Endometriosis Explained: Causes, Symptoms, Risk Factors & Treatment Options

What is Endometriosis?

Endometriosis is defined as the presence of endometrial-like tissue outside the uterus. While this tissue is normally found within the uterus, in endometriosis it can appear in other parts of the body, including the chest and, in severe cases, even the brain.

Who is Impacted by Endometriosis?

Endometriosis is a gynecological diagnosis affecting approximately 5.5 million women in the United States, with an estimated annual cost of around 49 billion dollars. Globally, it affects about 6–10% of women.

Diagnosis can take an average of 7–8 years and is typically confirmed through exploratory laparoscopic surgery with biopsy.

Endometriosis most commonly occurs in women of childbearing age and is associated with a high degree of morbidity. It is a leading cause of pelvic pain, infertility, hysterectomy, and gynecological hospitalizations. The condition can be cyclic, often worsening with menstrual cycles, though symptoms may persist throughout all phases of menstruation.

What Are Some Risk Factors for Endometriosis?

• Being of childbearing age

• Shorter menstrual cycles (less than 27 days)

• Early onset of menstruation

• Genetic predisposition

  
  

What Are Common Symptoms of Endometriosis?

• Pain with sexual activity (dyspareunia)

• Painful bowel movements

• Cyclical pelvic pain, which may become constant in severe cases

• Painful periods that require pain medication

• Intense rectal pain

• Back, hip, and lower abdominal pain

• Pain after orgasm or anorgasmia (inability to reach orgasm)

• Constipation

• Fatigue

• Nausea and vomiting

• The "evil triplets" of pelvic pain: interstitial cystitis, pudendal neuralgia, and endometriosis

• Difficulty emptying the bladder

• Inability to tolerate gynecological exams

  
  

What Are Possible Treatment Options?

There is currently no cure for endometriosis, but several treatment options are available.

Surgical Interventions:

• Laparoscopic surgery to remove endometrial tissue, often followed by IUD placement and oral birth control to manage hormonal impact

• Hysterectomy (removal of the uterus)

• Oophorectomy (removal of the ovaries)

• Salpingo-oophorectomy (removal of the fallopian tubes and ovaries)

  
  

Non-Surgical Interventions:

• Physical therapy

• Dietary changes

  • Consider a multivitamin (including vitamins B, C, and E), with approval from your healthcare provider

  • Consider a gluten-free diet

  • Focus on a low-inflammatory diet

• Exercise

• Hormonal medication therapies

  
  

The Role of Physical Therapy in Endometriosis Management

Physical therapy offers a non-surgical approach to managing endometriosis-related pain and dysfunction. After a thorough musculoskeletal assessment of the thoracic, lumbar, and pelvic girdle regions, treatment may include:

• Movement and flexibility assessment

• Evaluation of the abdominal wall, pelvic floor muscles, obturator internus, rectus femoris, psoas, iliacus, and lumbar musculature

• Education and practice of proper diaphragmatic breathing

• Pelvic floor muscle stretching

• Manual therapy for tense or tight muscles

• Strengthening exercises for weak muscles

• Dilator or pelvic wand training (if pelvic floor tension is present)

• Pain education

• Down-training (muscle relaxation techniques)

• Education on bowel-emptying techniques

At IVY Integrative, you can work with our pelvic floor therapist or build your own team of holistic practitioners including our naturopathic doctors and nutritionists! Reach your optimum health in-person or online. Check out our Get Started page to learn how to work with us!

Author: Dr. Mièka Bryan PT, DPT

References:

1. Minerva Chir. 2012 Dec;67(6):499-504. ‘Gluten-free diet: a new strategy for 

   management of painful endometriosis related symptoms?’ Marziali M, Venza M, Lazzaro 

   S, Lazzaro A, Micossi C, Stolfi VM.

2. J Endometr. 2013 Jan 1; 5(1): 17–26 ‘A prospective cohort study of Vitamins B, C, E, 

   and multivitamin intake and endometriosis’ Anne Marie Darling,1 Jorge E.

3. Phys Ther. 2007 Jun;87(6):801-10. Epub 2007 Apr 18. ‘Differential diagnosis of 

   endometriosis in a young adult woman with nonspecific low back pain.’ Troyer MR

   Arch Phys Med Rehabil. 1989 Mar;70(3):220-9. ‘Exercise and osteoporosis.’ Sinaki M

4. Journal of Endometriosis 2011; 3(4): 188 – 196 DOI:10.5301/JE.2012.9088 Decreasing 

   dyspareunia and dysmenorrhea in women with endometriosis via a a manual physical 

   therapy: Results from two independent studies’ Wurn, B et al

   https://www.asrm.org/BOOKLET_Endometriosis/: The American Society for 

   Reproductive Medicine Guidelines on Endometriosis

Disclaimer: This information is generalized and intended for educational purposes only. Due to potential individual contraindications, please see your primary care provider before implementing any strategies in these posts.