Definition

Endometriosis is a condition where tissue that resembles the

tissue lining the uterus (endometrium) grows outside of the

uterus. The endometriosis growths can cause inflammation and

adhesions to form within the body.

Endometriosis is most common in the abdominopelvic cavity

although in rare cases it has been found elsewhere. Science

cannot yet explain why endometriosis occurs, which means

that currently there is no cure.

Common symptoms:

• Chronic Pelvic Pain 
• Painful intercourse
• Pain with menstruation
• How back/hip/ groin pain 
• Infertility
• IBS
• Bloating
• Diarrhea/constipation
• Difficulty emptying bowel/bladder
• Painful bowel movements

Diagnosis

The only definitive method of diagnosis for

endometriosis is laparoscopy - surgery and analysis of

the extracted tissue to identify whether or not it is

endometriosis. MRI's, ultrasounds or other tests can help

to rule out potential causes of symptoms but cannot

diagnose endometriosis.

Endometriosis affects one in ten women, though

research shows that it typically takes 6-10 years to

receive a definitive diagnosis. This is often because of

the medical field's lack of common knowledge of

endometriosis.

One study showed that 63% of general practitioners felt

uncomfortable diagnosing or treating patients with

endometriosis. 50% could not list three main symptoms

of endometriosis. Yet only 24% referred a patient

immediately to a specialist.

Treatment

Treatment of endometriosis is difficult because

there is no known cause of the condition. As a

result, even the best treatments cannot cure

endometriosis. Because there is no cure,

treatment of endometriosis is the most

successful when the condition is addressed

from all perspectives - a multidisciplinary

approach including combinations of the

following treatments.

• Surgery
• Hormone Therapy
• Physical Therapy
• Pain medication
• Alternative treatments

Surgery

Excision surgery to remove endometriosis is the gold standard of endometriosis treatment. It has been shown to reduce pelvic pain and may improve fertility in women with endometriosis. Unfortunately, these gains are not always permanent. Between 21- 37% of women request a follow-up surgery within two years due to pain. At five years post-op, that number rises to nearly half of women with endometriosis. Other surgery options such as ablation surgery or hysterectomy should be approached with caution. Ablation surgery involves burning away the endometriosis growths but should be avoided due to high rates of regrowth after surgery - likely because the method is not able to completely remove all of the endometriosis. If the surgery is being performed to diagnose and remove the endometriosis, ablation is not advisable because it will destroy the tissue, leaving nothing to examine in order to verify that it is endometriosis. Any surgical site should be carefully treated after it heals to prevent the scar tissue from adhering and causing additional pain or symptoms. Pelvic floor physical therapy after surgery mobilizes the scar tissue to minimize the impact of the surgery and restore normal movement after recovery.

Hormone Therapy

Most women with endometriosis notice their symptoms are cyclical, peaking at different periods of their menstrual cycle -- often during menstruation but sometimes during other stages. Hormone therapy aims to stabilize hormones throughout the cycle. These treatments can be highly effective for reducing symptoms (except infertility) but do not cure endometriosis. Symptoms resume once the hormone therapy is stopped. All forms of hormone therapy present a risk for various side effects that should be discussed with a physician.

Contraceptives - Hormonal contraceptives have been shown to reduce pain and endometriosis symptoms, particularly those associated with the menstrual cycle. Menstrual flow is typically more regular, lighter, and shorter in women on hormonal contraceptives. It can sometimes stop menstrual periods. They can come in the form of "the pill", vaginal ring, or patch. Continuous oral contraceptives have been shown to be more effective in some cases than cyclical contraception. Progestin - Use of a progestin implant (such as an IUD), injection, or progestin-only oral contraceptives can stop menstrual periods and the associated pain for women with endometriosis. Gonadotropin-releasing hormone agonists (GnRH) - This treatment blocks the production of estrogen; in essence, it artificially induces (temporary) menopause and decreases symptoms associated. GnRH has a high risk for serious side effects, so it is recommended to take along with hormonal contraceptives as "add-back" therapy to minimize the side effects.

Physical Therapy is where myself and other pelvic PTs come in to play!

Multiple studies have shown that there is no correlation

between the amount of endometrial growth and pelvic

pain; often, the pelvic pain is due to trigger points in

the pelvic floor muscles, chronic inflammation in the

pelvic region, adhesions from endometriosis and scar

adhesions from previous surgeries.

Physical therapists who specialize in treating the pelvic

floor and conditions such as endometriosis are trained to

evaluate and treat these symptoms. Physical therapy

works to relieve endometriosis symptoms by releasing

these trigger points, clearing inflammation, restoring

normal blood circulation, and releasing painful scar

adhesions. Patients are also taught self treatment skills

to independently manage their symptoms. Not all

physical therapists have the same training, so it is

important to find a qualified pelvic physical therapist.

Pain medications

Many women with endometriosis find that over-the-counter or prescription medication can help manage pain. Options range from NSAIDs to medical marijuana to opioid painkillers in cases of extreme chronic pelvic pain. When considering these options, it is important to ask your doctor about possible side effects, especially with long-term use.

Alternative treatments

1) ACUPUNCTURE: Two separate, randomized clinical trials have shown that acupuncture can decrease pelvic pain associated with endometriosis by up to 62%.

2) YOGA: Eight weeks of yoga classes twice per week helped improve quality of life, lowered daily pain, and improved overall well-being and self-image in women with endometriosis

3) STRESS REDUCTION: Chronic pain or even the knowledge of an endometriosis diagnosis can be extremely stressful. Research has shown that stress can amplify pain and symptoms, while regaining a sense of control over your body can reduce both. In one study of women with endometriosis, the combination of psycho-therapy and physical therapy was shown to decrease pain, perceived stress, and even the levels of stress hormones in the bloodstream! Mindfulness is another practice to decrease stress.

4) DIET : Reducing inflammatory foods and eating a healthy, balanced diet may help reduce symptoms of endometriosis. In one study, 73% of participants with endometriosis who went on a gluten free diet for 12 months had a significant reduction in symptoms. Because digestive issues sometimes accompany endometriosis, it is worthwhile to regularly check for vitamin and mineral deficiencies and address any areas that are lacking with diet or supplements.

5) SUPPLEMENTS: Quercetin, Reservatol, Pycnogenol, Omega 3 fish oil, L-Arginine

Some of your team members may include:

GYNECOLOGIST (specialized in laproscopic excision surgery)

PELVIC FLOOR PHYSICAL THERAPIST

NATUROPATHIC DOCTOR

PSYCHOLOGIST OR THERAPIST

NUTRITIONIST

ACUPUNCTURIST

YOGA INSTRUCTOR

Other specialists depending on your symptoms:

PAIN MANAGEMENT DOCTOR

UROLOGIST OR UROGYNECOLOGIST OBSTETRICIAN-GYNECOLOGIST

GI DOCTOR

FERTILITY DOCTOR

ENDOCRINOLOGIST

SPECIALTY SURGEON (COLORECTAL, ORTHOPEDIC, ETC)

Reference: Pelvic Sanity Hello Endo: An Intro to Endometriosis 

Check out this article from Harvard about 5 myths about endometriosis

5 myths about endometriosis - Harvard Health