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Endometriosis is a disease in which similar tissue to the tissue that lines the uterus (endometrium) is found elsewhere in the body. It most commonly affects the ovaries, fallopian tubes, and the tissue lining of the pelvis. The surrounding tissue can become irritated and scar tissue can form. These bands of fibrous tissue called adhesions can reduce mobility between the pelvic tissue and the pelvic organs.
While this tissue is most commonly found in the abdomen and pelvis, it can be found elsewhere. When I worked at Emory University Hospital in Atlanta, there were patients we helped with rehabilitation after video-assisted minimally invasive surgery (VATS) to remove endometriosis from the lung tissue (thoracic endometriosis).
Endometriosis is a chronic inflammatory disease that is mediated by estrogen. It is estimated to affect 1 in 10 women. Often the disease is hidden or undetected as an official diagnosis is often delayed for years. This could lead to frustration and many years spent with significant symptoms. While endometrial lesions can be seen via ultrasound or with an MRI, visual inspection by laparoscopy with histological confirmation is the gold standard to confirm a diagnosis.
Each woman’s journey with endometriosis is different, and symptom intensity is not always correlated with the extent of the disease. Symptoms of endometriosis can include:
Infertility
Fatigue
Stomach problems including bloating, nausea and indigestion
Urinary urgency and frequency
Pelvic floor dysfunction
Pain with sex
Pain with urination and/or with bowel movements
Pain during menstruation
Pain can occur in the abdomen, the pelvis and/or the back.
It is estimated that 90% of women with endometriosis have pelvic floor dysfunction, often a tight pelvic floor can be the source or at least a factor leading to some of the symptoms. Pelvic floor dysfunction alone can cause dyspareunia or pain with sex. Because the endometrial innervated lesions can be found on the cervix, the disease itself can cause pain with sex.
Superficial and deep dyspareunia can be present with endometriosis with early signs of superficial discomfort may be painful pelvic exams, painful tampon use and dysuria or pain with urination. It is important to note that there are many other reasons this superficial pain could be present without underlying endometriosis.
The management of endometriosis takes a multidisciplinary approach. Pelvic physical therapy can offer symptomatic relief, but medical management is often needed. Hormonal suppressive therapy is often used after over-the-counter pain medications fail to offer relief. These suppress new growth of the lesions and help manage the symptoms, yet these medications can cause unwanted side effects for some women.
Surgery can be needed for symptomatic relief when conservative therapies are suboptimal. Not all GYNs perform these surgeries. If excision of the lesions is preferred, a surgeon with extra training is recommended.
Specialized surgeons: https://icarebetter.com/
Other helpful sites for more education and support:
A film to provide an accurate knowledge base about endometriosis from experts.
Endometriosis, Foundation, Endometriosis Foundation Of America | EndoFound: https://www.endofound.org/
Any questions? Brentwood Pelvic Health would love to hear from you.
*Blog content is for informational purposes only and is not considered medical advice.
