Endometriosis

It’s no secret that Endometriosis is a debilitating and often overlooked women’s health diagnosis.  The symptoms of endometriosis and its associated pain mechanisms are extremely complex and can be divided into three categories: inflammatory, neuropathic (from nerves) and nociceptive. The tissue found within the uterus and lesions of endometriosis are not identical. According to NIH and WHO, the estimated frequency of endometriosis in reproductive aged women is 10%.

Women with endometriosis typically face diagnostic delay of 7-10 years, despite more frequent GP and ER visits than women without the disease.

Symptoms of Endometriosis include:

• Heavy or irregular bleeding

• Pelvic pain, chronic pelvic pain

• Lower abdominal and/or back pain

• Painful intercourse

• Constipation

• Bloating, nausea

• Inguinal pain

Symptoms vary based on the area of endometriosis lesions. For example, lesions on the bladder can mimic painful bladder syndrome. Lesions between the uterus and the rectum can cause pain with intercourse or before or after bowel movements. Lesions on the intestines can cause issues with digestion and abnormal bowel movements. 

Diagnosis is performed through laparoscopy with biopsy and histology.

Subtypes of Endometriosis:

1. Ovarian Endometrioma

1. Forms in, over and around the ovaries

2. Can affect the ability to release an egg

2. Superficial Peritoneal Endometriosis

1. Most common subtype

2. Associated with pelvic pain and infertility

3. Deep Infiltrating Endometrioma

4. Silent Endometriosis

Medical Pharmacological Management of Endometriosis:

• NSAIDS to reduce the inflammatory process and decrease pain

• Oral contraceptives lowers follicle stimulating hormone and stabilizes the endometrium

• Progestins to lower levels of follicle stimulating hormone, estrogen and others

• Antidepressants (varies types)

• Elagolix

Surgical Management of Endometriosis:

For treatment, surgical ablation, or excision, or hysterectomy is performed. 

Studies indicate there is a greater improvement rate with excision versus ablation (Pundir et al., 2017).

Hysterectomy with or without oophorectomy is not a “cure” for endometriosis and is best reserved for those with coexisting adenomyosis. 

Recurrence rates of painful symptoms are at 21.5% at two years after surgery, and 40-50% at five years. In some cases, surgical treatment of some subtypes of endometriosis can exacerbate pain (Horne & Missmer, 2022).

Comprehensive Treatment:

Treatment of endometriosis must include pain management techniques as well as secondary musculoskeletal problems including PF dysfunction (Troyer, 2009). It is also important to keep the abdomen moving with techniques like manual therapy, stretching, and deep breathing. A study by Awad et al., in 2017 found that an 8-week exercise program improved pain levels and thoracic kyphosis in patients with endometriosis.

In Conclusion:

Individuals with endometriosis lost, on average, 10.8 hours of work weekly compared to those with similar symptoms and no endometriosis. People with endometriosis missed work mainly due to reduced effectiveness while working (Nnoaham et al., 2011). Another study found that women with endometriosis had a weekly loss of 5.3 hours of work. Loss of employment and household chore productivity were greater with increasing symptom severity (Soliman et al., 2017).

Endometriosis can limit individuals’ ability to “be physically active, obtain an education, work continuously, and interact with friends” (Rszala et al., 2022).

If you feel you may be experiencing symptoms of Endometriosis, I encourage you to seek the care of a trained pelvic health physical therapist.

Additionally, www.icarebetter.com is an amazing website that allows you to find highly trained professionals in your area skilled at treating Endometriosis.

Yours truly,

Dr. Jamie Bennett, PT, DPT