Endometriosis.
The endometrium is the lining of the uterus, or womb, which is a hollow, muscular organ in a woman's pelvis. Endometriosis is a syndrome defined by the presence of endometrial-like tissue growing outside of the uterus. It is estimated that endometriosis affects up to 10% of women of reproductive age (Zondervan et al., 2020)
Symptoms of endometriosis may include:
· Pelvic pain
· Severe menstrual and/or ovulatory pain
· Painful sex
· Diarrhea and/or constipation, IBS
· Infertility
· Painful bowel movements
· Painful urination
· Depression and/or anxiety
· Fatigue
· Heavy menstruation
Endometriosis lesions can be found in women without any symptoms and are detected in up to 50% of women seeking treatment for infertility (Meuleman et al., 2009). In addition, endometriosis lesions have been found in the upper abdominal organs like the stomach, liver and spleen, as well as the abdominal wall, diaphragm, around the lungs, and even in the brain (Andres et al., 2020).
How is endometriosis diagnosed?
The “Gold Standard” or best way to diagnose and stage endometriosis is visualization at surgery (typically through laparoscopy). Non-surgical diagnostic approaches include transvaginal ultrasounds and magnetic resonance imaging (MRI) to detect the presence of ovarian and deep endometriosis (Horne and Saunders, 2019).
How is endometriosis treated?
While currently there is no cure for endometriosis, clinicians have a number of research supported strategies for managing its symptoms.
1. Surgical removal
2. Hormonal suppressive therapy (example: oral contraceptives, IUD)
3. Pelvic physiotherapy – found to significantly improve pain intensity and physical function (Abril-Coello, 2023)
4. Acupuncture – found to significantly improve pain (Ticiana, 2018)
5. Diet – there is emerging evidence that low FODMAP diets, high intake of polyunsaturated fatty acids, a gluten-free diet and/or a low nickel diet may improve symptoms of painful endometriosis (Sverrisdóttir, 2022)
Note: please discuss any dietary changes with a licenced health care provider (specialist, family doctor, dietician or naturopath) to ensure it is safe and appropriate for you
Works Cited
Zondervan K.T., Becker C.M., Missmer S.A. Endometriosis. N. Engl. J. Med. 2020; 382: 1244-1256
Meuleman C., Vandenabeele B., Fieuws S., Spiessens C., Timmerman D., D’Hooghe T. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil. Steril. 2009; 92: 68-74
Andres M.P., Arcoverde F.V.L., Souza C.C.C., Fernandes L.F.C., Abrão M.S., Kho R.M. Extrapelvic Endometriosis: A Systematic Review. J. Minim. Invasive Gynecol. 2020; 27: 373-389
Horne A.W., Saunders P.T.K. SnapShot: Endometriosis. Cell. 2019; 179: 1677
Rebeca Abril-Coello 1, Marta Correyero-León 1, Luis Ceballos-Laita 2, Sandra Jiménez-Barrio. Benefits of physical therapy in improving quality of life and pain associated with endometriosis: A systematic review and meta-analysis. Int J Gynaecol Obstet. 2023 Jul;162(1):233-243
Ticiana A.A. Mira, Mariana M. Buen, Murilo G. Borges, Daniela A. Yela, Cristina L. Benetti-Pinto. Systematic review and meta-analysis of complementary treatments for women with symptomatic endometriosis. Int. J. of Gynecol. and Obstet. 2018; 143: 2-9
Una Áslaug Sverrisdóttir, Sara Hansen, Martin Rudnicki. Impact of diet on pain perception in women with endometriosis: A systematic review. Eur J Obstet Gynecol Reprod Biol. 2022 Apr:271:245-249.
