What is Endometriosis?
Happy March!
March is Endometriosis Awareness Month, a month dedicated to raising awareness of the condition, symptoms, and treatment options for women and girls worldwide who struggle with endometriosis. Endometriosis can affect anyone with a uterus, impacting about 11% of women between the ages of 15 and 44 in the United States and an estimated 190 million women and girls worldwide.
In this blog, we’ll learn about endometriosis, its symptoms, and causes, as well as how pelvic floor physical therapy can help relieve pain, improve mobility, and support better pelvic health.
So, What is Endometriosis?
Endometriosis occurs when endometrial-like tissue grows outside the uterus. These cells are normally only found in the uterus. They are actively involved in the growth and shedding of the uterine lining during menstruation, as well as the implantation of an embryo and the maintenance of a pregnancy.
Endometrial cells are sensitive to hormonal changes, especially estrogen, and they build up and shed accordingly during the menstrual cycle. When these cells are found outside of the uterus, they STILL respond to these hormone fluctuations, building up and bleeding each cycle. However, since there is nowhere for the tissue to go when it sheds, this buildup of tissue can lead to pain, inflammation, scar tissue, and adhesions.
If These Cells Aren't In The Uterus... Where Are They Growing??
Common implantation sites for endometrial tissues outside of the uterus include:
fallopian tubes
ligaments supporting the uterus
lining of the pelvic cavity
ovaries
the outside surface of the uterus
bladder
rectum
appendix
stomach
small intestine
cervix
diaphragm
What Are Some Things To Look Out For?
The symptoms of endometriosis will vary from person to person and may be more severe during a menstrual cycle. The most commonly reported symptoms include:
Painful menstrual cycles, usually pain in the low abdomen and/or low back
Pain during or after sex
Diarrhea or constipation (digestive issues)
Fatigue or low energy
Heavy and/or irregular periods
Pain with urination
Pain with bowel movements
Spotting between periods
Infertility
Many bowel and bladder symptoms occur due to adhesions restricting the movement of pelvic organs. Additionally, over half of women with endometriosis experience endometriosis-related fatigue (ERF), which can contribute to insomnia, depression, pain, and stress. The mechanism of ERF is not fully understood, but it is estimated that the body's immune response to try to fight inflammation causes this fatigue.
Infertility affects 30-40% of women with endometriosis, as the buildup of scar tissue and adhesions causes physical distortions in the pelvic cavity and obstructions to egg and sperm motility.
What Causes Endometriosis?
There are many different proposed mechanisms for the development of endometrial tissue outside of the uterus, but none have been proven definitively or consistent across all women. The most widely accepted theories are:
Blood or lymph transport: It is believed that endometrial cells can be transported to other parts of the body via the circulatory and lymphatics systems.
Direct or surgical transplantation: Endometrial cells may implant in other parts of the body during a surgery, like a C-section of hysterectomy. Endometrial cells have been found in some scar tissue sites from abdominal surgeries, supporting this theory.
Retrograde menstrual flow: During menstruation, it is believed that the flow can get backed up in the uterus and flow out of the fallopian tubes and into the abdominal cavity, where the endometrial cells will then implant.
Genetics: Women with immediate relatives that have endometriosis are 5-7x more likely to have the disease as well. Although there have been studies confirming this familial clustering, the exact genotype is unknown.
Environment: Certain environmental toxins, including dioxins, have been linked to the development of endometriosis.
How Is Endometriosis Diagnosed?
Currently, the gold standard for a definitive diagnosis of endometriosis is surgery via laparoscopy. A small camera is inserted into the abdomen, and the surgeon examines the abdominal cavity for signs of endometriosis. A small sample of the tissue is also taken for biopsy.
Endometriosis is classified into four stages depending on the number of lesions and the depth of the tissue:
Stage 1: Minimal endometriosis with few superficial implants
Stage 2: Mild endometriosis with more numerous superficial implants, but without the presence of cysts or adhesions
Stage 3: Moderate endometriosis with multiple deep implants, small cysts on one or both ovaries, and filmy adhesions
Stage 4: Severe endometriosis with many deep implants, large cysts on one or both ovaries, and many dense adhesions
Important: The severity of endometriosis does not always correlate with symptoms. Some women with mild endometriosis experience severe pain, while others with advanced endometriosis have few symptoms.
How Pelvic Floor Physical Therapy Can Help
Many women with endometriosis develop pelvic floor dysfunction due to chronic pain and inflammation. Pelvic floor PT can help by:
Reducing pelvic pain and muscle tightness
Improving bladder and bowel function
Enhancing mobility and reducing adhesions
Teaching pain management techniques
Addressing pain during sex
If you're experiencing symptoms of endometriosis, pelvic floor physical therapy can be an important part of your treatment plan!
Let’s Spread Endo Awareness!
Endometriosis affects millions of women and people with vaginas worldwide. This month, we will continue to spread information on endometriosis, treatment options, and how pelvic floor physical therapy can help. If you or someone you love is struggling with endometriosis symptoms, know that you’re not alone—and help is available. To take the first step in finding relief, request an appointment with one of our pelvic floor physical therapists.
About Pelvic Health & Wellness
Pelvic Health & Wellness was built with you in mind. We practice whole-person, individualized pelvic floor physical therapy in a caring and safe environment. Our physical therapists specialize in treating pelvic health concerns such as pelvic floor dysfunction, bowl and gut health, pain, prolapse, constipation, incontinence, fertility, and various pregnancy and postpartum-related conditions.
We understand that being ready to talk about and address your pelvic floor wellness concerns comes from a place of strength. We are here to support and encourage you on your journey back to health so you can return to doing what you love! If you are ready to take the first step in reclaiming your pelvic health and wellness, don't hesitate to get in touch with us today.