Endometriosis is not well understood condition, but it is very common. It has huge impact on women globally. It affects as many as 10% of women at reproductive age.
There are many theories about what causes it, but the etiology of endometriosis is not fully known. Many factors are considered to play a role here (e.g., genetics, immune dysfunction, inflammation, retrograde menstruation), while some experts think it may be a combination of disorders. Some studies suggest it may start as early as in the fetal life.
Most commonly, it occurs in the pelvis and abdomen cavity, but it can occur anywhere in the body (eg. heart, lungs, brain).
Endometrium is the lining of the uterus that is contained within the womb in women without endometriosis. Like-endometrium tissue (which seems to be more proinflammatory) is found outside the womb in women with endometriosis.
Are endometriosis and adenomyosis the same?
Endometriosis and adenomyosis were at one point considered the same condition. They differ, but many women will have both as there is an overlap.
Adenomyosis is where there is abnormal endometrial tissue developing within the muscle of the womb (the myometrium).
Sings of adenomyosis:
- more common in women age 30-40
- painful, heavy periods
- thickened uterus
- bleeding between periods
- crampy pain after intercourse
Signs of endometriosis:
- more common in teens and women in their 20`s
- painful periods, but not necessary heavy periods where pain may last few days after menstruation
- painful intercourse (especially deep penetration)
- pain with bowel movements (often suggests that the endometriosis is impacting near bowel)
- painful bladder and frequent urination (often suggests that the endometriosis is impacting near bladder)
- radiation pain down the leg (often suggests that the endometriosis is irritating some of the nerves within the pelvis)
Diagnosis
It takes approximately 9 years to achieve the diagnosis. It may be because symptoms can be quite subtle at the beginning, like some pain with menstruation (pain is subjective, we all perceive it differently and have different pain thresholds). Endometriosis can often be mistaken for other conditions that can cause pelvic pain (such as ovarian cysts, irritable bowel syndrome (which can coexist with endometriosis). Often, there are no features on ultrasound or physical examination. The definite way to diagnose seems to be laparoscopy, so called keyhole surgery (downside is that it is invasive and can cause scarring).
Types of endometriosis
There are different types of endometriosis:
- deeply infiltrating endometriosis where nodular disease is present, affecting bowel and/or pelvis and it can be visible on ultrasound
- endometriosis related ovarian cysts (so called chocolate cysts), which are also easy to detect on ultrasound
- superficial peritoneal endometriosis (the most common), which is difficult to see on imaging and it is likely that laparoscopy will be needed.
Can endometriosis affect fertility?
Endometriosis can affect woman`s ability to get pregnant. Firstly, it is difficult for women to have regular intercourse due to pain. Secondly, endometriosis is an inflammatory condition that can negatively affect ovaries and fallopian tubes function.
The good news is that majority of women will be able to get pregnant. When endometriosis is treated surgically (excision which is ”cutting it away” or ablation which is ”burning it away”) and/or conservatively and overall endometriosis is improved, women increase their chances of getting pregnant naturally. Some women, however, will require IVF. It is important to remember that not all women will require surgery and conservative options are worth exploring.
Non-surgical management
Conservative treatment may involve:
- physiotherapy
- pain relief (NSAID`s, paracetamol)
- hormonal therapy (progesterone only pill, coil- for women who are not trying to get pregnant)
- yoga
- diet
- acupuncture
Can endometriosis be cured with hysterectomy?
Hysterectomy, which is a surgical procedure to remove the womb, is not curative for classical endometriosis (which affects outside of the womb). Some studies suggest that it can be potentially beneficial for adenomyosis (abnormal endometrial tissue developing within the muscle of the womb). However, it is an invasive, controversial treatment and carries long-term risks.
Physiotherapy
Physiotherapy can greatly improve the quality of life of women with endometriosis. Treatment may involve:
- thorough examination (pelvic floor, pelvis, spine, hips, abdomen)
- manual therapy (external and/or internal such as per vaginam, per rectum)
- visceral mobilizations
- exercise program
- pain management techniques (such as relaxation techniques)
The goal of the physiotherapy is to:
- restore movement within the pelvic floor, pelvis, hips and spine
- improve bowel and bladder function
- improve sexual function (painful intercourse)
- improve period pain
- equip women with tools for self-management through movement
- empower and support women on their journey to better quality of life
Click the link below, if you are not sure what to expect on the first women`s health physio visit:https://mnaphysiotherapy.wordpress.com/2021/06/18/what-happens-at-the-first-womens-health-physiotherapy-appointment/
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