What is Endometriosis? 

Endometriosis is a chronic health condition where the tissue that lines the uterus implants outside of the uterine cavity. It is commonly found in the ovaries, fallopian tubes, uterosacral ligaments and gastrointestinal tract. It can however, also be found in the urinary system, pleura (lungs), pericardium (heart) or central nervous system. Whilst endometriosis is often considered a gynecological disease, it can affect many different systems within the body. 

There is still a lot that is not known about endometriosis but there are a few theories as to why and how it occurs. To date, there is not one theory that encompasses an explanation as to how endometriosis occurs is so many areas of the body, and this inability for one theory is often put down to how complex the expression of genes involved in endometriosis is, alongside all of the inflammatory reactions and disruption to a regular hormonal response. 

Symptoms of endometriosis 

The symptoms of endometriosis are highly varied, and some people may experience no symptoms, but common symptoms can include 

• Pelvic pain during menstruation
• Infertility 
• Pain during of after sexual intercourse
• Painful urination
• Painful defecation 

The pain experienced with endometriosis is often chronic, cyclic and progressive. 

Diagnosis of Endometriosis 

Diagnosis of endometriosis is often a very lengthy process, with the average delay lasting 4-11 years, partially due to the fact that the only method of definitive diagnosis is through laparoscopic surgery. There is no test or biomarker for endometriosis. It is also due to the variety of how the disease often presents with many other signs and symptoms of issues with the urinary, gastrointestinal and other bodily systems. 

Other forms of diagnosis such as transvaginal ultrasound are being investigated, especially for deep infiltrating endometriosis, and other modalities such as MRI.

It is estimated to affect 10-15% of all women of reproductive age, and up to 70% of women with chronic pelvic pain (Tsamantioti ES, Mahdy H, 2023). 

Risk factors for a person developing endometriosis include; starting your period before 11 years of age, a menstrual cycle less than 27 days and heavy menstrual bleeding. 

Treatment of Endometriosis 

Treatment is usually divided into two categories; pharmacological and surgical. For pharmacological management, there is no intervention that directly treats the condition, rather they are focused on managing the symptoms. This can include pain management, hormonal contraceptives and fertility treatment. Surgical treatment focuses on removing lesions and adhesions from within the body, but in severe cases can also include the excision of reproductive organs. 

Osteopathy and Endometriosis 

If treatment is usually either pharmacological or surgical, what role does osteopathy play in treating patients with endometriosis? Osteopathy can work with patients to help manage their symptoms that often affect multiple areas of the body. It can look at myofascial biomechanics and address restrictions that may be present within your body. Treatment may also address the diaphragm, breathing mechanics, pelvic floor and core function and their inter-relationship to get them working as optimally as possible. It can also help with visceral mobility and lymphatic drainage. There are also lifestyle factors that can be addressed such as fear avoidance behaviours, social factors and environmental factors. Your osteopath is also trained to know when onward referral may be required.