ENDOMETRIOSIS

What is it?

endometriosisEndometriosis is a female specific condition where cells similar to those that line the uterus (endometrial cells or endometrium), grow outside of the uterus in other parts of the body. In some women (not all) this can cause significant abdominal and pelvic pain, most often related to the menstrual cycle.

If your GP suspects Endometriosis from your description of symptoms (see below) and your symptoms are having a profound effect on your quality of life – you may be referred to a Gynaecologist for an investigative laparoscopic procedure either to diagnose, or refute the clinical impression of endometriosis.

Endometriosis affects 1 in 10 women of reproductive age and in the recent past, has taken an average of 7-10 years to be diagnosed. This is due to the ‘normalisation’ of symptoms associated with the menstrual cycle (eg no clear distinction/understanding of ‘normal period pain’ vs ‘abnormal period pain’).

In the last few years government funding for research into endometriosis has raised public and medical awareness around this condition. This has resulted in improved understanding, treatment and management for women suffering from endometriosis.

Causes

  • The exact causes for endometriosis are yet to be identified, however some theories are:
    • Genetic predisposition (ie family history)
    • Retrograde menstruation and the immune system:
    • menstrual fluid flows backwards into the open-ended fallopian tubes as well as out through the vagina during a woman’s period. The menstrual fluid includes endometrial cells which may end up in the pelvic cavity through retrograde menstruation.
    • In most women, these cells are destroyed by the immune system
    • However in 10% of women, it is postulated that the immune system is unable to control or stop the growth of the endometrial cells. The cells stick and grow on tissues/organs in the pelvic cavity (eg such as bladder/bowel) which may cause pain and discomfort.


Risk Factors

Include:

  • Family history of endometriosis
  • Menstrual cycle factors:
      • History of heavy and/or painful periods
      • Periods lasting longer than 1 week
      • Period at an early age (11yrs)
      • Short menstrual cycle (less than 27 days)

Symptoms

Include:

  • Premenstrual symptoms (eg nausea/lethargy/pain)
  • Abnormal periods:
      • Having to change tampons/pads every hour or so
      • Severe pain that causes you to miss school, work or other activities on a regular basis
  • Pain associated with bladder and/or bowel function
  • Abdominal-pelvic pain
  • Low back pain
  • Pain with sexual intercourse
  • Pain with tampons/PAP smears

Physiotherapy Treatment

  • Detailed education about your condition tailored to your specific circumstances
  • Manual therapy for tight and painful muscles, especially the muscles of the pelvic floor
  • Targeted treatment aimed at improving pain with functional activities such as:
      • sexual intercourse
      • PAP/cervical screens
      • tampon use
  • Lifestyle interventions which may include:
      • Developing an appropriate general exercise program to improve fatigue and mental clarity
      • Strategies to help manage pain flare-ups
      • A pelvic floor muscle training home regime

Other Treatment Options

Endometriosis is best treated collaboratively with a specialist team and may include:

  • Medication prescribed by your GP or specialist which may include anti-inflammatory medication and hormone treatment (eg oral contraceptive pill; Mirena)
  • Dietician: to address potential/actual dietary inflammatory contributors
  • Specialist pain psychologist
  • Surgery: usually performed by a Gynaecologist experienced with endometriosis and persistent pelvic pain

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