INTRODUCTION:
In the spirit and support of Endometriosis
Awareness Month (March 2024), the Women's Health Collaborative proudly
introduces the remarkable work and generous report of BARBARA BARTLIK, MD
(NYC). Our editors met with Dr. Bartlik, a NYC colleague of the IHRC
(Integrative Health Research Center), led by our own imaging diagnostic
director Dr. Robert Bard. Dr. Bartlik is a psychiatrist, sex therapist, and
integrative medicine specialist in Manhattan who has over three decades of
experience in clinical practice. She uses mainstream medications,
psychotherapy, cutting-edge technologies, and natural therapies, such as dietary
modification, detoxification, and supplementation with vitamins, minerals,
botanicals and essential fatty acids. Whether the problem is psychiatric (ADHD,
anxiety, bipolar disorder, depression, OCD, PTSD, schizophrenia) or medical
(autoimmune issues, dementia, fatigue, hormonal-related problems, insomnia,
pain, sexual dysfunction, weight management), this integrative approach is
effective and tends to minimize adverse effects.
AN INTEGRATIVE PSYCHIATRY APPROACH TO REDUCING PAIN DUE TO ENDOMETRIOSIS By: Dr. Barbara Bartlik | Edited by: Dr. Roberta Kline - (Part of the 2024 WHC EndoSpace feature series)
Women with endometriosis can suffer from many of the same mental health issues as other women. However, they can also suffer from additional problems caused by pain due to endometriosis, which can lead to depression, anxiety, sexual dysfunction, and sleep problems.
Because women with endometriosis may be
prescribed medications to manage their symptoms, it’s important to be aware of
options and their potential benefits and risks.
Psychiatric medications often prescribed for women with endometriosis
include selective serotonin reuptake inhibitor (SSRI), serotonin and
norepinephrine inhibitor (SNRI), and tricyclic antidepressants;
benzodiazepines, sleep medications, mood stabilizers, anticonvulsant
medications, and atypical antipsychotics. Antidepressants can help because they
reduce depression, which exacerbates pain [1]. Fluoxetine [2], an
SSRI antidepressant, and gabapentin[3] and
pregabalin [4], both anticonvulsants have been shown to
relieve chronic pelvic pain. Duloxetine[5],
venlafaxine [6], and desvenlafaxine [7], all of which are SNRI antidepressants, can
relieve various types of pain. Reports show that tricyclic antidepressants
doxepin[8], amitriptyline, and imipramine, out of
fashion for years as first-line treatment for depression, are now making a
comeback to relieve pain [9].
All the antidepressants mentioned above can cause side effects of sexual dysfunction, weight gain, fatigue, and more. Bupropion, a unique antidepressant, relieves neuropathic pain and is less likely to cause these side effects, but it is more likely to increase anxiety [10]. Benzodiazepines prescribed for the treatment of anxiety, muscle cramps, and insomnia can also be effective in relieving pain, but they can cause sedation and lead to addiction[11]. Sedative-hypnotics such as zolpidem aid sleep, but they, too, are habit-forming and can cause memory problems [12]. The second-generation antipsychotics, quetiapine[13] and olanzapine[14], reduce pain scores and aid sleep but are associated with significant weight gain and sexual dysfunction[15]. Sometimes, when there is severe acute pain, opiates may be prescribed, although other less addictive solutions may also be sought.
Research shows that women with endometriosis
have increased oxidative stress in their bodies[16].
Therefore, minimizing exposure to toxic substances that cause oxidative stress is
important. That is not easy since toxins are ubiquitous and difficult to avoid.
They are in food, air, water, household and personal care products, mold, and
more. Many of these toxins mimic hormones and damage the endocrine system. I
advise endometriosis patients to eat a clean, antibiotic-free, hormone-free,
organic, pesticide-free Paleolithic diet, which also minimizes alcohol, dairy,
gluten, genetically modified organisms (GMOs), highly processed foods, seed
oils, soy, and sugar. Become familiar with the Dirty Dozen and Clean Fifteen
lists, guides produced by the Environmental Working Group (www.ewg.org/foodnews/clean-fifteen.php) to
help consumers choose produce low in pesticides. Eat wild-caught fish,
free-range poultry and eggs, and grass-fed beef where possible.
Women with endometriosis tend to have higher
estrogen levels[17], and
estrogen stimulates endometrial lesions to grow. The liver can detoxify
unwanted estrogens and remove them from the body, but only if it has adequate
protein. Amino acids from protein attach to unwanted hormones, which allows
these and toxic chemicals to be excreted through the bowel. Without enough
protein, hormones and toxins build up and cause many health problems.
Read labels carefully to avoid additives and
toxic ingredients. If it needs to be clarified if a product contains toxins,
contact the manufacturer directly to obtain more information. Get rid of
plastic containers and transition to glassware and stainless steel. Don’t use
plastic bottles that contain endocrine-disrupting phthalates and bisphenol A
(BPA). Avoid using Teflon or other chemically-coated pans that contain forever
chemicals that remain in the body.
Research suggests that the antioxidants curcumin, melatonin, N-acetylcysteine, and vitamins C and E show promising results for endometriosis patients[18]. Nutrients that reduce menstrual pain are also helpful, such as a combination of magnesium and vitamin B6[19]. Vitamin D is another nutrient that can help reduce pelvic pain [20]. In addition, anti-inflammatory supplements such as omega-3 fatty acids can be helpful because women suffering from endometriosis have elevated inflammatory markers on blood tests [21][24].
The discomfort and pain experienced by women with endometriosis can dampen sexual feelings and make sexual pleasure more difficult to achieve. Sexual activities may have to be adjusted to reduce pain during sex and after. The woman’s partner may also be adversely affected. It is essential to remain flexible and open. Erotica and vibrators can boost the sexual response, which helps to overcome the pain. Numerous oral nutritional supplements and topical creams can stimulate desire and arousal. Two FDA-approved pharmaceuticals are available for low libido in premenopausal women (bremelanotide, flibanserin). Sexual problems can lead to both psychological and relationship problems, so it is important to get help. Consult a trained professional.
The utilizing of non-invasive transcutaneous electrical nerve stimulation (TENS) can help alleviate pelvic pain and augment the sexual response [22][23]. In addition, device-based energy medicine modalities such as pulsed electromagnetic field (PEMF), noncoagulative multipolar radiofrequency, and red-light therapy alleviate pelvic pain, increase blood flow, promote collagen formation, stimulate cell growth and repair, and reduce inflammation [24][25]. Studies have shown that they are effective in treating sexual problems [26][27] and may help with a range of psychiatric issues [28]. These devices are painless, non-invasive, and are viable alternatives to pharmaceuticals and surgery.
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