Will a hormone jab end monthly pain?

ENDOMETRIOSIS has reared its ugly head in our family — my daughter, aged 48, has been diagnosed with it after a laparoscopy. She had endured back pain and abdominal pain (on her left side) for many months.

My daughter is being treated with injections to encourage the menopause. The pain can be severe and is recurring. Can you advise?

Jean Sewell, Portavogie, Co. Down.

THe good news is that your daughter is very likely to soon be relieved of her pain completely. At the age of 48, the natural menopause is not far away, and in her case this is being hastened medically.

Whether this happens naturally or is induced, the key point is that endometriosis resolves once oestrogen levels decline.

For the benefit of other readers, let me explain what’s going on with this common condition. It affects between 10 and 30 per cent of women of reproductive age being checked for pelvic pain — usually after a laparoscopy, where the inside of the abdomen is examined using a tiny camera.

It is caused when endometrial tissue — the tissue that normally lines the womb — grows outside the womb, for instance, in the bladder, the ovaries and the other structures within the pelvic area, including the rectum.

As with the womb lining itself, this tissue breaks down and bleeds every month, But because there is no route for the blood to leave the body, it can trigger inflammation, which causes pain. The condition can also lead to problems with fertility.

The tissue breakdown occurs as a result of the normal hormonal changes of the menstrual cycle. This is why the condition disappears in postmenopausal women, as long as they are not taking oestrogen (which stimulates the endometrium) by way of HRT.

WHAT triggers it is still unclear. one suggestion is that at some stage when the womb lining was shed during menstruation, some cells passed back through the fallopian tubes (this is known as retrograde menstruation) and then became implanted on pelvic structures.

Treatment is aimed at eradicating all endometrial cells outside the womb. If the woman is still hoping for a pregnancy, at some stage treatment will involve careful attempts to remove all of the endometrial tissue at the abnormal sites — such as by using a laser as a keyhole procedure. For older patients such as your daughter, reducing oestrogen levels by hastening the menopause will cure the problem.

It is likely that she will be treated with a GnRH agonist — these drugs are widely used to suppress the ovaries’ production of oestrogen and are highly effective in reducing pelvic pain.

one such drug is goserelin, given every few weeks by injection. There will be side-effects, such as hot flushes and accelerated bone loss, due to the onset of the menopause — though the latter can be kept at bay by the addition of calcium and vitamin D or even a weekly bisphosphonate tablet.

However, the benefit of the GnRH injections is that your daughter will rapidly become pain-free as the endometrial tissue is reduced. I CAN’T walk far without getting distressed — breathless with a heavy feeling all over my body.

If I walk up a slight slope or steps, I can feel faint and sometimes nauseous. I do walk up stairs at home, mostly without feeling too distressed. In 2013, a heart specialist did a stress test and ECG — he said I performed well for my age and it must be a lung problem.

Later, it was thought I might have asthma and I was given a puffer. I’m not convinced it’s asthma. I am 80.

Jean Kilbey, by email. THe problem here is one of diagnosis. I simply do not believe your intolerance of exertion above a small limit can be put down to your age. There must be a cause and it is vital this is identified before you can take steps to put it right.

As you have explained, minimal exertion — the stairs at home, for example — is not enough to trigger the problem. I note that you are not suffering from breathlessness when at rest, such as when in bed at night.

In my opinion, the origins of the symptom must lie with your heart or lungs. Though a heart problem has already been considered and excluded, that was three years ago.

You tell me that you performed well on the exercise eCG (electro cardiogram). This measures the rhythm and electrical activity of the heart while you walk on a treadmill and may be performed when symptoms are triggered by physical activity.

However, we know this test can be misleading and can produce false positive or false negative results. It may be that if you were to take the test again, the cause would reveal itself. If your problem is down to a shortage of blood supply to the heart muscle, for example, this may not necessarily result in pain — known as angina — but as shortage of breath or weakness, because the heart isn’t pumping efficiently. These symptoms are similar to those you describe. The same symptoms can occur if your heart doesn’t contract fully — which is when it pushes the blood around the body.

This is called ‘heart failure’, and may be apparent only with physical exertion.

Another thought is that it may be a heart rhythm disorder — when you are walking, with your heart working that bit harder, the rhythm becomes temporarily irregular, which can also lead to a drop in the amount of blood pumped out, causing the sort of symptoms that trouble you.

All of these possibilities should be investigated further.

Some cardiologists might suggest an echocardiogram, an ultrasound scan of the heart, or an enhancement of that test, a stress echocardiogram, where the heart rate is increased with exercise or medication. This should be the next step.

Your lungs have been thought about as a cause of the symptoms.

Some people do become breathless on exertion because the physical stress triggers a form of asthma — but the puffer you were given didn’t ease the symptom, which leads me to think a lung problem is a less likely cause.

In summary, I suggest that what is needed is a reassessment by a heart specialist. That should allow your doctors to think about the most appropriate treatment to bring you some relief.