What is Endometriosis: Symptoms, Causes and How to Manage it?
What is endometriosis?
Endometriosis is a chronic inflammatory condition where tissue very similar to that which lines the uterus (endometrial tissue) is found outside the uterus, most commonly in the pelvis.
The endometrial tissue of your uterus responds to hormones during your menstrual cycle. Hormones signal endometrial tissue to grow to provide a suitable environment for a pregnancy. If pregnancy does not occur that cycle, different hormonal changes signal the lining to shed, which is when you get your period.
The endometrial-like tissue outside the uterus also responds to these same hormonal changes, so it grows, which can itself cause symptoms, and it sheds which leads to bleeding into the abdomen and pelvis.
What are the symptoms of endometriosis?
The presence of this tissue outside the uterus, the bleeding into the abdomen and pelvis and then the inflammation and scarring that result from this, can all cause symptoms. Some of the symptoms are very common, and others depend on the location of the endometriosis - for example, if it is attached to your ovary, bladder or bowel. Some women with endometriosis don’t have any symptoms.
The most common endometriosis symptoms in women is pain. Endometriosis is one of the causes of painful periods and others such as:
Pain at other times of the cycle (eg. ovulation)
Pain during intercourse
Pain when they do a wee or poo
Pelvic pain during menstruation is also common but may also be in other areas of the abdomen, back and thighs. The pain can be completely debilitating.
Other endometriosis symptoms include:
Heavy periods
Fatigue
Bloating
Bladder or bowel problems eg needing to wee more often, constipation or diarrhoea
You should see your doctor if you experience any of these endometriosis symptoms.
How common is endometriosis?
1 in 7 women in Australia have endometriosis.
What causes endometriosis?
We aren’t really sure what causes endometriosis. There is certainly a genetic component - if your mother or sister has endometriosis you are almost 10 times more likely to develop it than someone without any relatives with endometriosis. There is also a theory that in those with endometriosis, period blood may go backwards up the fallopian tubes and into the abdominal cavity.
How is endometriosis diagnosed?
Endometriosis is normally diagnosed based on your symptoms, especially when investigating the causes of painful periods that don't respond to standard treatments. Sometimes, changes can be seen on an ultrasound of your pelvis. However, the only way to truly see endometriosis is to have keyhole surgery called a laparoscopy. As surgery is a big deal and involves risks, it is reserved for specific cases only.
What are the complications of endometriosis and what conditions can it be associated with?
It isn’t just important to diagnose and manage endometriosis to help with symptoms like pain during intercourse or severe period pain—it’s also crucial because the condition is associated with other health risks. Being aware of these risks can help guide early intervention and support.
Endometriosis can be associated with fertility issues—30–50% of women with endometriosis find it hard to get pregnant, which is about 2–4 times that of the general population.
Aside from fertility issues, endometriosis is also associated with a range of other conditions including:
Cardiovascular disease - those with endometriosis experience 20% increased risk of heart attack and strokes
Autoimmune diseases
Early menopause
Some cancers like thyroid, breast and ovarian cancer.
Anxiety and depression
Can endometriosis be cured? What does treatment for endometriosis look like?
Unfortunately, there is no cure for endometriosis. However, there are many options available to help with the symptoms of endometriosis including physical therapy, medications and surgery.
Pain Relief Medications
Medications available over-the counter such as paracetamol and Non-Steroidal Anti-Inflammatories (NSAIDs - Ibuprofen, Naprogesic, Ponstan) can help with pain. Some people may also require other prescription-only pain medications.
Hormonal Medications
These medications help to suppress the menstrual cycle and so reduce the growth of endometrial tissue inside and outside the uterus. They include oral medications such as the combined oral contraceptive pill (the pill) or the progesterone only pill. There are also intra-uterine devices (IUDs), implants and injections.
Surgery
Laparoscopy is keyhole surgery that can be used to diagnose endometriosis, but the surgeon can also remove the endometriosis tissue at the same time, which can improve symptoms too. The endometriosis tissue tends to grow back so it is important to continue with hormonal suppressive therapy after surgery. Its important to note that hormonal suppressive therapy and hormonal replacement therapy are not the same.
Some women require a hysterectomy, which is the removal of the uterus, if they have severe symptoms which are unable to be controlled in other ways.
Physiotherapy
Pelvic physiotherapists are physiotherapists with extra training in conditions affecting the pelvis. Physiotherapy can be very helpful in managing pelvic pain during menstruation or other times in your cycle occurring for many reasons including endometriosis.
Looking to manage your endometriosis symptoms effectively?
Let us help! At Ponti Health, alongside our team of women’s health GPs, we have a team of expert women’s health physiotherapists who can help you manage the symptoms of endometriosis through pelvic physiotherapy effectively. Book your first appointment with Ponti Health today!