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Self-Care to Combat Endometriosis Symptoms
Self Care for Endometriosis | Image Courtesy of Callum Shaw via Unsplash

Self-Care and Self-Management Strategies to Combat Endometriosis Symptoms During the COVID-19 Pandemic

Since March of 2020, people living with endometriosis symptoms are facing tough challenges and barriers due to the Covid-19 pandemic: canceled surgeries, canceled appointments with family physicians, gynecologists, fertility specialists and/or other allied healthcare providers, postponed in-office assessments and visits, and changes in overall work environment and social activities. This can worsen feelings of isolation, depression, anxiety, hopelessness, and have a negative impact on self-reported pain and disability levels during this time. 

How you respond or adapt to a stressor or illness depends on how you think about the situation, the actions you take, and behaviors or changes you implement in response to the demand of the situation. This problem-focused strategy for understanding response to stress and illness explains that problem-solving, information-seeking, acceptance, seeking support, and planning, allow one to more effectively cope with the ongoing stresses of living with endometriosis symptoms in light of added challenges due to the pandemic (Kvillemo and Bränström (2014)).

On the other hand, coping strategies that are maladaptive (focus attention away from thoughts and feelings about endometriosis, such as denial, substance use, and self-blame) are likely to heighten feelings of being out of control and feeling distress. A study by Donatti et al. in 2017 found that people with endometriosis who take a positive, problem-focused approach report lower stress levels, have less depressive symptoms, report less non-cyclical pelvic pain and less painful periods than those with endometriosis who use maladaptive coping strategies (avoidance, substance-abuse, denial for example). 

While medical and surgical management of pain and associated endometriosis symptoms can be effective, it is not a cure-all, and to date, there is no cure for endometriosis. When facing endometriosis symptoms, learning and implementing positive self-management and self-care strategies to manage stress, pain, and changes in work/life/ social environments is key, especially during the Covid-19 pandemic. 

Read on to learn about these strategies and how to start implementing them. 

Self-Care & Self-Management Strategies for Endometriosis Symptoms 

1. Manage Work / School Schedules: 

Be honest with employers, professors, or teachers about anticipated and possibly unanticipated episodes of pain. Discuss modifications of work/school obligations during times of pain exacerbation, if appropriate.

2. Maintain safe social activities and social support during times of necessary isolation:

  1. link up with friends, family, and/or colleagues via messaging, video chats.
  2. When safe to do so, participate in Covid-Friendly meet-ups such as outdoors at a park or backyard, and with masking precautions. 
  3. Consider joining a support group such as these virtual groups found here.

3.Educate yourself to gain control over endometriosis symptoms:

Learn about endometriosis, treatment and management options, how to find providers with experience caring for people living with endo, and explore resources on how to optimize your quality of life, physical well-being, pain management, and mental health. Below you will find a few key resources, but this list is by no means exhaustive: 

  1. Support Groups: https://www.pelvicpain.org/public/resources/support-groups 
  2. Support Groups: https://nancysnookendo.com/resources/ 
  3. Find a Healthcare Provider: https://app.v1.statusplus.net/membership/provider/index?society=ipps
  4. Read the book Beating Endo: How to Reclaim Your Life From Endometriosis, written by two of the world’s experts on endometriosis: https://www.barnesandnoble.com/w/beating-endo-iris-orbuch-md-md/1130636804  

4. Sleep Hygiene:

Get at least 7-8 hours nightly. This is key to managing stress, supporting optimal immune system function, and to help manage pain levels. 

If you find it tough to peel yourself away from the TV at night, or you have a habit of checking work emails in bed before sleep, I encourage you to start “winding down” (avoid using electronics like the phone, TV, your tablet) at least 60-minutes before bedtime. Instead, you can listen to some soothing music, meditate, do some gentle stretching or diaphragmatic breathing. Your body and mind will thank you for it. 

5. Exercise:

Maintain a regular schedule of light to moderate physical activity (find something you enjoy) to help manage pain levels, improve mood, decrease stress, decrease symptoms of anxiety and depression, improve blood flow, and maintain optimal immune system functioning. Exercise has also been shown to have an anti-inflammatory effect which can help improve symptoms of endo too.

If you are unsure which type of physical activity or exercise is right for you, please reach out to a pelvic floor/women’s health physical therapist with experience treating patients with endometriosis symptoms and pelvic pain conditions. 

6. Establish and maintain a regular Mindfulness/ Meditation Practice:

Evidence shows that people with pelvic pain or chronic pain that practice regular (daily) mindfulness or meditation practices report better pain control, better quality of life, and decreased disability levels.

There are many apps accessible for free or available on a subscription basis: 

  1.  Insight TimerI personally use Insight Timer App. It has a free and subscription option. I recommend guided meditations/ mindfulness focused on progressive muscle relaxation, deep sleep meditations, sound healing, stress management, setting boundaries. 
  2. Headspace: Free trial versions available
  3. CalmFree trial versions available
  4. Aura.

7. Heating pad / cold pack: 

These alter blood flow and nerve conduction time and therefore can have a positive impact on endometriosis symptoms including cramping and pelvic pain. 

8. Pelvic floor self-myofascial release, pelvic floor relaxation exercises, and nervous system down-regulation techniques. 

If you are unsure about these techniques, consult with a pelvic floor physical therapist. We are trained to treat pain associated with muscle, fascia, joint, and nerve-related symptoms due to endo or other chronic pain conditions. Your pelvic floor physical therapist will teach you self-management and activity modifications as well. 

9. Endocannabinoids (CBD) tincture, capsules, topical creams, or vaginal suppositories for managing pelvic pain:

The female reproductive system has high concentrations of cannabinoid receptors. CBD has been shown to reduce symptoms of muscle cramping and pelvic pain. Read more about it here: https://nancysnookendo.com/endocannabinoids-and-endometriosis/

Important note: if you are trying to conceive, think you may be pregnant, or going through any fertility treatments, you need to discuss the risk of use of CBD with your medical provider. 

A few products that I would recommend: 

Diet modification:

Consider trialing modifications in your diet. Possible considerations include: anti-inflammatory diet; gluten-free diet; low FODMAP diet. People with endometriosis symptoms often have GI symptoms or conditions such as SIBO or H. Pylori, bloating, gas, constipation/loose stools, straining with bowel movements and/or food allergies/intolerances. 

Important note: If you have an eating disorder or history of an eating disorder, you should consult with a registered dietician or nutritionist first before eliminating foods from your diet. 

If you are living with endometriosis symptoms, don’t let the pandemic derail your quality of life or mental health. If you have endometriosis or think you may have endometriosis symptoms, these resources mentioned here, in addition to having a good team of providers to support you is key!  Contact us to discuss your options.

Additional Sources:

Leonardi M, Horne AW, Vincent K, et al. Self-management strategies to consider to combat endometriosis symptoms during the COVID-19 pandemic. Hum Reprod Open. 2020;2020(2):hoaa028. Published 2020 Jun 1. doi:10.1093/hropen/hoaa028 ​​https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263080/pdf/hoaa028.pdf 

Kvillemo P, Bra ̈nstro ̈m R. Coping with breast cancer: a meta-analysis. PLoS One 2014;9:1–26.

Donatti L, Ramos DG, Andres M de P, Passman LJ, Podgaec S. Patients with endometriosis symptoms using positive coping strategies have less depression, stress and pelvic pain. Einstein (Sao Paulo) 2017; 15:65–70.

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Testimonial by Julie T.

Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to her.

What is even better is she gave me practical exercises to do at home that were not tedious and provided instant (and lasting) relief. Although I mainly work with Laureen, my interaction with the owner (Heather) has been great. She is very generous, kind, and committed to her business.

It hurts to know there are women out there suffering who will never know or have the opportunity to work with women like Laureen and Heather because this issue is hardly talked about and this field is so rare. I hope more doctors and physical therapists see the value in this work and can relieve more woman of their pain.

-- Julie T., 12/4/16 via Yelp!

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While pregnant with my twins, Heather took care with keeping me on my feet and pain free. She saved my back, my sanity and the holidays! I would recommend her to every “mom” looking to stay on her feet during pregnancy and post-partum.

-- T.C.

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Heather is without exaggerating AMAZING! After years of trouble with a certain part of my body, in no time, she made everything change back to equilibrium and to what would be considered normal. She explains everything in detail and therefore gives you a better understanding of why things are the way they are, and how you can work towards turning things around. I would highly recommend Heather for any type of Physical Therapy. She has created her own "Method/Therapy" through years of studying (with some of the greatest practitioners), practice and breaking down the issues of her past patients, enabling her to fine tune her own system. I'm so thankful to have found her, and I'm especially grateful for the quick recovery I've achieved, after years of distress. If you cannot afford her, I recommend you purchase her book. Although it may not be Heather in person, it can still help you to get on the right path to recovery!

-- Alexandra B., 5/20/2015 via Yelp!

Testimonial by A.B.

Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
-- A.B.

Testimonial by Lauren B.

Femina PT (née Fusion Wellness & Physical Therapy) has been such an answer to prayer, i'm so glad I found them! I've been struggling with vaginismus my whole life, but didn't have a name for it until about 6 or 7 months ago. Even once I did have a name for it though, I didn't know where to begin in getting help. My OB/GYN had me get a set of dilators, but I couldn't even insert the smallest one by myself. Most times I tried I just ended up frustrated and in tears. I felt really alone, like I was broken and didn't have the energy to keep trying. When I got engaged a few months ago though, I realized I needed to get answers so i wasn't dreading my honeymoon.

Read more: Testimonial by Lauren B.

Testimonial by Fritzette H.

I went to Heather after the birth of my third child. It was lucky, really, that I was referred to her, because my doctor had referred me to a surgeon for a possible hysterectomy or pelvic wall rebuild. Thankfully, I went to Heather before undergoing either surgery, she was able to fix the problem. She has studied extensively in women's health--even written a book about it--and was able to diagnose my problem, suggest a course of treatment (6 weeks), and then follow through with said treatment. By the end, as she said, I was as good as gold. Boy, was it worth it! Though uncomfortable to talk about, much less write about, it is worth getting the word out there. If you have painful intercourse, especially after birth or other trauma, the treatment may be as simple as Physical Therapy (with Heather, of course). I highly recommend her.

-- Fritzette H., 3/24/16 via Yelp!

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