Endometriosis: signs, symptoms and treatment options

In a series of 4 blogs I am going to talk about Endometriosis: signs, symptoms and treatment options, Endometriosis and chances of having a baby, Painful sex and endometriosis and lastly Hysterectomy as a treatment for endometriosis.

What are the signs and symptoms of endometriosis?

Endometriosis has been causing women severe pelvic pain for eternity and medical professionals have not been able to tell them why. Even today, an average of 8 years passes before their symptoms are diagnosed! It is still poorly understood but knowledge and good management has rapidly advanced in more recent years. Endometriosis is such a complex beast with many possible presentations. It can not only cause pelvic pain and painful periods but can also cause low back pain, pain with intercourse, mood disturbances, tiredness, bloating, changing bowel motions, bowel pain, painful bladder syndrome, migraines and difficulty conceiving! (1)

“Even today, an average of 8 years passes before their symptoms are diagnosed!”

What is endometriosis?

Endometriosis is lesions made of material similar to the lining of uterus (endometrium), growing where it is not meant to. It commonly grows on the lining of the pelvis (peritoneum) but also on the surfaces of pelvic (or higher) organs, thus affecting their function or causing pain in these regions. The lesions could grow around pelvic nerves causing nerve pain too (2).

Lesions and surgery

You should talk to a gynaecologist, who specialises in endometriosis about treatment options. Laparoscopy surgery is often the best management for diagnosis and treatment by removal (not cauterising (burning)) of the lesions. They have to be removed completely which greatly minimises the chances of them growing back so a good surgeon is important. This only heals the lesions component of endometriosis however (1).

“They have to be removed completely which greatly minimises the chances of them growing back so a good surgeon is important”

Migraines

Migraines can be common with ladies with endometriosis. Migraines often present around the time of their period (menstrual migraine) or ovulation and this is due to hormone/ chemical changes at these times (a decrease in oestrogen and increase in prostaglandins) (1). See your doctor about medications that can help this.

Painful periods

If you have heavy and painful periods various medications can help with this too. Several contraceptive pills can be used to lighten your periods and pain or enable you to avoid periods altogether. An inserted Mirena has been found to be effective at reducing period pain too by constantly releasing progesterone which decreases the uterus lining which then decreases bleeding and pain at period time (1). Talk to your GP or gynaecologist about this.

Painful bladder syndrome (PBS)

Painful bladder syndrome (PBS) is common with endometriosis too. If you have pelvic pain but also urinary frequency (needing to urinate more than 6 times/ day), the need to go to the toilet whilst you are sleeping, urinary urgency (having the sudden urgent need to go to the toilet), a burning or shooting pain or spasm in the low middle part of your abdomen which is most painful when the bladder fills up and relieves when you empty your bladder, or pain with intercourse positions that put pressure on your bladder/ front vagina wall you may have PBS (1). PBS can be hard to diagnose but your doctor/ urologist can run tests that are somewhat reliable. However it is important to try some diet modifications first to see if that will help as 50% of PBS is affected by diet. Decreasing potassium, acid, caffeine, chocolate, artificial sweeteners, all fizzy drinks and cigarettes can help reduce PBS (1).

“it is important to try some diet modifications first to see if that will help as 50% of PBS is affected by diet.”

Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS) and endometriosis can cause similar pain symptoms in the lower abdomen (1). With IBS, a bowel movement will improve symptoms and in addition to pain, there can be symptoms of diarrhoea or constipation, bloating and excessive wind, urgency to use bowels or straining to use them or a feeling that the bowels are never empty (1). See your doctor who can run several tests to diagnose IBS, endometriosis or other. Lifestyle changes such as reducing stress and alcohol, stopping smoking, eating meals slowly and eating a healthy diet low in fat, salt, caffeine and a high fibre diet generally helps IBS too (1). If this doesn’t work talk to a dietician who can test for food intolerances which may be causing your pain. You many have heard of FODMAP diets. Eliminating certain “FODMAP” foods may help IBS pain (1).

“Irritable Bowel Syndrome (IBS) and endometriosis can cause similar pain symptoms in the lower abdomen. ”

Pelvic floor tightness, pain and sex

Endometriosis can cause pelvic floor muscle tightness which is painful in itself. The tightness is caused by our unconscious bracing of the pelvic muscles in response to the chronic pelvic pain. Pelvic floor muscle tightness can give low back pain and can be one of the main causes of painful sex that is often associated with endometriosis too. I will talk about this more in the future blog Pain with Sex. Women’s Health physiotherapists are the best at treating this muscle tightness and successfully relieving this cause of pain.

“Pelvic floor muscle tightness can give low back pain and can be one of the main causes of painful sex ”

Chronic pain affecting mental health

The chronic pelvic pain can also cause chronic pain patterns which are hard to treat but doctors, pain management specialists, psychologists and physiotherapists amongst others can help with guidance on managing chronic pain. Finding ways to keep positive such as regular exercise to release endorphins may help. Talking to your partner, family, friends or a psychologist or counsellor could help you process and better manage your potential feelings of depression, frustration, guilt etc. Getting educated about endometriosis to explain your symptoms can help with your pain and anxiety too. Endometriosis affects around 10% of women so do not feel that you are alone (2). Knowing that endometriosis is common too can be helpful and that you should not feel embarrassed about the condition is important too. There are many people that can help you.

“Endometriosis affects about 10% of women so do not feel that you are alone.”

Summary

Endometriosis is a common painful condition that can have widespread effects such as pelvic lesions, nerve pain, migraines, painful periods, pelvic floor tightness and pain, painful sex, IBS and PBS.

It used to be poorly diagnosed and still takes 8 years on average to diagnose.

However there are several effective treatment options to treat the various aspects of the condition but it is complicated, takes time and specialised medical professionals to help you.

References:

1. Evans, S (2010) Endometriosis and pelvic pain. Adelaide. Dr Susan F Evans Pty Ltd.

2. https://www.endometriosisaustralia.org/

Melli Tilbrook is a Physiotherapist at Adelaide Physiotherapy and Pilates Studio, Beulah Park