“Maybe I’m grasping at straws,” she wrote, “but I can’t help wondering bow I got endometriosis. There’s nothing like it in my family and I seem to be the only woman I know of out here with the condition. Isn’t there some likelihood that a shock to the system can start some internal chain reaction that brings on this disease?”

Sherry had been an active teenager, although menstrual cramps slowed her down through her high school years. During the last half of her senior year, her cramps worsened. Yet she suffered silently. “I was raised to be tough about things that made us physically and emotionally uncomfortable.” she wrote. “It isn’t unusual out here. This is a ranching community and lire can be hard. No one cares about complainers.” It was during a difficult bout with menstrual cramps that she played in a school volleyball competition and was struck by the ball as she jumped to hit it.

“I doubled over so suddenly, and I was in so much pain,” she wrote, “that I had to be carried off the court. For days after that, I felt like I had to urinate all the time. The pain soon stopped, but my cramps started to get worse from about that time.” Over-the-counter painkillers offered some relief while she waited to “grow out of” the problem. But it was not to be. Five years later. Sherry went on to say in her letter, she was horseback riding with her new husband when she was thrown by the horse, landing belly-down on a rock. This time, she began bleeding. Frightened, she went to a gynecologist.

Sherry was hospitalized and went into surgery for removal of an ovarian “chocolate cyst.” a cyst with blood in it that has become dark brown and thick as tar. When a biopsy of the cyst was performed, it revealed endometriosis. Curious, Sherry asked her doctor if the first accident might have set off some “internal disorder” that fostered growth of the disease. It was the doctors opinion that accidental traumas have no effect on the onset of endometriosis.

We have found no reference in any scientific journal that implicates any sort of trauma—such as being hit by a ball, falling off a horse, or being injured in an automobile accident—in the onset of endometriosis. In Sherry’s case, the second accident only helped identify the disease. The fall ruptured an endometriotic cyst, which, upon rapturing, leaked blood over the pelvic organs, causing extreme pain.

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Perhaps you were trying to get pregnant before your endometriosis was discovered and the prospect of a six to nine month course of drugs which will prevent you from getting pregnant during that time will be exasperating.

You may have to consider going on a course of fertility drugs if you want to get pregnant — something you may never have considered before.

Having to make a decision about which hormonal or surgical treatment is best for you will almost certainly be overwhelming.

Isolation

‘I feel so alone. I have never heard of this disease and most of my family and friends don’t even know how to pronounce it let alone understand what it means. How can I explain it to them in simple terms when I don’t understand it myself?’.

This is a common cry for help. Many women find it difficult to discuss their gynaecological problems with family or friends because they are embarrassed or simply do not want to burden people with their problems.

Some may find that they feel isolated because partners or family and friends have heard about the symptoms for so long that they no longer want to discuss it now that a diagnosis has been made.

Others believe that once the woman has had surgery such as a laparoscopy or laparotomy she is cured and should have no more problems. Little do they realise that this may be just the beginning.

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In general, the treatments aim to relieve the symptoms and, where desired, improve the chances of conception by eradicating as many endometrial implants, cysts and adhesions as possible.

The main options available for the management of endometriosis are:

Observation

Symptomatic management

Hormonal treatment

Surgical treatment

Combined treatment

Alternative therapies

Observation

Observation or a ‘wait-and-see’ approach involves no active treatment. Rather, as the name suggests, it simply involves a period of observation and monitoring. Such an approach should still involve regular visits to your gynaecologist to monitor any possible progression of your endometriosis and its symptoms.

Some gynaecologists believe that a period of observation is the most appropriate form of management for young women who have minimal endometriosis with no significant symptoms. Others believe that it is inappropriate because they believe endometriosis should be treated as it usually progresses.

A period of observation may be the most appropriate form of management if a woman decides that she does not want to have active treatment, particularly if she has minimal or no symptoms.

Symptomatic management

Symptomatic management for endometriosis involves treating only the symptoms — usually the pain — without attempting to treat the underlying disease.

It usually involves the use of various analgesic or anti-inflammatory drugs if the pain is intermittent, or a range of pain management techniques if the pain is chronic and ongoing.

Symptomatic management may be appropriate if a woman decides not to have treatment or if she has symptoms that have not responded to previous treatments.

Symptomatic management may also be used as an adjunct to conventional or alternative treatments in order to relieve ongoing symptoms.

If you decide to have only symptomatic management you need to be aware that it will not treat your endometriosis in any way and that in fact your endometriosis may progress.

Hormonal treatments

The hormonal treatment of endometriosis uses drugs to treat the condition. In general, hormonal treatments aim to eradicate the endometriosis by suppressing the menstrual cycle and preventing the growth and development of the endometrial implants and cysts.

Surgical treatments

In general, surgery for endometriosis aims to remove as many endometrial implants, cysts, endometriomas and adhesions as possible and to repair any damage caused by the disease. In the case of a hysterectomy, surgery aims to cure the disease by removing the uterus and sometimes the ovaries as well.

Combined treatment

Combined treatment is the use of a course of hormonal treatment before, or after, surgery to enhance the effects of the surgical treatment.

Alternative therapies

A variety of treatments are used by alternative therapists. Each therapist uses a combination of treatments, although the actual treatments used for each individual will usually depend on an assessment of her problems.

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1. Eat complex carbohydrates regularly.

2. Avoid refined foods, especially sugar.

3. Reduce foods and drinks that are stimulants.

1. Eat Complex Carbohydrates Regularly

You need to eat foods that give a slow rise in blood sugar and keep a constant level for about three hours. Then you need to eat again, to prevent the level from dropping. Spacing food at three-hourly intervals in this way maintains a good balance.

And the best foods for this are complex carbohydrates. They give a slow release of energy because it takes time for the digestive tract to break them down into simpler substances that the body can use.

To help maintain a steady blood sugar level, aim to eat complex carbohydrates as part of your main meals and also regularly during the day. You do not necessarily need to eat large amounts. Sometimes just an oatcake between meals can be enough to keep eating urges at bay.

If you find the symptoms associated with low blood sugar level are greatest first thing in the morning or you wake during the night, heart pounding, and cannot get back to sleep, then it is very likely that your blood sugar level has dropped overnight and adrenalin has been released. Eating a small, starchy snack, like an oatcake, one hour before going to bed and, if possible, one hour after getting up, will help to alleviate these symptoms.

2. Avoid Refined Foods, Especially Sugar

Simple carbohydrates, with the exception of fruit, are all refined foods and should be avoided. Although fruit contains fructose (fruit sugar), which is a simple sugar, the fibre content of the fruit is a complex carbohydrate which slows the digestion rate. So fructose is acceptable when taken in the whole fruit, like an apple, but not when used in the refined form of powdered white fructose bought in boxes.

Pure fruit juice can also cause a rapid change in blood sugar level because it is not buffered by the fibre that is normally present in the fruit. It is therefore better to dilute fruit juice in water to make it less concentrated.

Sugar seems to be everywhere, even in unexpected places. And, by the way, the ‘brown-is-best rule’ doesn’t apply to sugar. All colours do the same damage to your blood sugar balance!

A can of cola may contain up to eight teaspoons of sugar, as may a pot of fruit yogurt. Most of the convenience foods and drinks we buy are laden with it. Sugar is also in savoury foods, such as baked beans and mayonnaise. Did you know that tomato ketchup has just 8 per cent less sugar, weight for weight, than ice cream, and that the cream substitute used for coffee is 65 per cent sugar (compared to 51 per cent for a chocolate bar)?

Indeed, sugar is added to practically everything, as it is an inexpensive bulking agent. Even some toothpastes contain sugar but, as toothpaste is not a food, sugar does not have to be included on the ingredients list.

Sugar is just ‘empty’ calories. This means that it contains no nutritional value so you can happily cut it out and lose nothing but weight. You may be tempted to replace sugar with artificial sweeteners – don’t. You are simply substituting an alien chemical which your body then has to deal with, giving it extra work, to do. Nobody really knows what havoc these chemicals may cause when introduced into our own bodies’ delicately balanced biochemistry.

If a food or drink is described as ‘low sugar’ or ‘diet’ it will usually contain an artificial chemical sweetener such as saccharin or aspartame. They are also found in some non-diet crisps, ice lollies, sauces, pot noodles and some over-the-counter medicines so it’s worth checking labels carefully.

3. Reduce Foods and Drinks That are Stimulants

Sugar, smoking and caffeine in tea, coffee, chocolate and caffeinated soft drinks, are all stimulants and cause a fast rise in blood sugar level, followed by a quick drop. Avoid them whenever possible. Or, even better, cut them out of your diet completely. Replace with herbal teas and grain coffee, spring water and diluted pure fruit juices.

Do:

• Eat plenty of unrefined complex carbohydrates, including whole-wheat bread, whole meal pasta, potatoes, brown rice, millet, oats and rye.

• Eat fruit and drink diluted pure fruit juice.

• Always eat breakfast – porridge oats are good.

• Eat small, frequent meals no more than three hours apart.

• Reduce, and preferably avoid, stimulants including tea, coffee, chocolate, smoking and canned drinks that contain caffeine.

Don’t:

• Eat refined carbohydrates. Avoid ‘white’ in general. Remember that white flour is in many foods, like cakes, biscuits, pastries and white bread.

• Eat sugar or foods containing it, including chocolate, sweets, biscuits, pastries and soft drinks.

• Replace coffee with decaffeinated coffee (as it contains two other stimulants, even when the caffeine is removed).

• Eat convenience foods, as they are likely to contain refined carbohydrates, sugar and high levels of fat and salt.

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