Endometriosis affects 1 in 10 reproductive-aged individuals across all races. Endometriosis occurs when the endometrium, or lining of the uterus, grows outside of the uterus in the pelvis and abdomen.
Endometriosis can grow on the ovaries, fallopian tubes, intestines, bladder, and lining of the pelvis, and has been identified in almost every organ of the body. Endometriotic implants grow in response to estrogen and can trigger an inflammatory response in the pelvis. This inflammation is what causes painful symptoms.
What are the Symptoms of Endometriosis?
The classic presentation of endometriosis is extremely painful periods. The pain typically begins before your period and continues until after the period is over. Patients with endometriosis often describe pain in their lower abdomen that travels to their back and down their legs.
Other common symptoms include:
- Pain with sex
- Pain with bowel movements
- Painful urination
- Pelvic pain outside of periods.
Endometriosis can also cause infertility. Up to 7 in 10 of those with pelvic pain and infertility will have endometriosis.
However, some patients with endometriosis are asymptomatic or have very mild symptoms. The severity of symptoms does not correlate with how much endometriosis is present at the time of surgery.
How is Endometriosis Diagnosed?
Endometriosis is underdiagnosed because the only way to definitively confirm endometriosis is with a biopsy performed during surgery. On average, patients see seven doctors over seven years between symptom onset and diagnosis.
In the primary care setting, endometriosis is a clinical diagnosis based primarily on history and physical exam. There are no accurate blood tests for endometriosis however medical providers can use imaging (such as an ultrasound) to narrow their diagnosis for endometriosis.
Medical professionals can presume endometriosis in patients with classic symptoms and begin treatment without surgery. The more symptoms a patient has, the more likely they will have endometriosis at the time of surgery.
Treatment for Endometriosis
- Medical - Patients with painful periods should start by taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or celecoxib. If the pain does not improve, your doctor may recommend hormonal medication to help relieve your symptoms. Hormonal options include the combined (estrogen and progesterone) birth control pill, progesterone-only pill, Depo Provera shot, the progesterone intrauterine devices (IUDs), and gonadotropin-releasing hormone (GnRH) agonists and antagonists.
- Surgical - Surgery for endometriosis is recommended when medical management is not effective. The goal of surgery is to both diagnose and treat endometriosis by removing and/or destroying the implants. This can improve pain and quality of life in patients with endometriosis. Typically, this surgery is performed through a minimally invasive approach (either laparoscopic or robotic) and does not require an overnight hospital stay. Surgery for endometriosis can be very difficult due to the scarring endometriosis causes. Consult with your provider to ensure your surgeon is experienced with endometriosis surgery.
What is the Role of Pelvic Floor Physical Therapy in the Treatment of Endometriosis?
Patients suffering from endometriosis can also experience dysfunction in their pelvic floor. Chronic pain can cause trauma to the muscles, ligaments, nerves, and fascia of the pelvis and abdominal wall. This can result in pain in the pelvis, difficulty urinating, difficulty having bowel movements, painful sex, and pain with movement.
Pelvic floor therapy directly targets the pelvic floor to improve patients’ symptoms. Research shows patients with endometriosis have improved pain relief when treated with pelvic floor physical therapy after surgery. Pelvic floor physical therapy combines exercises, stretches, manual techniques, and behavior modification to improve patients’ quality of life. Pelvic floor physical therapists partner with the patient to identify their function and quality of life goals to achieve maximal results.
Why Should Patients Care About Endometriosis?
Many patients suffer from painful periods without knowing why. Patients whose quality of life is impacted by their pelvic pain, painful periods, painful sex, or infertility should seek consultation with their doctor about treatment options. You should not be missing work, school, or social events, or limiting your daily activity due to painful periods.
Partner with your healthcare provider to determine if you suffer from endometriosis. If you have questions or concerns related to endometriosis or pelvic floor therapy, contact the MIGS team.
Disclaimer: While I am a doctor, I am not your doctor. The content in this blog is for informational and educational purposes only and should not serve as medical advice, consultation, or diagnosis. If you have a medical concern, please consult your healthcare provider, or seek immediate medical treatment.