Understanding Endometriosis: Symptoms, Treatment, and How Pelvic Health Physiotherapy Can Help
September 4, 2024
Endometriosis is a chronic condition that happens when endometrial-like tissue (aka the tissue that usually lines the uterus) is present outside of the uterus. Estimated to affect about 10% of women of reproductive age globally, and an unknown number of gender-diverse folks, endometriosis is believed to affect roughly 1 million people in Canada.
Research has shown that 40 to 50% of women and adolescents with persistent pelvic pain and 30 to 40% of women with infertility have endometriosis. (Note that endometriosis can make it more difficult to become pregnant, but it’s still possible for folks with endometriosis to have children.)
Endometriosis Symptoms
Because endometriosis can lead to estrogen-driven inflammation, the most common symptom is severe menstrual cramps (or dysmenorrhea). Unfortunately, these typically don’t respond to over-the-counter pain medications and can get in the way of attending school, work, or other activities.
Other common symptoms include experiencing deep pain during penetrative sex (referred to as deep dyspareunia) or pain in the pelvis or lower abdomen. Endometriosis can also be associated with chronic pelvic pain, fatigue, and infertility.
In some cases, people with endometriosis can develop more complex and persistent pain due to a phenomenon called “central sensitization”. Essentially, this means that the nervous system becomes more sensitive to pain: there’s a lower threshold to trigger a painful sensation, which can lead to a vicious cycle of further sensitivity, leading to chronic pain.
This can happen even if there’s no actual or potential damage to your tissue. However, it can lead to chronic pelvic pain and other chronic pain conditions like vulvodynia, irritable bowel syndrome, and painful bladder syndrome.
It’s important to note that endometriosis symptoms can vary in severity. Having more severe symptoms also doesn’t mean that your endometriosis is more severe. Every body is different!
When it comes to onset timing, many folks report their symptoms beginning in adolescence and improving at menopause, but some might continue to experience pain after menopause.
Treating Endometriosis
While there is unfortunately no cure for endometriosis, there are lots of treatment approaches that can help with symptoms:
- Medical treatments, like taking hormones or undergoing surgery
- Physiotherapy treatments that look at how your musculoskeletal and nervous systems relate to your symptoms
- Psychological consultation with a psychologist or counsellor to help manage any secondary psychological effects related to endometriosis is also recommended.
- Diet may also play a role in treating endometriosis, but further research is still needed to confirm and understand this.
Current research suggests that early treatment of endometriosis – and any pain associated with it – might decrease the risk that a patient develops chronic pain. This is just one of the reasons why it’s so important to assess and start treating endometriosis as early as possible.
Diagnosing Endometriosis
Until recently, endometriosis has usually been diagnosed via laparoscopy, a surgical procedure that is used to examine the organs in the abdomen or pelvis via a tiny camera attached to a thin, tube-like instrument. However, recent guidelines support diagnosis based on symptoms and findings from physical examination and imaging.
Unfortunately, like menstruation and other gynecological topics and conditions, endometriosis has historically been associated with shame, stigma, and patient gaslighting. Health providers and patients alike have also tended to lack sufficient knowledge about the condition, making it difficult to diagnose and treat in a timely or effective way.
While righting these wrongs is long overdue, we’re proud to see more companies stepping up to destigmatize menstrual health and create an open dialogue around historically uncomfortable topics. Two examples we love are joni’s Once Upon a Time of the Month campaign and Knix’s Sport Your Period campaign.
Opening up the conversation and creating more awareness around endometriosis is only part of the solution, however. Healthcare providers should also be routinely asking patients about their menstrual cycle and screening for endometriosis symptoms.
How Physiotherapy Can Help With Endometriosis
Seeing a pelvic health physiotherapist is a great way to take care of your overall menstrual health, from screening for symptoms to managing menstrual pain. Pelvic health practitioners routinely ask menstrual health questions, which can help identify any issues early and ensure that patients are directed to healthcare providers who can provide the appropriate medical treatments.
Pelvic health physiotherapists can also help manage pain and muscle tension associated with endometriosis. Our nervous system is hard-wired to protect us, but one of the ways it does that is by tightening up the muscles around an area of pain. Unfortunately, this muscle tension can contribute to further pain, potentially leading to impaired movement or stiffness in the joints of the lower back, pelvis, and hips.
Muscle tension can also affect breathing, and bowel, bladder and sexual function. A pelvic health physiotherapist can help you understand all these connections, and teach you strategies to decrease tension, and breathe, move, and function more easily. This might include a mix of education, exercise, and manual therapy.
Need some support?
Don’t let endometriosis or menstrual pain get in the way of living your life. We can develop a treatment plan specific to you. If you’re a new client, get matched with a physiotherapist here. If you’re a current client, book here.
Alllaire C, Bedaiwy M, Yong P. Diagnosis and management of endometriosis. CMAJ. March 14, 2023. 195(10: E363-371)