Endometriosis: What is it?
Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus, most commonly within the pelvis on structures such as the ovaries, bowel, and bladder. It has also been found in areas outside the pelvis, including the diaphragm, lungs, and, in rare cases, the lower limbs. These lesions respond to hormonal changes during the menstrual cycle, which can cause them to become inflamed, painful, and contribute to the development of adhesions and scar tissue. Over time, this may lead to organs sticking together and reduced mobility within the pelvis.
It is important to note that symptoms and disease severity do not always correlate. Some individuals with mild disease experience significant pain, while others with more extensive endometriosis may have few or no symptoms at all.
Endometriosis is a common condition, affecting approximately 1 in 10 people of reproductive age globally. Despite this, diagnosis is often delayed, taking up to 7 years on average, which can be a long and frustrating journey for many.
Common symptoms of endometriosis
Endometriosis presents differently for everyone, but there are several common features. One of the most recognised is significant pain, which may or may not correlate with the menstrual cycle.
People living with endometriosis may experience:
- Painful periods (often worsening over time)
- Pain during or around ovulation
- Chronic pelvic pain, which may also be felt in the lower back, abdomen, hips, or legs
- Pain with intercourse
- Pain with bowel movements or urination
- Heavy or irregular menstrual bleeding
- Bloating, fatigue, or nausea
- Fertility challenges
- Gut and digestive symptoms
- Fatigue, brain fog, or headaches
- Or, in some cases, there are no symptoms at all
It is often assumed that endometriosis must involve period-related pain, however this is not always the case. This misconception can contribute to delayed diagnosis, with symptoms sometimes being attributed to other conditions such as IBS.
What causes endometriosis?
The exact cause of endometriosis is still unknown. However, it is thought to be multifactorial, with hormonal, inflammatory, genetic, and immunological factors all likely playing a role in its development.
Why does endometriosis cause pain?
There are several factors that may contribute to pain in endometriosis, including:
- Inflammation from endometrial-like tissue
- Scar tissue and adhesions
- Nervous system sensitisation, where the body becomes more sensitive to pain signals over time
- Muscle responses, particularly increased tension in the pelvic floor and surrounding pelvic muscles
How can pelvic health physiotherapy support you?
The pelvic floor is a group of muscles that support the pelvic organs and help with bladder, bowel, and sexual function.
With endometriosis ongoing pain can cause the pelvic floor muscles to become overactive and ‘tight’. This can contribute to symptoms such as:
- Pain with intercourse
- Pain with tampon use or during cervical checks
- Urinary urgency or bowel symptoms
- Chronic pelvic pain
Whilst pelvic health physiotherapy doesn’t treat the endometriosis lesions directly – it plays an important role in managing symptoms and improving quality of life, especially as part of a multidisciplinary team.
A pelvic health physiotherapist can help with:
- Reducing muscle tension and pain throughout the pelvic floor or other areas
- Improving bladder, bowel, and sexual function
- Strategies and ways to help with chronic pain and nervous system regulation
- Provide you with self-care and management strategies
- Post-surgical rehabilitation
Who else should be involved in your care?
Endometriosis is best managed with a team-based approach, and this can include:
- GP
- Gynaecologist
- Pain specialist
- Pelvic floor physiotherapist
- Psychologist or counsellor
- Dietitian or Naturopath
- Acupuncturist
Your GP is a good place to start if you have some of these symptoms or suspect you may have endometriosis, they will likely refer you to a gynaecologist who may suggest further investigations such as a pelvic ultrasound.
Final thoughts…
Painful periods are common, but they are not something you simply have to “put up with.” It’s also important to remember that endometriosis is not just period pain, it can present in many different ways, as outlined above.
If endometriosis is part of your experience, pelvic floor physiotherapy can be a valuable piece of the puzzle, helping you move more comfortably, reduce pain, and regain confidence in your body.
Written by Aisling Lane
