Once the disease has been diagnosed, it is important to provide follow-up to help patients understand, live with and alleviate the potential consequences.
The treatment and follow-up of patients with deep-infiltrating endometriosis should be performed in specialised tertiary care centres, especially for individuals with urinary tract and/or intestinal compromise, and/or who have required multiple operations.
Furthermore, in advanced cases, this disease results in time off work and entails a socioeconomic impact. More generally, endometriosis may imply consequences for personal, romantic, family and workplace relationships. That is why patients should always have access to all the therapeutic options available and no single treatment should rule out the others.
Toxic habits. Toxic agents such as tobacco and alcohol are considered harmful and, in the case of endometriosis, trigger inflammation and enhance pain. What is more, treatment with oestrogens as part of a combined contraceptive is contraindicated in women over 35 who smoke, which complicates treatment.
Obesity. Obesity can reduce the effectiveness of medical treatment because it increases the risk involved with hormone therapy and complicates all surgical approaches, both laparoscopy and laparotomy.
Diet. A high intake of saturated fats (e.g., red meat, cured meats, whole milk dairy products), eggs, refined cereals and sugars are considered pro-inflammatory and oestrogen-boosting foods, hence they should be consumed in moderation. Although there are no specific diets available to treat endometriosis, patients are recommended to increase their consumption of olive oil, vegetables, whole grain foods, pulses and nuts, which are believed to be protective foods.
Exercise. Physical exercise contributes to an improvement in quality of life.
Sex. The impact on sexuality is clearly evident in endometriosis. Physically, endometrial implants produce pain during sexual intercourse (dyspareunia), which ultimately interferes with romantic relationships. Even so, the pelvic pain can cause reflexive contractions of the pelvic floor and a certain degree of vaginismus and pain. Sexual desire may also be affected by the use of hormone therapies that can produce dryness in some patients. Similarly, morphine-based painkillers, antidepressants and/or anxiolytics, which are often used as adjuvant treatments in endometriosis patients, can alter the sexual sphere. Repeated operations on the pelvis, scarring in the vagina and reproductive problems also bring about changes in sexual desire.
Social and emotional support. Although a cause and effect relationship has yet to be demonstrated, endometriosis is known to be associated with stress. That is, women with endometriosis have been shown to suffer greater degrees of stress than women without the disease. Psychological therapy is widely known to reduce the symptoms in endometriosis patients. Experimental studies in animals induced with endometriosis have established that stress can cause changes in biochemical mediators, such as cortisol and other factors.