Endometriosis
Hi again, Bestie. Thanks for stopping by! I thought we could chat a bit about endometriosis, today. It’s one of those topics that is discussed often, but not entirely understood. So let’s jump right in!
What is it?
Endometriosis (sometimes also referred to in brief as “endo”) is the growth of endometrial-like tissue outside of the uterus. To really understand what this means, let’s go back a few steps. The uterus is comprised of three main layers. The first, outermost layer, is the perimetrium. This layer is the uterus’s protection. The second, middle layer, is called the myometrium. The term “myo” typically refers to muscle, so as the name signifies, the myometrium is the muscle layer of the uterus. Finally, we have the inner-most layer, the endometrium. The endometrium lines the inside of the uterus. Its purpose is to prepare for potential implantation of a fertilized egg and support a pregnancy if one occurs (1). If a pregnancy does not occur, the endometrium is shed and menstruation occurs (1).
Endometriosis present on the fallopian tubes, ovaries, and outer portion of the uterus.
When endometrial tissue grows in places outside of the uterus, often causing an inflammatory response, it is called endometriosis. The reason for tissue growing outside of the uterus is not well understood, which can make endometriosis difficult to diagnose and treat.
What are the signs of endometriosis?
Endometriosis typically occurs in females around reproductive age. It has been reported to be found in 1 out of 10 females of reproductive age and has also been linked to infertility and pain (2). In fact, up to 87% of females with gynecologic causes of pelvic pain have endometriosis (3). Common signs of the condition include dysmenorrhea (painful periods), dyspareunia (pain during penetrative intercourse), lower abdominal pain, back pain, chronic pelvic pain, and infertility. There is limited knowledge as to why this condition occurs and more research needs to be completed in order to gain a better understanding of endometriosis.
How is it diagnosed?
Diagnosis of endometriosis will start with a thorough history and physical examination. Your physician might use ultrasound or MRI to aid in the diagnosis process. The “gold-standard” and only way to definitively diagnosis endometriosis is through laparoscopic surgery and direct visualization of the endometrial lesions. Unfortunately, the typical time between first symptoms and diagnosis is over a decade (11-17 years) (4). Hopefully in the future this will be improved upon. Many patients will suffer in debilitating pain for years due to endometriosis without any answers or a clear diagnosis.
How is endometriosis treated?
There is no cure for endometriosis, but there is a broad range of potential treatments for the condition. One option is hormonal therapy. Since endometriosis is estrogen-dependent, meaning it relies on the presence of estrogen to occur, when estrogen is depleted, endometriosis improves. Hormonal treatments can include hormonal contraceptives, progestogens, anti-progestogens, and more. There is variable research regarding how well these techniques work to treat endometriosis. Another treatment option is surgery. Laparoscopic excision can be used to remove endometrial lesions. Hysterectomy (removal of the uterus) is also commonly used to treat severe endometriosis.
Finally, physical therapy (PT) is a treatment option for endometriosis. While PT cannot decrease the size or number of endometrial lesions, it can help reduce the pain associated with endometriosis. Treatment in PT may include massage, transcutaneous electrical nerve stimulation (TENS), dilator therapy, stretching, exercise, biofeedback, and more. For those suffering from endometriosis-related pelvic pain, who do not wish to endure an invasive surgery or use medication, PT is a great option for managing pain. PT also works well in conjunction with the other treatments!
Endometriosis is a common condition, but remains elusive to a fair share of healthcare providers. Many celebrities, such as Bindi Irwin, Emma Roberts, Chrissy Teigen, Amy Schumer, and heaps more have spoken openly about their endometriosis diagnoses and have helped to pave a pathway toward a different reality. If you believe you are suffering from endometriosis, talk with your healthcare provider about your symptoms and what you can do to manage them. Advocate for yourself and remember that your pain should not go unexplained. You’ve got this!
XOXO,
Your Pelvic Bestie
References:
1. Critchley HOD, Maybin JA, Armstrong GM, Williams ARW. Physiology of the Endometrium and Regulation of Menstruation. Physiol Rev. 2020 Jul 1;100(3):1149-1179.
2. Rogers PA, D'Hooghe TM, Fazleabas A, Gargett CE, Giudice LC, Montgomery GW, Rombauts L, Salamonsen LA, Zondervan KT. Priorities for endometriosis research: recommendations from an international consensus workshop. Reprod Sci. 2009 Apr;16(4):335-46.
3. Walker, E., Katon, W., Jones, L. M., & Russo, J. (1989). Relationship between endometriosis and affective disorder. The American Journal of Psychiatry, 146(3), 380–381.
4. Fassbender A, Burney RO, O DF, D'Hooghe T, Giudice L. Update on Biomarkers for the Detection of Endometriosis. Biomed Res Int. 2015;2015:130854.
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives.
