How to deal with postpartum endometritis

In recent years, endometriosis has been a gynecological disease that is gaining visibility. And for good reason: this endometrial disease, until now little known and difficult to diagnose, affects nearly 10% of women in France and around the world! Despite its growing recognition, endometriosis remains a source of pain, misunderstandings and long and tumultuous diagnostic journeys. For example, we are often unaware that there are several forms of endometriosis and that it can begin after childbirth. In today's article, let's discover postpartum endometriosis , its causes, its symptoms and solutions to soothe it.

What is endometriosis?

Endometriosis is a gynecological disease. As the name suggests rather transparently, endometriosis affects the endometrium .

How does endometriosis affect the endometrium?

The endometrium is the lining of the uterus. In healthy menstruating people without endometriosis, the endometrium expands on the wall of the uterus during the luteal phase of the menstrual cycle to accommodate the recently fertilized egg and is expelled during menstruation in the absence of fertilization. In people with endometriosis, endometrial development is not limited to inside the uterus. The exterior of the uterus and neighboring organs (ovaries, large intestine and small intestine) are also affected and the endometrium does not resorb, leading to adhesions in the organs.

What are the symptoms of endometriosis?

The symptoms of endometriosis can vary enormously depending on the person affected and can be more or less debilitating. Here is a supposedly exhaustive list of the symptoms of endometriosis – although not all endometriosis sufferers experience them:

• Painful menstruation: Also called “dysmenorrhea”, painful menstruation is the symptom of endometriosis par excellence. Severe period pain is often a clue that can lead to the diagnosis of endometriosis. Menstrual cramps can be severe, or even unresponsive to usual medications;
• Chronic pelvic pain: Along with menstrual cramps, this is the most common symptom of endometriosis. Lower abdominal pain is recurrent, can be severe and, above all, increases during menstruation;
• Pain during sex: Some women experience pain during or after sex. This can be explained by the accumulation of endometrial cells which do not evacuate properly, as well as by the various adhesions existing within their abdomen;
• Heavy or irregular menstrual bleeding: In cases of endometriosis, the flow of periods may be heavier and/or more prolonged than normal.
• Intestinal or urinary pain during menstruation: Abdominal pain, digestive problems or pain when urinating may occur during menstruation. These symptoms are consistent with the development of endometrial cells in organs neighboring the uterus;

Last symptom of endometriosis and not the least: infertility . Some women with endometriosis may have difficulty conceiving . Please note, however, that infertility is not a common symptom of endometriosis and the disease that causes the most cases of infertility/sterility in France is Polycystic Ovary Syndrome.

The different forms of endometriosis

There are 3 forms of endometriosis depending on how it develops in the body of menstruating people:

• Superficial endometriosis: we speak of superficial endometriosis when the disease only affects the pelvic area (ovaries and abdominal organs);
• Deep endometriosis: in this form, the disease affects the rectovaginal septum, the bladder and the rectum;
• Extrapelvic endometriosis: In rare cases, the disease causes lesions outside of the pelvic area, such as on the lungs, surgical scars or even the brain.

What causes endometriosis?

Today we do not know the exact causes that lead to the appearance of endometriosis, but health professionals and scientists have different avenues and hypotheses. Certain factors seem to increase the risk of contracting this disease:

• Retrograde menstruation theory: This theory is currently the most commonly accepted to explain endometriosis. According to her, fragments of endometrial tissue break away from the uterus during menstruation and travel through the fallopian tubes to other parts of the pelvic cavity, where they implant and grow, causing endometriosis.
• Genetic Factors: There appears to be a genetic component to the development of endometriosis, as it appears to occur more frequently in women with a family history of the disease;
• Hormonal factors : Hormones, especially estrogen, play an important role in the growth and development of endometriosis. Some researchers believe that hormonal imbalances or increased sensitivity to hormones may contribute to the development of the disease.
• Environmental factors: Certain environmental factors, such as exposure to toxic chemicals or endocrine disruptors, could also play a role in the development of endometriosis. However, research on this is still limited.
• Immune system dysfunction hypothesis: It has been suggested that abnormalities in the immune system may allow endometrial cells to spread and implant in other parts of the pelvic cavity, instead of being eliminated. normally by the immune system.
• Hypothesis of an infection: More recently, in June 2023, a Japanese study showed that endometriosis could be caused/encouraged by exposure to a bacteria, fusobacterium . Very recent, this hypothesis, different from all those that had so far been proposed, offers new perspectives regarding the diagnosis and development of treatments for this disease.

Can we cure endometriosis?

Currently, there is no treatment and definitive solution to cure endometriosis . However, different treatments exist to slow down its progression, alleviate its symptoms and live as best as possible with endometriosis. We'll talk about it again a little later in the part of this article dedicated to endometriosis treatments.

And what is postpartum endometriosis?

The term “Postpartum endometritis” refers to the appearance or worsening of endometriosis symptoms after childbirth.

Although endometriosis is not generally considered a direct complication of pregnancy or childbirth, some women may find that their symptoms related to the menstrual cycle or their already diagnosed endometriosis worsen after giving birth. We then speak of postpartum endometriosis.

It's important to note here that not all menstruators experience worsening endometriosis symptoms after giving birth. Quite the contrary: some women may even notice a temporary improvement in their symptoms during pregnancy and breastfeeding.

Why can endometriosis appear after childbirth?

There are several theories about how pregnancy and childbirth can affect endometriosis. As mentioned previously, there is currently no consensus on the causes of endometriosis. Likewise, there can be no certainty about the appearance or worsening of endometriosis postpartum.

Some research suggests that pregnancy may temporarily relieve endometriosis symptoms in some women due to hormonal changes that occur during pregnancy, including a decrease in estrogen levels . However, after childbirth and the return of menstruation, symptoms may return or worsen, in part due to hormonal fluctuations and increased estrogen levels.

Beyond hormonal variations linked to pregnancy and childbirth, other factors could contribute to the worsening of endometriosis symptoms after childbirth. This is the case for the physical and emotional stress of pregnancy and birth, postpartum fatigue and postpartum insomnia of young parents and changes in the pelvic structure after childbirth. It is also essential to talk about baby blues and postpartum depression which can also cause an increase in postpartum endometriosis symptoms.

Can it impact my fertility?

Yes.

Endometriosis, but also postpartum endometritis which is a form of endometriosis, can have an impact on your fertility . But rest assured: the majority of women with endometriosis are capable of conceiving a child.

Disruption of fertility in a person with endometriosis most often depends on the severity of the disease. However, sometimes it only takes a few outbreaks of endometriosis to cause infertility. Positioned in the wrong place, this scar tissue can block the fallopian tubes and prevent eggs and sperm from meeting, preventing you from getting pregnant.

Whether or not you are diagnosed with endometriosis, if your couple is having difficulty conceiving a child, the possibility of endometriosis will be considered and you will undergo various examinations.

Spotting the symptoms of postpartum endometriosis

Have you just given birth and are afraid of contracting or having contracted endometriosis? The period following childbirth is fraught with many upheavals! And this, for your mental health, your relationship and your body! It is normal to be worried during this time. Here are some things to keep in mind the day after giving birth if you are worried about postpartum endometritis.

Stay attentive to your cycle

In the months following childbirth, you will experience the period of returning to childbirth . Menstrual bleeding resumes more or less quickly after childbirth, depending on whether you are breastfeeding or not. Generally, it is estimated that the return of diapers occurs two to three months after giving birth if you are not breastfeeding and up to two to three months after stopping breastfeeding. During this particular period, your cycle may be particularly disrupted. It's normal.

Know the symptoms of postpartum endometriosis

The symptoms of endometriosis and postpartum endometritis are similar. Knowing them is a first step towards understanding and diagnosis – although spotting them, as we will see later, can be more complicated as the postpartum period can be fraught with inconveniences linked to the menstrual cycle and the return of diapers.

The symptoms of postpartum endometriosis are:

• Painful periods
• Recurrent pelvic pain
• Pain during sex
• Heavy periods
• Bleeding outside of periods
• Intestinal or urinary pain during menstruation

Differentiate endometriosis and PMS

The day after childbirth, when returning from confinement, the menstrual cycle is very often disrupted. The cycles may be longer or the cycles may be shorter , the pain (menstrual cramps, catamenial migraines, back pain, etc.) may be amplified, modified or reduced, the symptoms may differ from those you have experienced... In short, the Menstrual cycle and PMS symptoms change after pregnancy and childbirth. However, these changes do not necessarily (and fortunately) mean that you have endometriosis or that you have developed postpartum endometritis.

Take action: what to do in case of doubt?

As is often the case in our articles, we can only recommend that you talk about your doubts with the health professionals who follow you (treating doctor, gynecologist and/or midwife).

However, there is no need to be alarmed by the slightest change: generally speaking, menstrual balance occurs over approximately three menstrual cycles . Also, it is interesting to wait three cycles after returning from diapers to worry about the changes that have occurred.

However, two symptoms should lead you to consult:

• Excessive pain: the treatments you have been taking until now (if you took any) are no longer enough to contain the pain linked to your menstruation and the latter is handicapping you to the point of having a role in your quality of life? Consult. Postpartum endometriosis or not, there are certainly solutions to alleviate the pain linked to your menstrual cycles;
• Vaginal bleeding between menstrual cycles: while vaginal bleeding following childbirth is common, bleeding between your periods after the return of diapers should not be neglected and can be of pathological origin. Talk to your healthcare professional.

How to get diagnosed?

Although endometriosis affects between 10 and 20% of menstruating people worldwide, its diagnosis remains a complex subject.

The tools to detect endometriosis are:

• History and physical exam: Your doctor will often begin by discussing your medical history, symptoms, and performing a physical exam, including a pelvic exam, looking for any abnormalities, such as painful nodules, that may indicate the presence of endometriosis.
• Pelvic ultrasound: A pelvic ultrasound can be used to look for endometriotic cysts in the ovaries. However, this method cannot always detect all endometriosis lesions.
• Pelvic MRI: MRI can be used to view the organs in the pelvic cavity and detect smaller or deeper endometriosis lesions.
• Laparoscopy: Laparoscopy is considered the most effective test for diagnosing endometriosis. It's a surgical procedure in which a doctor inserts a small instrument with a camera into the abdomen to examine the pelvic organs and look for signs of endometriosis.
• Colonoscopy: In some cases of deep endometriosis, a colonoscopy may be considered to check that endometriosis lesions have not become nestled in the large and small intestines. This invasive examination is performed under general anesthesia after ingestion of laxatives.

🖐️ To be continued! Very recently, a saliva test capable of detecting endometriosis was developed by the company Ziwig. The High Health Authority is currently carrying out tests to evaluate its effectiveness , which could lead to its reimbursement by social security and mutual insurance companies.

What treatments?

There are currently no treatments to treat endometriosis and prevent its recurrence. However, it is possible to slow its progression when the disease is detected early or to limit its impact by removing endometriotic cysts which cause pain or even infertility.

Slow the progression of the disease

When the disease is detected early and more generally, to slow its progression, it is customary to prescribe a hormonal pill continuously . Its objective: to stop the menstrual cycles which are the cause of the diffusion of the endometrium in the body.

Because endometriosis is considered an inflammatory disease, it is also common to advise an anti-inflammatory diet so as not to encourage endometriosis attacks. Many menstruating people with endometriosis limit gluten, a food known to be inflammatory. However, this point is contested and is not accepted and applied by all doctors, the scientific consensus on these questions having not been established.

Limit pain

The second treatment for endometriosis concerns the pain it causes on a daily basis. During menstruation, on the one hand, but also at the intestinal level and more widely throughout the pelvic area. This treatment can be done through medications accompanied by natural responses. We explain these to you in the last point of this article.

In addition to hormonal contraceptives which will slow down menstrual cycles and the pain caused by them, medications that can help with endometriosis pain are as follows:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs calm menstrual pain. These medications (ibuprofen, flurbiprofen, naproxen, etc.) slow down the production of prostaglandins, which are largely responsible for uterine contractions. They thus reduce the number and frequency of uterine contractions and reduce menstrual pain.
• Analgesics: An analgesic is a medication that reduces or eliminates pain without treating the cause. Paracetamol (contained in particular in Doliprane) is an analgesic which can help alleviate painful periods.
• Antispasmodics: Antispasmodics such as Spasfon may be helpful in relieving pain associated with uterine contractions. However, health authorities believe that their effectiveness is low. Adverse effects are rare (allergic skin reaction).

Intervene on the consequences of the disease

The third treatment consists of surgically removing the physical consequences of the disease which are endometriotic cysts. These can be lodged in the uterus, in the fallopian tubes, or even outside the uterus, on the different organs of the pelvic region.

Supporting mental health

Alongside these physical treatments, it seems important to us to talk about support and support for people with endometriosis. There are in particular associations of endometriosis patients and support groups to discuss the disease and meet other people affected. Even more, do not hesitate to consult a mental health professional: this aspect of health is sometimes forgotten but a diagnosis can be heavy to carry alone ❤️

Are there natural solutions to relieve pain?

If you are breastfeeding, it may be difficult to consider medications to relieve your postpartum endometritis. We have compiled for you several natural solutions to relieve the pain and discomfort caused by endometriosis.

First of all: consult a doctor

Are you in so much pain that your pain impacts your daily life and prevents you from working and enjoying your usual leisure activities? Talk to your healthcare professional: they will be able to help you find solutions that match your wishes (medications, breastfeeding, etc.).

Adopt a healthy lifestyle

A varied diet, correct hydration, sleep and limiting abuse (avoiding alcohol, tobacco or even caffeine) can help to alleviate the pain linked to endometriosis. Excess sugar or alcohol during your period can amplify premenstrual syndrome and make you feel even worse.

To try to relieve your pain

• Apply heat: Since heat is a muscle relaxant, it can help reduce uterine contractions that cause pain and thus alleviate menstrual pain. The hot water bottle or a very hot bath (perfect for relaxation!) are two interesting solutions!
• Practicing physical activity: Although exercising if your pain is severe is not easy, the endorphins released by the body can help relieve your pain.
• Massaging your stomach: Massaging your stomach, by generating heat and forcing you to stop and focus on your sensations, can help ease your pain. 🌈 We recommend Jho's Soothing Balm , a balm to apply locally to sensitive areas . With a slightly minty hot-cold effect and 100% natural ingredients, its virtues are both calming for lower stomach or back pain.

I want it >

• Adopt relaxation: Yoga, meditation or even sophrology are practices that can help limit your period pain. Test the practices that suit you and adapt to your pain.
• Adopt electrostimulation: Electrostimulation consists of running tiny electrical currents through the body to limit pain. This electrostimulation stops the pain message sent by our nerves to our brain so that the latter no longer perceives the pain. 🌈 We recommend our favorite product: the Bluetens electrostimulation device . It is a small box extended by electrodes and controlled via an application to install on your smartphone. We like its effectiveness, we had it tested on several of our consumers with endometriosis, before offering it on our store.

I want it >

• Making love / Masturbating: Masturbating during your period is full of virtues, particularly for relieving pain. Hormones released by physical activity and orgasm can help ease pain. Please note: if penetration is complicated for you, because of your pain or because it disgusts you because of your period, clitoral stimulation can also work. Keep in mind, however, that you never have to force yourself. It's just one solution among others. ;)

Discover herbal medicine

Phytotherapy consists of treating yourself with plants. If herbal medicine is natural, its effects can be significant and strong, even dangerous for your infant if you are breastfeeding. It can therefore be a good natural remedy to relieve pain linked to endometriosis but may prove unsuitable if you are breastfeeding. Talk to your healthcare professionals before supplementing.

Among the interesting solutions:

• Cannabidiol (also called CBD) is a molecule derived from hemp and more precisely from hemp flowers. Its effects on menstrual pain are currently being studied and seem interesting. You can consume it in the form of oil for an immediate effect or in the form of a cure, in oil or herbal tea, to supplement your body in the long term.

  🌈 To test the effects of CBD on you and your cycle, we recommend CBD oil 10% from Équilibre CBD, a sublingual oil perfect for starting to take CBD .

• Several plants, consumed as herbal teas or as food supplements, can support your body to limit menstrual pain and the disorders caused by endometriosis.

  🌈 To alleviate your pain without CBD, we like Happy Cycles herbal tea from the Miyé brand. Its key ingredients are raspberry leaves to regulate the menstrual cycle and calm painful periods, while toning the reproductive system and yarrow to soothe menstrual abdominal cramps in women, support digestion and better kidney function.