, which evaluates for cervical and uterine cancers or changes in their cells, but not for ovarian cancer.

Pelvic ultrasound: This will take a “picture” of your ovaries and analyze what might account for that full, bloated feeling. It does not involve any radiation, just sound waves. Usually part of the test involves putting an ultrasound probe in the vagina, which may show the ovaries better. If there are growths, the ultrasound can’t always determine if these growths are likely to be cancer.

CT scan: This test uses X-rays to examine part of the body. It allows smaller problems to be detected. It visualizes the ovaries and uterus, as well as the bowel, lymph nodes and the spaces around them. A CT scan for ovarian cancer often includes an examination of the abdomen, as well as the pelvis. In that case, oral contrast is given to you to drink so that the bowel will stand out from the surrounding area. When the abdomen is examined, the liver, kidneys, spleen and pancreas are also seen. Often the radiologist doing the test will want to better visualize the blood vessels. This is done by an injection of dye into your arm. The dye contains iodine. So if you are allergic to iodine-containing substances, be sure and tell the doctor, as you will likely be allergic to the dye. Also, if you have any problems with kidney function, be sure to tell the doctor, as he or she might not want to do this part of the test.

MRI scan: This scan uses a magnetic field instead of X-rays to view the internal organs. It sees soft tissues very well. The best test is done with an enclosed scanner, where you’ll hear a lot of banging. (If you’re claustrophobic, speak up.) An injection of gadolinium (an element used as a contrast agent in MRI scans) is often done to see the blood vessels. Your kidney function should be confirmed as normal before you are given gadolinium, particularly if you have any problems that could affect the kidneys, like high blood pressure, diabetes mellitus, lupus, dehydration or kidney diseases.

Blood tests: A blood count (CBC) looking for anemia and liver function tests are commonly done. In fact, there is a blood test (CA-125) that had been touted to diagnose ovarian cancer. Unfortunately it is not a good screening test and has not been recommended as a routine screen in most people. CA-125 can be falsely high in someone who does not have ovarian cancer and falsely low in someone who does have ovarian cancer. On the other hand, CA-125 is often used to detect early recurrence of cancer in someone who had a high CA-125 with the original cancer and has had her ovarian cancer treated.

Laparoscopy: This is an even more precise test, in which a thin viewing tube (called a laparoscope) is placed through a small cut made in the abdomen. Using the scope as a guide, the surgeon takes a sample of fluid and tissue from the growth. These samples are then tested for cancer.

Every month around my period, I get bloated, I cramp and I have horrible diarrhea. I don’t mean to be a big baby, but how can I deal with it without letting it ruin my life?

Well, first remember that you’re not alone: about 85 percent of women suffer from some form of PMS each month, whether or not they have endometriosis. PMS, as defined by the American Congress of Obstetricians and Gynecologists, is “the cyclic occurrence of symptoms that are sufficiently severe to interfere with some aspects of life, and that appear with consistent and predictable relationship to the menses [menstrual period].” Only about 3 to 8 percent of women have severe symptoms. PMS symptoms may include upset stomach, bloating, constipation or diarrhea, appetite changes, mood disturbances, joint pain, headache and acne.