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“A wonderful thing when you’re in pain is heat. The heat will help to soothe your pain.” 28 CONTRACEPTION VS FERTILITY PART 1 FROM PAGE 27 Management Although, as Dr Jacobson points out, endometriosis tends to be a “lifelong condition and despite removing the endometriosis surgically, you may not be able to remove all of it, or it may recur”, there are ways to manage the painful condition. Ms Ciccia says the main ways of managing endometriosis are through medication, surgery, and complementary and allied health treatments (physiotherapy, psychology, etc). Lifestyle changes can help in managing the condition, according to Dr Jacobson. “There’s no specific endometriosis diet, but people have looked at dietary changes \[such as\] less red meat, more vegetables – \[an overall\] healthier lifestyle,” he said, “and there are studies that do show some benefit to that. “Fitness for health and managing pain is \[also\] beneficial, as are other approaches to pelvic pain management.” These include “hormonal treatments, pain \[medication\] such as NSAIDs, and paracetamol”. “We quite often use allied health such as pelvic floor physiotherapists,” Dr Jacobson said. “They help manage the complications of pelvic pain, which put the pelvic floor muscles into spasms. \[Physiotherapists\] help to relax the pelvic floor muscles.” Psychology is another management approach, he adds, using “psychology strategies to manage strong pelvic pain”. Ms Angel-Mobbs said: “A wonderful thing when you’re in pain is heat. A lot of people with endometriosis will take heat packs with them wherever they go, or a hot water bottle. The heat will help to soothe your pain.” When it comes to managing her pain medically, Ms Angel-Mobbs says that due to “endometriosis complications” she’s no longer able to use products such as Nurofen. “Panadol’s the only thing I’m able to take,” she said. “But there are alternatives you can try as well. Acupuncture is another thing that I swear by, and just for taking time out to relax. And though I haven’t done it yet, yoga is supposed to be wonderful, too.” In terms of alternative approaches, Dr Jacobson adds that curcumin and ginger capsules have been shown to be beneficial in the management of endometriosis. “Curcumin is thought to have anti-inflammatory and potential analgesic properties,” he said. “The other one is ginger capsules, which you can buy over the counter. The dose is 500mg three times a day for pain. These are really simple \[alternatives that don’t\] require a prescription and may be of interest to people.” Community pharmacist Gerald Quigley adds that other supplements, such as essential fatty acids, iron, magnesium and vitamin C, are also important in the lifestyle management of endometriosis. “Iron is very important for anaemia \[but it’s important to be\] well aware of the least gut irritating iron supplement available,” he said. “Magnesium \[is beneficial\] because we’re talking about relieving pain with menstrual cramps. Vitamin C \[is good for\] immune support because many women \[with endometriosis\] are immune compromised here.” Does endometriosis spell an end to fertility? A very important message that Dr Jacobson is keen to make clear is that “having endometriosis doesn’t mean you’re not going to be able to get pregnant”. “If you do have endometriosis, your risk of infertility is increased, and we know that \[among\] infertile women there’s a high proportion of endometriosis,” he said. “But it’s really important \[to understand that\] just because you have endometriosis doesn’t mean you won’t be able to conceive. “There are so many other factors that contribute to this, like your age, the sperm quality ... it’s not usually just down to one factor.” Dr Jacobson added: “There’s some evidence that if you have endometriosis and you’re having trouble conceiving, then if you have laparoscopic surgery to treat or remove the endometriosis, your chance of conception does improve.” The reason endometriosis may contribute to difficulty conceiving is unknown, he adds. “It has something to do with the hormonal environment, which we don’t completely understand, that seems to prevent women from getting pregnant if they have endometriosis,” Dr Jacobson said. “So, by removing the endometriosis, it seems to reset that system. “One of my phrases – and there’s certainly no evidence around it – is that under 35, age beats endometriosis \[and\] you’re more likely to get pregnant than not; over 35, your having endometriosis, combined with your age, can make it quite difficult to get pregnant.” Adding personal light to the story, Ms Angel-Mobbs shares an occurrence from when she began dating her now husband. RETAIL PHARMACY ASSISTANTS • MAY 2020