Up until recently, I thought I had a fairly good understanding of endometriosis. However, several weeks ago I attended a talk by local surgeon Dr. Shaunti Mohling at Northwest Endometriosis and Pelvic Surgery, and she inspired me to take a deeper dive into the modern research and treatment for endometriosis, which showed me how much information I was lacking about this disease. Here are some of the key things I have learned:
Endometriosis doesn’t (always) just affect the pelvis. Endometrial tissue can be found in areas far away from the uterus, including on the intestines, where it can cause bowel obstruction, the diaphragm, the liver, around the sciatic nerve, and the lungs (in rare cases). This means that it may cause pain in many different areas of the body.
Many people with endometriosis have had symptoms since their very first period. This supports the theory that the tissue is spread not through menstruation, but during embryological development in a process called “mulleriosis”. Although this theory has not been proven, it does help answer the question as to why symptoms often appear so early on in a person’s life, before they have had many periods.
Most of the time, if a patient receives surgical treatment for their endometriosis they have an “ablation” procedure where the surface of the tissue is burned in a laparoscopic procedure. This may be effective for very mild and superficial level endometriosis, but for individuals with the more severe disease involving larger affected areas in the pelvic and abdominal cavities, there is strong evidence to support radical excision surgery, in which the maximum amount of the endometrial tissue is removed from the body. A systematic review and meta-analysis of many scientific studies on endometriosis surgery spells out these findings here.
Physical Therapy can help! While PT cannot remove the endometrial tissue, we can certainly help address issues such as pelvic floor tightness, pain with sex, and pain with bowel movements, all of which are extremely common side effects of endometriosis.