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Endometriosis Symptoms, Diagnosis, and Treatment: What Every Woman Should Know
- stephanytritt
- Nov 7
- 4 min read
The World Health Organization (WHO) estimates that 10% or 190 million women of reproductive age and individuals assigned female at birth worldwide are affected with endometriosis. It occurs when endometrial-like tissue (usually found only inside the uterus) is found outside of the uterus. It may react in sync with the menstrual cycle and causes inflammation and scar tissue in the areas it invades. Endometriosis symptoms start at menarche (first period) through menopause and can include:
Dysmenorrhea (Painful menstrual periods)
Chronic pelvic pain
Infertility
Dyspareunia (painful intercourse)
Dysuria (painful or difficult urination)
Dyschezia (painful or difficult bowel movements)
Heavy menstrual bleeding
Pelvic inflammatory disease
Irritable bowel syndrome
Fibrocystic breast disease
Retrospectively, the more symptoms one has, the higher the likelihood of endometriosis.
Endometriosis is a chronic condition that can significantly impact quality of life. Due to limited access to health care or knowledgeable practitioners, or minimization of symptoms, it commonly goes undiagnosed for 7-10 years, which results in muscular compensations in movement patterns, posture and of course changes behavior. It is also a common reason for missed school or work. A delayed diagnosis may also result in an excessive prolonged activation of the sympathetic nervous system (fight or flight) which maintains the inflammatory response of the body. In addition, the impact of infertility further confounds the anguish women experience.
Early Diagnosis of Endometriosis
Laparoscopic surgery to evaluate and remove endometrioma is still considered the gold standard for diagnosing endometriosis. However, there is a stronger push for earlier diagnosis of endometriosis to begin treatment based on clinical symptoms and imaging, such as ultrasound or MRI. Although imaging may not always identify endometriosis, when suspected, a clinician may start treating it to assess changes in symptoms, improve quality of life, manage overall costs, and better manage the progression of the disease prior to confirmation via laparoscopy.
Endometriosis Treatment Considerations
There are a variety of non-surgical treatment options that are available considering the severity of your symptoms, whether you have fertility issues and your intentions on conceiving now or later in life.
Treatment options can be separated into a few categories:
Medicinal
Pain controlmedications like Non-steroidal Anti-inflammatory (NSAIDs) may be used to manage general pain. They are not specific to endometrial associated pain and do not alter the disease mechanism. They have little side effects, however can affect the gastrointestinal system and should be monitored with prolonged use.
Hormonal treatments for endometriosis: These may include hormonal contraceptives, progestogens (like intrauterine devices IUDs), GnRH agonists/antagonists, Aromatase inhibitors. These treatments more specifically address endometrial associated pain. Results and side-effects may vary in different women and therefore must be assessed by your physician. Which hormonal treatments are suggested may depend on your fertility status and goals.
Conservative/complementary
Pelvic floor PT for endometriosis can directly help with symptoms directly related to the pelvic floor muscles such as bowel or bladder symptoms, or pain with intercourse/penetration. Physical therapy can also help with gastrointestinal symptoms with manual techniques to the organs and abdomen. Considering the heightened response of the neuroimmune system common with chronic conditions, PTs can instruct in relaxation practices to stimulate the parasympathetic nervous system (rest and digest). Combining exercises, stretches, manual techniques and behavioral modifications can all help prepare you for or support you after surgery.
People may find both physical and emotional support from acupuncture and mental health professionals.
Surgical
Laparoscopy for assessment and removal of endometrial lesions. Laparoscopic surgery is a minimally invasive surgery involving very small incisions to insert small tubes into the body containing a camera or other tools to remove or repair tissue.
Hysterectomy (removal of the uterus) - this is a more radical procedure that prevents further pregnancies and results in menopause if ovaries are also removed. This may be done if other therapies have failed and symptoms are more due to adenomyosis (endometrial tissue that grows into the muscle of the uterus). Since endometriosis is, by definition, endometrial-like tissue found outside the uterus, it may not change symptoms and must be discussed with your doctor.
Recognizing Endometriosis in Teens and Adolescents
Early signs of endometriosis can appear during adolescence and are similar to those in adults. Conditions like a family history of endometriosis, early onset of menstruation, short menstrual cycles, cyclical pelvic pain combined with nausea or cyclical absenteeism may suggest endometriosis. Adolescents who require oral contraceptives for dysmenorrhea should be evaluated for possible endometriosis.
At Foothill Physical Therapy, we specialize in pelvic health and understand the unique challenges that come with chronic conditions like endometriosis. We offer compassionate, evidence-based care to help you manage symptoms and reconnect with your body. We’re here to help in whatever stage of healing you’re in. Reach out today to schedule a consultation.
References:
Kalaitzopoulos DR, Samartzis N, Kolovos GN, Mareti E, Samartzis EP, Eberhard M, Dinas K, Daniilidis A. Treatment of endometriosis: a review with comparison of 8 guidelines. BMC Womens Health. 2021 Nov 29;21(1):397. doi: 10.1186/s12905-021-01545-5. PMID: 34844587; PMCID: PMC8628449.
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