Sunday, 18 March 2012

Endometriosis Awareness Month: Part 4

Brains are funny things, all grey and squishy. Inside the roughly 3lbs of brain you have is held all your accumulated memories, dreams, fears, loves and just about everything that makes you, you. But for all its complexity and sophistication the human brain is far from a perfect construct. Whilst it is the source of all our joy, it is also the reason we feel pain, and this is especially not good if you’re in pain for a significant portion of your waking life, for example if you happen to suffer from a chronic condition like endometriosis.

What then, is the effect of pain on the brain? If you have suffered from pain for any length of time then you’ll know that the relentless assault of pain, and all the limitations it puts on your body, can have a deleterious effect on you mental condition. It will probably come as little surprise to you to learn that studies have shown that women with endometriosis present with a very high levels of depressive symptoms. The study in the link above found that 86.5% of women with endo presented with depressive symptoms (22.1% mild, 31.7% moderate, 32.7% severe) and 87.5% presented anxiety (24% minor, 63.5% major).

Does this mean that the brains of women with endometriosis function in a unique way? Is there such a thing as an ‘endo brain’, a specific psychological profile, which is created by suffering long-term with the condition? According to one study, no there isn’t. This study took women suffering from chronic pelvic pain (CPP) either due to endometriosis (30 women), myofascial abdominal/pelvic pain (70 women) or pelvic adhesions (38 women). The authors then asked the women to complete a number of ‘inventories’ (basically questionnaires) asking them about factors such as demographic status, pain experience and symptoms, disability caused by pain, depressive symptoms, level of affective distress, satisfaction with pain treatment and satisfaction with their relationships. So overall it was a pretty comprehensive, and what they found was that the emotional, social and psychological distress caused by endometriosis was not significantly different to that caused by other chronic pain conditions.

This is actually a good thing to know, because it’s a way to shut up any of the idiots who think endometriosis is the result of psychological disturbance. If we can show that the suffering experienced by women with endometriosis is so similar to that of women with other chronic conditions, then it is impossible to say it is ‘all in your head’. Because if that were the case, then the suffering experienced by all those people with other chronic pain conditions must be ‘all in their head’ too.

Is this finding at odds then, with another recent study which found that a greater proportion of women with endometriosis presented with bipolar disorder? Perhaps, but there are a lot of factors to consider; for example, we need to examine what bipolar disorder is. There are good websites giving descriptions of bipolar disorder here and here which basically describe it as rapid, extreme swings of mood from feeling very high to feeling very low. Now we need to consider whether there is some neurological alteration in women with endometriosis that makes them more susceptible to bipolar disorder, or could it be that there is something about living with endometriosis that causes these extreme mood swings? It is know that the steroidal, in particular hormonal, medications used to treat endometriosis can lead to extreme mood swings and living with a chronic pain condition is bound to affect the suffers mental state (as we have seen from the studies I’ve mentioned previously, and just through plain old common sense really).

So it’s more likely that for the majority of women with endometriosis who present with symptoms indicative of bipolar disorder, the moods swings they feel are due to the conditions of living with the disease (of course, there are women with endo who have the symptoms of bipolar disorder for other reasons).The only way to tell for sure would be to do a follow-up study, where women who have been successfully treated for endometriosis are tested again to see if the signs of bipolar disorder remain after symptoms have abated.

In conclusion then; you’re not mad, it’s not all in your head and if you live with a chronic pain condition you may get depressed (well there’s a shocking revelation).

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