Endometriosis Explained

By: Dr. Hannah Lattanzio PT, DPT

March is endometriosis month and this blog post is dedicated to sharing up-to-date information on current terminology, treatment options, and new research. In this post, we use the terms “woman” and “women.” However, it is important to note that endometriosis can affect all people assigned female at birth.

Introduction

Endometriosis is defined by the presence of endometrium-like tissue outside of the endometrium and myometrium (the inner and muscular layers of the uterus) – in laymen's terms, endometriosis is defined by the presence of uterine tissue growing outside of the uterus. This is usually associated with an estrogen-driven inflammatory process and will affect approximately 10% of women during their reproductive years – 190 million women worldwide! 

The true cause of endometriosis is unknown. The most accepted theory is that endometrial cells reach the peritoneal cavity through retrograde menstruation (a physiologic process that occurs in 90% of women); these cells are usually broken down and cleared. Alteration in this process is what is believed to contribute to endometriosis. 

Most endometriosis is found within the abdominal cavity and involves three subtypes: superficial (the most common), ovarian, and deep endometriosis. 

More than 50% of adults diagnosed with endometriosis report onset of pelvic pain in adolescence however most young women do not receive timely treatment or diagnosis. More than half of women will typically see three or more providers before an endometriosis diagnosis is made, after an average of seven years with symptoms!

Symptoms and Comorbidities

Endometriosis is associated with a wide variety of symptoms including chronic pelvic pain, painful sex, painful periods, painful urination and pain on defecation (this symptom specifically is potentially predictive of endometriosis). Interestingly, symptom severity does not correspond to the extent of the disease, adding to the confusion around the condition.

Those with this condition have a higher risk or association with comorbid chronic pain conditions such as migraines, fibromyalgia, and rheumatoid arthritis. Reports of bladder, bowel and back pain are also extremely common. Nearly 50% of women with bladder pain, interstitial cystitis, and/or irritable bowel syndrome also have endometriosis. 

Endometriosis also affects fertility by altering pelvic and reproductive anatomy. About 30% of patients with endometriosis have difficulty conceiving. 

Diagnosis

The diagnosis of endometriosis can be difficult to make, leading to delays in treatment and care. Diagnosis should be considered in those with chronic pelvic pain, deep pelvic pain with intercourse (deep dyspareunia), painful periods affecting quality of life (dysmenorrhea), gastrointestinal symptoms such as painful bowel movements and urinary symptoms including pain (dysuria) and burning with urination. Most symptoms are cyclical in nature but do not necessarily have to be. 

Imaging for endometriosis includes ultrasound and MRI. These tools can be used to diagnose endometriosis preoperatively (before surgery), but it is important to note the absence of findings does not exclude diagnosis. In women with suspected endometriosis, laparoscopy is recommended for diagnosis if imaging does not reveal pathology or when they fail conservative treatment options. 

Laparoscopic visualization of endometriosis (exploratory surgery to identify the presence of the disease) has long been considered the gold standard for diagnosis, however updated guidelines advocate for a nonsurgical diagnosis based on symptoms and findings on physical examination and imaging. This recent change comes from the consideration that surgery is not curative and has risks, and that reliance on a surgical diagnosis can lead to a long delay between onset of symptoms and the start of treatment.

Current Treatment Options 

There is a growing understanding that endometriosis involves many body systems and thus requires a personalized interdisciplinary approach. 

Various treatment options include but are not limited to: analgesic medications, hormonal treatments, surgical excision of lesions, and non-drug therapies including physical therapy and talk therapy.  

Research remains unclear on the effectiveness of surgery for endometriosis. Current review concludes uncertainty of the effect of laparoscopic surgery on pain and quality of life. Women should be informed surgery is not a “cure” for endometriosis (even a radical hysterectomy) and is best reserved for women with severe pain who have exhausted all other options. 

How Pelvic Floor PT can Help

Pelvic floor physical therapy can not cure endometriosis or alter the pathophysiology of the condition. However, a pelvic floor therapist can help those who experience pain from endometriosis. Chronic pain from endometriosis adhesions and lesions can cause the pelvic floor muscles to protectively guard and contract. As these sustained contractions occur over time, muscle tightness is created and can cause pelvic, abdominal, and back pain. Your physical therapist is uniquely trained to address the musculoskeletal system and soft tissue restrictions and dysfunction contributing to this pain. 

Various techniques your therapist may use include but are not limited to: stretches, breath work, strengthening, and manual techniques such as trigger point release and soft tissue mobilization to improve your symptoms. By improving muscle function, this can help mitigate the symptoms originating from the pelvic floor. 

Still Have Questions?

If you still have questions on what pelvic floor physical therapy can do for you: book a discovery call with us today!