May 5, 2021

What is Endometriosis?

The cause and effects of Endometriosis explained by a pelvic floor physical therapist.

Endometriosis can be a scary and sometimes debilitating diagnosis that affects roughly 10% of menstruating women. Many women suffering with endo have pain for years before they receive a formal diagnosis, and often have difficulty finding a treatment that works for them. So, what exactly is endometriosis anyway?

What is Endometriosis?

Endometriosis is a condition in which endometrial cells (the cells that typically line the uterine wall) are found outside the uterus. Although misplaced these cells are found outside the uterus, they behave like the endometrial cells that line the uterine wall and therefore are affected by hormonal changes that occur throughout the menstrual cycle. During the menstrual cycle, these cells build up and then break down as the body goes through menses.  Since there is no way for these extra-uterine cells to be expelled from the body, they will typically scar down on the adjacent tissue. This scarring can lead to inflammation, pain and adhesions along many of the adjacent organs. In some cases these adhesions can become so severe that they can obstruct and restrict the affected organs and tissues.

Some places that endometrial cells are often found in patients with endometriosis include, but are not limited to:

  1. The Fallopian tubes

  2. The ovaries

  3. The rectum and/or intestines

  4. The bladder

  5. Various positions of the abdominal cavity

The Effects of Endometriosis

Over time, this scar tissue can lead to chronic pelvic pain, pain with intercourse, constipation and pain with bowel movements, difficulty and pain with urination, and infertility. According to the NIH, between 30 and 50% of women with endometriosis also experience infertility. While the exact correlation between endo and infertility is not known, it is believed to potentially be due to abnormalities in pelvic anatomy, endocrine function, abnormal ovulation, and how the endometrial cells are affected by hormonal changes. Because these cells are so heavily affected by hormonal change, many patients’ symptoms are considerably more severe during their period. Many patients experience such significant increase in symptoms during menses, that they have to take time off work, school, or other daily activities.

Symptoms of Endometriosis

Some of the symptoms endometriosis patients may experience include

  1. Excessive bleeding during menstruation, or bleeding between periods

  2. Extremely painful periods 

  3. Diarrhea

  4. Constipation 

  5. Bloating or nausea

  6. Painful intercourse 

  7. Painful bowel movements or urination (more significant during menstruation).

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If you are reading this and feel you might have endometriosis, you might be asking yourself “How do I know? How do I get a diagnosis?” Unfortunately, many women go years before getting a diagnosis. However, there are certain tests that can be helpful in diagnosing endometriosis. While none of these tests on their own can diagnose endometriosis, when bundled together they can be helpful in ruling out other conditions and can be utilized in preparation for surgery. These tests include:

  1. Pelvic exam– this can be utilized to palpate anatomical abnormalities, cysts, and scar tissue present from endometriosis

  2. Ultrasound (often abdominal and transvaginal)- this test alone cannot be used to identify endometriosis, but can be used to locate/identify cysts on the reproductive organs that may be resultant of endometriosis.

  3. MRI- this test can be used to identify the size and location of endometrial implants, and therefore can be helpful with surgical planning.

  4. Exploratory laparoscopy- this is where a surgeon uses a small camera that is surgically inserted into your abdomen to locate endometrial implants. This procedure can also be used to biopsy the tissue to determine if it is in fact endometriosis.

Some other information your doctor might take into consideration when diagnosing you include any risk factors you might have. While none of these risk factors alone point to endometriosis; when they are present in addition to positive findings with the above testing, they often make diagnosis a bit easier. These risk factors include:

  1. Beginning your period earlier than 12 years of age

  2. Heavy periods that last longer than 7 days

  3. A menstrual cycle that is less than 27 days

  4. A family history of endometriosis

  5. Having high levels of estrogen

  6. Abnormalities of the reproductive tract.

Our Pelvic Floor Physical Therapists are here to help

Emily McElrath PT, DPT, MTC, CIDN is an orthopedic and pelvic health physical therapist with a passion for helping women achieve optimal sports performance. She is an avid runner and Crossfitter and has personal experience modifying these activities during pregnancy and postpartum. She is certified in manual therapy and dry needling. When not working, Emily enjoys time with her husband and two kids.

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