What is Endometriosis and where would you find it?

Endometriosis is a condition where tissue similar to the lining of the endometrium (the lining of the uterus) grows in other areas of the body, most commonly the pelvis.  These deposits can cause a number of symptoms such as pelvic pain and infertility.

The majority of people who have endometriosis have it, in and around the pelvic organs, the pelvic peritoneum and the ovaries. About 12% of people will end up with endometriosis higher in the pelvis (known as extra-pelvic endometriosis) or the lower abdomen in the bowel wall (rectum, sigmoid, caecum, small bowel). It is estimated that less than 2% will end up with endometriosis around the right side of the liver and diaphragm.

A smaller undetermined number of people will have endometriosis in the chest (thorax) or lungs.  This condition is called Thoracic Endometriosis Syndrome or TES. The true prevalence of this type of endometriosis is unknown as there has been little research beyond case reports in the medical literature. (Source: Endometriosis Australia)

Endometriosis has also been found in Laparoscopy/laparotomy scars, Caesarean-section scars.

Why does it hurt?

Each month, the endometriosis tissue bleeds during menstruation, which causes inflammation, further growth and scarring and therefore pain.

The tissue growths associated with endometriosis react to the same hormones as the uterine lining. However, unlike the tissue inside the uterus that sheds through menstruation, the misplaced tissue has no way to exit the body. As a result, blood accumulates around surrounding organs and tissues, causing irritation, inflammation, and sometimes leading to scarring.

The severity of endometriosis can vary from woman to woman, and pain can persist even after surgery or hormonal treatments.

Endometriosis pain is not limited to the time of menstruation.  Pain can be felt during ovulation and menstruation or every day in different levels of severity.

Pain can be experienced when exercising, socialising or in relation to intimacy.  Pain can be felt during intercourse, post intercourse or both.

It is also good to note that the degree of symptoms does not always indicate the damage the disease is causing.

HOW IS THE DIAGNOSIS MADE?

A diagnosis of endometriosis can be made by a surgery called a laparoscopy which is performed under a general anaesthetic.  The procedure uses a thin telescope that is placed into the umbilicus (belly button). To allows your doctor to see inside your abdomen and remove the unwanted tissue.

Advance Endometriosis can be found on Ultrasound by a trained gynaecologist.

Facts you should know about endometriosis:

• Period pain that puts your life on hold is not normal
• Teenagers are not too young to have endometriosis
• Pain levels are not related to the extent of the disease
• Endometriosis does not always cause infertility
• Getting pregnant is not a cure for endometriosis
• A hysterectomy is not a cure for endometriosis
• Endometriosis is not an STI; you cannot catch it
• Endometriosis cannot be prevented
• There is no cure

A comprehensive, multidisciplinary approach is essential for managing endometriosis and adenomyosis. This often includes support from a gynaecologist, GP, pelvic floor physiotherapist, and sometimes pain specialists, gastroenterologists, or psychologists.

At our clinic, we take a holistic approach to managing your symptoms. Through physiotherapy, we focus on relieving pain and improving your body’s function, empowering you to live a more active, fulfilling life. We incorporate techniques that foster good long-term health habits and overall wellness.

What is the difference between Endometriosis and Adenomyosis?

Adenomyosis occurs when endometrial-like cells are present within the muscular wall of the uterus. Like endometriosis, these cells bleed during menstruation, causing pain, heavy periods, and discomfort during sex. The involvement of the nervous system can also amplify the pain experience.

Common Symptoms:

Symptoms of endometriosis and adenomyosis can be ongoing or may worsen during your period. Some common symptoms include:

• Painful periods or ovulation
• Pain during sex
• Chronic pelvic or abdominal pain
• Pelvic and abdominal muscle tension
• Heavy menstrual bleeding
• Bladder or bowel issues
• Lower back, abdominal, thigh, or leg pain
• Bloating, fatigue, and mood changes

What to expect from our Women’s Health Physiotherapists at Alara Women’s Health

Our Women’s Health Physiotherapists have the specialist knowledge to work with you to establish a clear pathway forwards for your individual needs.

Your plan can involve:

• A thorough investigation of your journey to gain a solid understanding of your body, your mindset and your lifestyle so we can work with you where you are at.
• A comprehensive physical assessment, which may include an internal vaginal

examination if and when you’re comfortable with it.

• An education where we provide a detailed explanation of the causes of your pain and a plan of action to help manage and alleviate it.
• Creating of a personalized treatment program designed to meet your specific needs and goals.
• Creating a plan to provide strategies for managing your pain during periods or flare-ups.
• Hands on techniques that may involve scar management, visceral manipulation of your internal organs to allow movement and decrease pain.
• Desensitisation techniques, including internal massage and learning how to manage this at home.
• Stretches and exercises for your musculoskeletal system
• Targeted exercises for strengthening your pelvic floor muscles.
• Treatment and support for bladder or bowel issues.
• Education around intimacy, arousal, and libido, and how to integrate relaxation into intimate moments.
• Insights into the science of pain, helping you understand the connection between pain, your nervous system, and both your physical and emotional health.
• Advice on how to manage sleep, diet, and stress management.