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Endometriosis and Ca125

April 16, 2018
endometriosis and ca125

Endometriosis is a disease diagnosed via laparoscopic exam. This exam is the gold standard of diagnosis, where doctors examine the pelvic cavity and its surroundings looking for endometrial tissue. If found, they will also remove it during the procedure.  

While a non-invasive gold standard of diagnosis does not currently exist, however there is a promising biomarker known as Ca125 that may help in ruling in endometriosis as a potential cause for painful periods. 

What is Ca125

Ca125 (cancer antigen 125) is a biomarker traditionally used for ovarian cancer – monitoring therapies and to assess recurrence. It’s shown to be increased in women with endometriosis, and has therefore been proposed as a biomarker for endometriosis. This may help to reduce diagnostic time, offer treatment options, reduce progression of disease, and may even provide reassurance to women that they are not living with endometriosis. 

A 2017 study examined Ca125 levels in women who had symptoms of endometriosis (painful periods, painful sex and chronic pelvic pain). Ca125 levels and a laparoscopic exam (to confirm a histological diagnosis of endometriosis) were assessed in these women to determine the accuracy of Ca125 in the presence of endometriosis. Results showed that women with a high Ca125 level were also found to have endometriosis (in the absence of any other potential causes for disease). Moreover, they determined that a level of Ca125 greater than or equal to 30IU/mL would rule in endometriosis, while a measurement less than that would not rule out endometriosis. 

Next Steps

Measuring Ca125 levels may be a good first step in examining if endometriosis could be a cause of painful periods, painful sex and chronic pelvic pain. While it will not rule out endometriosis, it may lead to faster diagnostic times (the average time is 7-10 years), and help with its management. Naturopathic Doctors and Medical Doctors are able to run this test if you are hoping to rule endometriosis in before scheduling a laparoscopic exam. 

References

Hirsch M, Duffy J, Deguara C, Davis C, Khan K. Diagnostic accuracy of Cancer Antigen 125 (CA125) for endometriosis in symptomatic women: A multi-center study. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2017;210:102-107. doi:10.1016/j.ejogrb.2016.12.002.

Karimi-Zarchi M, Dehshiri-Zadeh N, Sekhavat L, Nosouhi F. Correlation of CA-125 serum level and clinico-pathological characteristic of patients with endometriosis. International Journal of Reproductive BioMedicine. 2016;14(11):713-718. doi:10.29252/ijrm.14.11.713.

Oliveira M, Raymundo T, Soares L, Pereira T, Demôro A. How to Use CA-125 More Effectively in the Diagnosis of Deep Endometriosis. Biomed Res Int. 2017;2017:1-6. doi:10.1155/2017/9857196.

Your Endometriosis Health Team

endometriosis health team, toronto naturopathic doctor, naturopath toronto

If you are living with endometriosis, you’re likely aware that it’s a complex condition that can benefit from a health team (#endometriosisdreamteam). Because I believe in integrative medicine and the value of different wisdom and experiences, I wanted to share a few of health practitioners (aside from your Ob/Gyn) that can help you alleviate pain and improve your quality of life!

 

Who should be on your team

Pelvic Floor Physiotherapist

Pelvic floor physiotherapy is more than just kegels! Within the pelvic region, endometriosis can cause inflammation, scar tissue, adhesions, pain and muscle tightness. Muscle tightness may occur when women are curled up in fetal position or because of anticipation of painful sex. Pelvic floor physiotherapists are able to assess the pelvic floor muscles and release any trigger points as well as help release scar tissue. 

Moreover, the alignment of pelvic organs and ligaments may be distorted due to pain or other factors, and pelvic floor physios are able to help bring back a healthy alignment to the pelvic region. 

When the body has a pelvic floor dysfuntion, it may lead to the following symptoms:

  • Pain in the back, hips, and sacroiliac joint
  • difficulty urinating, increases urination, burning or pain with urination
  • constipation or diarrhea
  • painful bowel movements and faecal incontinence
  • painful sex
  • inability to tolerate a speculum during a gynaecological exam
  • pain with wearing tampons and menstrual cups

Massage Therapist

Massage therapy is one of those gentle, yet effective treatments that can have big results. Abdominal massage is designed to stimulate and increase the flow of blood, lymph and qi to everything in the pelvic region (such as organs, ligaments and tissues). Moreover, some treatments can gently shift the uterus and other organs into a healthier alignment – which may lead to the reduction of uterine spasms and adhesions. 

Sex Therapist 

Sexual therapy can aid people who are experiencing sexual difficulties, with the goal of promoting physical intimacy. Many women with endometriosis suffer from sexual dysfunction, specifically when it comes to deep penetrative sex (likely due to the area inhabited by endometrial lesions). Down the line, this may lead to negative effects on relationships, mental and emotional well-being, a decrease in quality of life. 

Because fear and anticipation of pain can inhibit the sexual response (and affect desire and lubrication), a sex therapist may suggest and facilitate communication between partners, help with alternative sexual practices, and provide relaxation techniques.  

Naturopathic Doctor

I might be biased, but Naturopathic Doctors bring a lot to the table! When I work with my endometriosis clients, I like taking a look at the modifiable causes when it comes to guiding treatments. Specifically I take a look at inflammation and estrogen and work on those to help decrease pain within the body. 

Therefore treatments include acupuncture (yes, NDs can perform acupuncture!), nutritional support, lifestyle changes, and smart supplementation. For instance, turmeric can be quite helpful for pain experienced with endometriosis. But before you make yourself a golden milk latte, it’s important to remember dose and duration of treatment is necessary to elicit the desired effects. Lastly additional testing to assess stress and cortisol levels, as well as estrogen detoxification, can be quite useful in helping to guide treatment plans.  

Final Thoughts

It’s obvious that each member of this endometriosis dream team provides something unique in the treatment of this condition. And to be honest, you don’t need to have endometriosis to have a well-rounded group of health practitioners. Most of us have a GP, Optometrist, Dentist – which help us take care of physical components of our body. But don’t underestimate the value of taking care of your emotional and mental states as well!

Understanding Period Pain

February 12, 2018
period pain, menstrual cramps, period pain relief, toronto naturopathic doctor, menstrual pain

Talking about period pain isn’t easy – especially when most women believe that it’s a normal part of the experience. I remember when I first learned about periods, I was told that experiencing menstrual cramps were to be expected. Luckily, there are things that provide period pain relief!

What is period pain?

Dysmenorrhea is a fancy word for painful periods. In fact, painful periods are the most common gynecological symptom affecting almost 45-95% of women! While many women think that pain is a normal part of their menstrual cycle, it can have negative effects on their daily activities (forcing them to stay home from school and/or work). 

When you’re on your period, the lining releases prostaglandins which causes the uterine muscles to contract. Too many prostaglandins will ultimately cause period pain – like menstrual cramps and feelings of pressure. 

Types of dysmenorrhea

Primary Dysmenorrhea

Primary dysmenorrhea is pain without a pathology (ie. a structural cause), and can be due to prostaglandin production, nutritional deficiencies, and diet and lifestyle factors. This usually happens after a woman first experiences her period that has ovulatory cycles. It may be present right at the beginning of her period and will improve over time. 

Secondary Dysmenorrhea

Secondary dysmenorrhea is pain due to an underlying condition which increases during menses. Causes can include: endometriosis, adenomyosis, fibroids and cysts, infection, and even IUDs. This usually occurs in a woman’s 20s to 40s, and worsens over time. Not to mention, she might be experiencing her pain before, during, and after her period. 

For the purposes of this post, I’ll be focusing on primary dysmenorrhea

Is PMS the same thing as period pain?

Dysmenorrhea isn’t quite the same as PMS. Dysmenorrhea occurs during your period (typically on your heaviest days). Symptoms can include abdominal and lower back pain, diarrhea, nausea and vomiting, and dizziness and headaches.

Whereas, PMS (premenstrual syndrome) occurs a few days before your period and may continue a few days in. It’s an mix of psychological and physical symptoms that may encompass dysmenorrhea including: depression, anxiety, irritability, bloating and painful breasts. In order to ‘diagnose’ PMS we should be recording our symptoms for at least 2 cycles using a symptom chart.

Period Pain and TCM

You know I love bringing in Traditional Chinese Medicine into the mix of things. Here are some causes of menstrual cramps from a TCM perspective:

Cold

When the body is cold, it can cause the blood to stagnate. Think of it this way, when you’re freezing you want to curl up with a wool blanket and not move. You may find that warmth relieves period pain and gravitate towards warm foods and drinks. 

Heat

Similarly, when women are experiencing heat signs like early, bright or dark red periods, a yellow-coated tongue, and constipation, they usually find relief with cold foods and drinks. 

Period Pain Remedies

Remedies are wide ranging, and would best be tried after exploring the root cause of why the cramps are happening. Nevertheless, we may want to begin by reducing prostaglandins. 

Dairy

Cow dairy may cause inflammation within the body that leads to feelings of pain. While it is recommended to avoid cow dairy – have no fear, goat, buffalo and sheep dairy is just as delicious!

Histamines

Too much histamine in the body may result in an increase in estrogen (resulting in a deficiency of progesterone) as well as inflammation. Increased inflammation in the body can translate into pain. Reducing histamine would be indicated, which means limiting histamine producing foods (dairy and alcohol) as well as histamine containing foods (bone broth, cheese, fermented foods like kimchi and red wine).  

Magnesium

Magnesium is one of the body’s most essential nutrients. It reduces prostaglandins and relaxes the smooth muscle of the uterus. There are many forms of magnesium, but my favourite is magnesium bisglycinate. It doesn’t cause loose stools, and it’s absorbed by the body to help promote muscle relaxation. 

Acupuncture

Whenever I’m having trouble with my period (thanks to stress!), I immediately book an acupuncture appointment. Acupuncture helps get the qi and blood flowing smoothy throughout the body and is a calming treatment which focuses on the mind and spirit.  

Ginger

Ginger can be used in a variety of ways – supplements, teas, tinctures, etc. By nature it’s a very warming herb and can help with blood circulation and inflammation. Most of all, if you experience nausea with period pain – this is the herb for you! With menstrual cramps, ginger is primarily used a few days before the menstrual cycle and a a couple of days into it. This is because it targets the prostaglandin production, and acts as an anti-inflammatory. 

Lavender

This is the one herb that I always have diffusing in my home. A study showed that women who inhaled lavender essential oil experienced significantly fewer symptoms of dysmenorrhea.  

Bodywork

Sometimes you just need to stretch it out. Because menstruation is part of the ‘yin’ phase of the cycle, it’s recommended that you take it easy. Going for a walk, or even doing a couple of yoga poses can help promote pelvic circulation and decrease pain!

Final Thoughts

Yes, this post was jam-packed with info! But, I hope it gave you an idea of the difference between period pain and PMS, as well as gave you some options to help manage your period pain. Like always, I would recommend working with a Naturopathic Doctor, so they can help you figure out why your period pain is happening and the most appropriate treatments for you. 

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