Endometriosis is a debilitating female disease that disrupts her job, psychological functions, relationships, social interactions, exercise or sport participation and fertility which significantly restricts her quality of life. It can cause pelvic pain, back pain, weight gain, menstrual cycle irregularities, cramping, heavy bleeding, pain with sex, urinary issues and bowel or elimination problems as well as causing fertility complications. Endometriosis is an inflammatory condition where estrogen fed “lesions” are present in the pelvic bowl around the bladder, rectum, ovaries and uterus, all throughout the abdominal cavity and organs, along the diaphragm, in or around the lungs and heart and even in the brain and spinal cord. 1 in 10 women in the US suffer from the disease and it takes on average, 8 years for diagnosis and treatment to commence. It costs approximately $18 billion per year in medical care, pharmaceuticals, lost productivity and personal hygiene and pain control products. We are unsure of the origins of the disease which are constantly being researched yet there have been studies indicating it can be found in fetal tissue indicating some women are born with it.

It is not seen on diagnostic testing like MRI’s or CT scans although the presence of an ovarian cyst or pelvic mass might alert the medical provider to the possibility of endometriosis. The diagnosis is made initially by the symptom presentation as listed above and if any treatments for those symptoms have been successful. Commonly, hormones or birth control are used as the first line, then pain, anti anxiety or other symptom controlling medications might be added. Because women have been taught that having pain with their periods is normal and many medical practitioners do not know how to identify the clusters of symptoms, they don’t often get the medical attention they deserve. Currently, the only definitive way to diagnose the disease is by seeing the actual lesions in surgery and doing a biopsy of the lesions. Not many women want to undergo exploratory surgery unless they are desperate.

In the past, attempts were made to control the disease by cutting out the uterus or ovaries to limit the effects of estrogen or cutting off the top of the lesions (ablation). The gold standard for treatment now is to excise or cut out the disease itself all the way to the root (excision). Even with removal of the uterus and ovaries, there could still be symptoms. Research now shows that the lesions themselves can create their own estrogen and progesterone supply meaning menopausal women can also suffer with these debilitating symptoms. The lesions have to be removed, period! Ladies, if you don’t get anything out of this blog, understand that painful periods and heavy bleeding are NOT normal!

Physical therapy can be helpful with the symptoms of endometriosis before and after surgical excision. Techniques to treat pain, improving tissue mobility around the scars or adhesions, trigger point releases, nerve glides, relaxation techniques, stretching and flexibility exercises, spinal mobilization, dry needling are a few modalities used to help improve the quality of life for endometriosis sufferers.

Mehedintu, C., Plotogea, M. N., Ionescu, S., & Antonovici, M. (2014). Endometriosis still a challenge. Journal of medicine and life, 7(3), 349–357.

Mounsey, A. L., Wilgus, A., & Slawson, D. C. (2006). Diagnosis and management of endometriosis. American family physician, 74(4), 594–600.

https://www.iahe.com/docs/articles/Endometriosis_and_Physical_Therapy__VM_included_.pdf