What is endometriosis?
Endometriosis (AKA endo) is a chronic condition that impacts 1 in 10 women, girls, and those with estrogen-dominant (female/ assigned female at birth) reproductive systems1. In endo, endometrial-like cells, similar to the ones that line the uterus, end up outside of the uterus. Like the endometrium inside the uterus, the endometrial-like cells are programmed to grow and then shed each month. The shedding products in your uterus can leave your body through the cervix and vagina causing your period. BUT if you have cells that act like your endometrium but they are locked inside your abdomen or your pelvis, they can’t escape. The cells are still trying to shed each month - with no exit from your body! Your immune system does NOT like this so you end up with a heightened immune response which leads to scarring and pain.
What kind of symptoms can people with endo experience?
Here’s the tricky part about endo – most people have painful periods, but not everyone! If we think about the pelvis, the organs of the urinary, reproductive, and digestive system are pretty tightly packed so people can experience symptoms in all of these body systems. That means you can have constipation, diarrhea, pain with pooping (dyskezia), painful sex (dyspareunia), painful urination (dysuria), urinary frequency, urinary urgency, urinary incontinence, difficulty emptying your bladder, infertility, bloating, gas, brain fog, and nausea. A great pelvic health physical therapist can help you with many of these symptoms!
Wait, endo can cause infertility?
Yes! 30-50% of people with unexplained infertility have endometriosis2. One recent study found that 90.7% of people who had failed assisted fertility had endometriosis3!
What should I do if I think I have endometriosis?
Start by talking to your primary care provider and/ or gynecologist. Though they might not have specialized training in managing endometriosis, they are your partner in care and should be on board with whatever treatment you seek. They may start by suggesting NSAIDS and/ or hormonal birth control. Often suppressing periods with continuous pills or IUD can be a good start. If you are trying to conceive, consider working with a reproductive endocrinologist.
The gold standard treatment for endometriosis is excision surgery where the surgeon removes as much endo as they possibly can. These surgeries can be extensive and require a specially trained surgeon – you want to see someone who is trained as a Minimally Invasive Gynecologic Surgeon (MIGS). While most gynecologists are trained in some surgeries, endometriosis excision is a specialty surgery and you want a someone with specialty training. Many surgeons offer ablation surgery which burns the surface off of endometrial lesions. It is much better to get them fully removed through excision.
Some additional resources to help you learn about endo are here.
Depending on your symptoms, you may also want to have other care providers on your team including an acupuncturist, dietitian, colorectal doctor, urologist, massage therapist, and/ or craniosacral therapist.
A great pelvic health physical therapist also should be on your care team. I can help you unwind the impacts that your endo has had on your body including muscular, nervous system, postural, and breathing changes. We will work on increasing your body’s ability to relax and ground itself. We will work on improving your ability to do what you want to do whether it’s pain-free sex, great bowel movements, fully emptying your bladder, wearing jeans, or preparing for hiking season.
References:
- https://www.who.int/news-room/fact-sheets/detail/endometriosis (Accessed 10/16/1014)
- https://www.reproductivefacts.org/globalassets/_rf/news-and-publications/bookletsfact-sheets/english-pdf/endometriosis_and_infertility_can_surgery_help-factsheet.pdf (Accessed 10/17/1014)
- https://www.mdpi.com/2077-0383/13/2/444 (Accessed 10/17/1014)