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It’s good to be educated about our bodies every month of the year, but with Endometriosis Awareness Month observed in March, it’s an excellent time to learn about this condition that up to 10 percent of people with uteruses have—endometriosis.

What is endometriosis?

Endometriosis is when the tissue that lines your uterus grows outside of your uterus as well. This tissue is called the endometrium. During your menstrual cycle, the endometrium tissue builds up, sheds if you have no fertilized eggs, then leaves your body through your period. When this tissue grows outside of the uterus, it still builds up as part of your menstrual cycle, but then it has nowhere to shed and exit the body. Endometriosis develops over time, usually several years after your first period, and affects up to 10 percent of people with uteruses ages 25-40.

What are the symptoms?

Since everyone’s bodies are so different, endometriosis symptoms can be mild to severe and vary for everyone depending on their body. The severity of your symptoms does not indicate the severity of the actual tissue buildup. This tissue can grow on your ovaries, bowel, and pelvis, and comes with a wide variety of symptoms. Because this tissue is building up and isn’t shedding, it can become increasingly painful over time. The most common endometriosis symptom is pelvic pain and cramps. This pain and cramping hit you in the same areas you might feel period cramps, but it’s much more intense. This cramping can be just during your period, but for some people, there’s constant pelvic pain. These cramps aren’t like normal period cramps. Some people experience cramps so intense they can’t go to work or function normally.

In addition to painful periods, other symptoms include pain during or after sexual intercourse, pain with bowel movements or peeing, as well as diarrhea, constipation, and bloating, heavy bleeding during your period, or bleeding between periods, and in some cases, infertility. About 30 to 40 percent of people with endometriosis experience fertility issues. These issues can be discussed with your doctor, and there are options to maximize your fertility with endometriosis.

Because the tissue can grow in several places in your body, it can affect these places in different ways. Another symptom is developing scars on your ovaries and pelvis, as well as adhesions or tissues growing so that they bind your organs together. Because the symptoms are so general, endometriosis can be hard to diagnose initially. People can be misdiagnosed with Pelvic Inflammatory Disease, ovarian cysts, or even Irritable Bowel Syndrome.

Are there treatment options?

Although endometriosis is not curable, there are several different treatment options. The growth of your endometrium outside of the womb is due to varying levels of estrogen in your body. Your changing hormones during your menstrual cycle that promote the growth and shedding of your uterine lining are the exact hormones promoting the growth of this tissue as well. Remember, the only difference is this tissue has nowhere to go once it’s grown. Hormone therapy or hormonal contraception can be used as an effective treatment. Hormonal birth control pills are a popular treatment for endometriosis because they shut down ovulation. If you’re not ovulating, your uterine lining is not building up to shed, so it should stop the growth of this tissue outside of the uterus as well. Any hormones that help stop menstruation could help treat endometriosis. Gonadotropin-releasing hormone agonists and antagonists can be used to treat endometriosis as well. GnRH is used to essentially create early menopause by stopping the production of estrogen in the body. Because it puts you in an early menopause, side effects would include vaginal dryness and hot flashes. This treatment sounds intense, and I’d guess it would likely be used for severe cases. Danazol is another medication that can stop your period and help stop the growth of endometrium tissue. These treatment options can help with pain and help stop tissue growth, but they don’t necessarily help with fertility.

If you are wanting to get pregnant or have a severe case of endometriosis and hormones haven’t helped, surgery is another option. During the surgery, the excess tissue growing outside of the uterus is removed. The surgery is called laparoscopy, uses lasers, and is minimally invasive. Again, this is the only treatment option that can help improve fertility. In extremely severe cases, and if you are not wanting to get pregnant, you could also have a total hysterectomy. This is a surgery to remove your uterus and cervix. This is usually only recommended for severe cases or for someone who knows they do not want to get pregnant. Once your uterus and cervix are removed, you won’t be able to get pregnant because your uterus will be gone.

What is the cause of endometriosis?

The exact cause of endometriosis is not known, which can be frustrating. One theory is that during menstruation the blood flows back into the fallopian tubes, causing build-up, while another theory suggests that hormones transform cells outside of the uterus into ones similar to those inside the uterus, confusing the body. If you experience any of the symptoms listed above, or even just have incredibly painful periods, go see your gynecologist. They will likely do a physical exam and an ultrasound to see what your uterine tissue looks like. Once diagnosed, your doctor will discuss the severity of your case with you. If left untreated, endometriosis can get worse over time because of the continuation of tissue building up. Once your doctor tells you the severity (minimal, mild, moderate, or severe) you can work together to discuss treatment options. Although endometriosis isn’t curable, you can still live a relatively pain-free life with it. If you are planning on having a family and want to maintain your fertility, be sure to mention that to your doctor.

If you suspect you have endometriosis or have incredibly painful periods, speak up and talk to your doctor about it. Intense period pain isn’t normal or something you should live with! It can indicate there’s a deeper issue going on. Talk with your doctor to find a solution.

There are many birth control options available for people these days, which is great because you can find a method that works best for you and your lifestyle. Condoms, hormonal birth control pills, IUDs, Nuva Ring, the shot, the implant—the list goes on and on. One of the most popular forms of birth control is the hormonal birth control pill.

A refresher on the hormonal birth control pill

Typically, the hormonal birth control pill uses either a combination of estrogen and progestin, or just progestin to shut down ovulation in your body so you don’t release an egg for fertilization. These hormones are naturally occurring in your body, and the pill just provides you with amounts of these hormones so your body essentially thinks it’s pregnant and doesn’t ovulate. These pills also thicken your cervical mucus so if an egg is released, your womb isn’t in a state where implantation could occur. The pill needs to be taken every day at the same time to be most effective. Even missing one pill can cause some people to get pregnant, so the pill isn’t the best option for someone with a super unpredictable schedule, someone who travels between time zones frequently, or someone who just isn’t punctual. Not brag, but I could win an award for taking my pill on time.

Since the pill is such an effective method (99% effective when taken perfectly), it is a popular option. It’s also popular because it’s non-invasive, can be stopped at any time, is covered in full by most insurance or is fairly inexpensive if it’s not, and doesn’t affect your fertility. Starting in late 2019, studies have begun to help develop a birth control pill that just needs to be taken once a month. What? Sounds too good to be true, right?

How would a once-a-month pill work?

Because of the stomach’s acids and the way our bodies take in and digest medicine, the pill, and most other medications, needs to be taken daily. Doctors at Brigham and Women’s Hospital and MIT discovered a new design for a slow releasing pill while doing research on drugs for HIV and malaria treatment. After doing some research on these other drugs, the team discovered this same design would work for birth control bills. With this once a month design, the birth control hormones for the month are distributed on six little “arms” extending from the center of the whole pill. When the pill capsule is open and spread out inside your body, it looks like a little starfish with six arms full of hormones. The pill is made out of body-safe polyurethane and is taken all folded up in a capsule. Once in the body, its arms will spread out and slowly release the hormones over a period of 29 days. This is the same cycle for most birth control pills, you would just take this one capsule at the beginning of the month and be good to go until 29 days later.

The initial trials on this capsule design were tested on pigs, and the results were really promising. The little legs of the starfish design broke off and passed safely through the body after the hormones were released, and the starfish didn’t obstruct anything from entering or leaving the body either. Pigs have more similar insides to humans than rats, so the positive results in pigs were a good sign. The scientists behind this hope to build artificial stomachs next, and eventually begin testing on humans.

When could this birth control pill be released?

If this birth control ends up being developed, in theory, it should be as effective as the daily pill, that is if the user is taking it at the same time every month. One of the complaints of the daily pill is having to remember to take it at the same time every day, but I would argue that remembering to take a pill at the same time just once a month might be harder to remember because it’s not part of your daily routine. Birth control options that you must take orally, or even the shot, is most effective when taken on time. So this design might make birth control seem like less of a hassle for some women, but it might be harder for others to remember to take it.

Human trials haven’t even begun yet, so it will likely be several more years until this type of pill is available on the market. Either way, it’s incredibly exciting that people have more options for how they want to take their birth control and be in charge of their reproductive health.

Talking Birth Control Options with Your Friends

From the pill to the IUD to the non-hormonal IUD to condoms to the injection…(should I go on? there’s more) there are MANY options for birth control in this good year of 2020, so how do you know which option is right for you, or which ones to even consider? What are the pros and cons of all these different ways to prevent pregnancy, stabilize hormones, or manage periods or acne? If you’re considering starting a form of birth control or changing to a new form of birth control, it’s essential to talk to your doctor about it before making any changes! But, sometimes it’s helpful talking birth control options with your friends before you take your big questions to the doc. 

Talking openly about birth control with your friends is not only helpful and educational, but also helps normalize women talking openly about birth control methods. There seems to be a stigma around women talking about birth control methods unless they can clearly state that they are on said birth control for a medical reason other than not wanting to get pregnant. Yes hormonal birth control can help treat many conditions such as cystic acne, PCOS, or endometriosis, but it’s also just as valid to be on birth control just to prevent pregnancy. Openly discussing your preferred method, as well as your reasons for being on birth control, help bond you and your pals in friendship, normalize this conversation, and help you make informed decisions. 

Because of the varying levels of hormones in hormonal forms of birth control, such as the pill, implant, shot, NuvaRing, or IUD for example, everyone has a different reaction to these birth controls. Talking about how your body reacted to your preferred method, or even an old method you tried and didn’t like can help inform those around you! It’s also interesting to hear about how hormones affect us differently and see how people consider the pros and cons for themselves. Also, a lot of the time women’s health issues are dismissed, our pain is minimized, or all of our symptoms are blamed on our periods. Our hormones and reproductive systems are complex, and sharing our experiences, struggles, and preferences finding what works best for us helps us be more educated and make more informed and empowered decisions in advocating for our reproductive health. 

Maybe you’ve been on the pill forever, but are wanting something with less hormones. Ask your friends if they have an IUD and hear about their experience getting it inserted, adjusting to having something in their uterus full time, and see what they think. Maybe your friend is considering starting the pill, but is fearful of having bad side effects. Tell them about your experience and how the pill did or did not affect you. Do you have really bad periods and cramps so intense you can’t get out of bed? Ask your friends about their periods, their symptoms, and how they manage it! Not only will you learn more, but having these vulnerable conversations will also bring you closer together.

After chatting with your pals about birth control options, be sure to make an appointment with your doctor and tell them everything you’ve learned and are considering. Make sure you don’t make any birth control changes without consulting your doctor first.