Understanding Endometriosis: Types, Causes, Signs, Prevention, Treatment, and the Role of Physiotherapy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on October 11, 2024
Endometriosis is a chronic condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterus, affecting millions of women globally (Giudice, 2010). This condition commonly affects women of reproductive age and is often associated with severe pain and fertility issues. Understanding endometriosis is essential for both patients and their caregivers, as early detection and management can significantly improve the quality of life. Physiotherapy plays a crucial role in alleviating pain and enhancing daily function for individuals with endometriosis (Bulun, 2009).
What is endometriosis?
Understanding what endometriosis is and how it affects the body is crucial for managing its symptoms effectively. This section provides an overview of the condition and its impact on those affected.
Endometriosis occurs when tissue similar to the uterine lining grows in areas outside the uterus, such as the ovaries, fallopian tubes, and pelvic lining. This misplaced tissue continues to act like the endometrial lining—it thickens, breaks down, and bleeds with each menstrual cycle. However, because this blood has no way to exit the body, it leads to inflammation, scarring, and adhesions in surrounding tissues (Giudice, 2010). This condition is often associated with chronic pelvic pain, infertility, and a reduced quality of life for many women.
Types of endometriosis
Endometriosis can present in different forms, with varying symptoms and degrees of severity. This section explores the main types of endometriosis to help you understand how they differ.
Superficial peritoneal lesions: This is the most common form of endometriosis, where lesions appear on the peritoneum, a thin lining of the abdomen. These lesions can cause mild to moderate pelvic pain and discomfort (Bulun, 2009).
Ovarian endometriomas (chocolate cysts): These are fluid-filled cysts that form on the ovaries, filled with old blood, giving them a dark appearance. Ovarian endometriomas are often linked to severe pain and can impact fertility (Vercellini et al., 2014).
Deeply infiltrating endometriosis: This type involves lesions that penetrate deeper into pelvic tissues and can affect organs such as the bladder or bowel, often leading to more severe symptoms and complications (Chapron et al., 2003).
Abdominal wall endometriosis: Endometrial tissue can sometimes be found in the abdominal wall, particularly following surgeries like cesarean sections. This type often presents as a palpable mass and localized pain (Chapron et al., 2003).
Recognizing the different types of endometriosis is crucial in tailoring treatment plans to address specific symptoms and complications, enabling more precise and effective management.
Causes of endometriosis
The exact cause of endometriosis remains unclear, but several theories explain its development. This section delves into these theories and how they might contribute to the condition.
Retrograde menstruation: This theory suggests that menstrual blood flows backward through the fallopian tubes into the pelvic cavity, where endometrial cells implant and grow (Mihalyi et al., 2006).
Embryonic cell transformation: Some experts believe that cells in the embryo can transform into endometrial-like cells later in life, particularly influenced by hormones during puberty (Mihalyi et al., 2006).
Immune system disorders: Immune dysfunction may contribute to the inability of the body to recognize and destroy the endometrial-like tissue growing outside the uterus (Gazvani & Templeton, 2002).
Genetic factors: Endometriosis is known to run in families, suggesting that genetics play a significant role in increasing the risk of developing the condition (Treloar et al., 1999).
Other theories: Other potential causes include surgical scarring from procedures like C-sections, and exposure to environmental toxins that might disrupt the immune or hormonal systems.
Identifying the causes of endometriosis helps in understanding its development and progression, guiding research into targeted treatments and prevention strategies.
Signs and symptoms of endometriosis
Recognizing the signs and symptoms of endometriosis early can lead to better management and improved outcomes. This section outlines the most common indicators of the condition.
The symptoms of endometriosis can vary widely, but often include:
Pelvic pain: The most common symptom, often linked to the menstrual cycle but can also occur independently.
Pain during intercourse: Often described as deep pain felt during or after sexual activity.
Heavy menstrual bleeding: Women with endometriosis may experience menorrhagia or intermenstrual bleeding.
Fertility issues: Approximately 30-50% of women with endometriosis may struggle with infertility (Giudice, 2010).
Recognizing the signs and symptoms of endometriosis is key to early diagnosis and effective treatment, preventing further complications and enhancing the quality of life.
Prevention of endometriosis
While endometriosis cannot always be prevented, certain strategies may help reduce the risk or manage its progression.
Hormonal management: Hormonal contraceptives like birth control pills can lower estrogen levels, reducing endometrial growth (Bulun, 2009).
Lifestyle adjustments: A balanced diet, regular exercise, and effective stress management can support overall health and potentially reduce the risk of developing endometriosis.
Regular medical checkups: Women with a family history of endometriosis should consider regular screenings and early interventions to monitor for symptoms.
Although endometriosis prevention is not always possible, adopting a proactive approach through lifestyle changes and regular checkups can significantly mitigate its impact.
Treatment and diagnostics of endometriosis
Effective diagnosis and treatment of endometriosis can greatly improve patients' quality of life. This section covers diagnostic tools and various treatment options.
Diagnostics: Diagnosis is usually confirmed through pelvic exams, ultrasounds, and laparoscopy, which allows direct visualization of the endometrial tissue (Treloar et al., 1999).
Treatment options:
Medication: Hormonal treatments like GnRH agonists and NSAIDs are commonly prescribed to manage pain.
Surgical options: Laparoscopy can be used to remove endometrial tissue or, in severe cases, a hysterectomy may be recommended (Giudice, 2010)
Alternative therapies: Techniques like acupuncture and herbal treatments may offer complementary benefits for symptom relief.
Comprehensive diagnosis and personalized treatment plans are essential for managing endometriosis, enabling individuals to control symptoms and enhance their quality of life.
The role of physiotherapy in managing endometriosis
Physiotherapy offers a holistic approach to managing endometriosis symptoms, focusing on reducing pain and improving function.
Pelvic floor therapy: Specialized exercises and techniques can relax tight pelvic muscles, easing pain and discomfort.
Pain management: Physiotherapists utilize manual therapy and relaxation methods to help manage chronic pain associated with endometriosis (Haugstad et al., 2008).
Exercise programs: Individualized exercise routines aim to strengthen the body, improve flexibility, and reduce the severity of symptoms.
Education and self-management: Teaching patients about posture, ergonomics, and lifestyle adjustments empowers them to manage symptoms effectively at home.
Physiotherapy plays a crucial role in managing endometriosis by addressing both physical discomfort and functional limitations, helping patients achieve better pain control and quality of life.
Conclusion
In conclusion, understanding endometriosis and its various treatment options is essential for effective symptom management and improved quality of life. Physiotherapy is a vital component in managing endometriosis, providing relief through techniques that address pain, mobility, and overall health. If you or someone you know is affected by endometriosis, consider reaching out to a certified physiotherapist for a tailored treatment plan.
Consult with a certified physiotherapist today to develop a personalized approach to managing endometriosis and enhancing your quality of life.
References:
Bulun, S. E. (2009). Endometriosis. The New England Journal of Medicine, 360(3), 268-279. https://doi.org/10.1056/NEJMra0804690
Chapron, C., Fauconnier, A., Dubuisson, J. B., Barakat, H., Vieira, M., & Breart, G. (2003). Deep infiltrating endometriosis: Relation between severity of dysmenorrhea and extent of disease. Human Reproduction, 18(4), 760-766.
Gazvani, R., & Templeton, A. (2002). New considerations for the pathogenesis of endometriosis. International Journal of Gynecology & Obstetrics, 76(2), 117-126.
Giudice, L. C. (2010). Clinical practice. Endometriosis. The New England Journal of Medicine, 362(25), 2389-2398. https://doi.org/10.1056/NEJMcp1000274
Haugstad, G. K., Haugstad, T. S., Kirste, U. M., Leganger, R., Wojniusz, S., & Eikeland, T. O. (2008). Continuing improvement in women with chronic pelvic pain treated with physical therapy: A follow-up study. American Journal of Obstetrics and Gynecology, 194(5), 1303-1310.
Mihalyi, A., Simsa, P., Mutinda, K., Kyama, C. M., & Mwenda, J. M. (2006). Emerging therapeutic targets for endometriosis. Frontiers in Bioscience, 15, 1246-1274.
Treloar, S. A., O'Connor, D. T., O'Connor, V. M., & Martin, N. G. (1999). Genetic influences on endometriosis in an Australian twin sample. Fertility and Sterility, 71(4), 701-710.
Vercellini, P., Viganò, P., Somigliana, E., & Fedele, L. (2014). Endometriosis: Pathogenesis and treatment. Nature Reviews Endocrinology, 10(5), 261-275.
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.