Woman laying on couch in pain suffering from endometriosis

Endometriosis, or “endo,” is a painful disease where tissue similar to the endometrium (the normal thickening of the uterine lining that sheds during the menstrual cycle) grows in abnormal places. Typically, endo grows in the pelvis and can affect the reproductive organs, bowel, bladder, surrounding muscles, and supporting soft tissue. Endometriosis can also grow outside the pelvis.

There are three types of endometriosis, and one or more can be present simultaneously:

1. Superficial endometriosis is when the growth is superficial (on the tissue surface).
2. Deep endometriosis involves deeper attachments into the tissue, which can infiltrate on or underneath organs and cause severe damage to them.
3. Endometriomas are growths on the ovaries, sometimes known as “chocolate cysts” because they are filled with dark brown fluid.

Signs and symptoms of endometriosis can include the following (Kuznetsov, Dworzynski, Davies, & Overton, 2017):

  • Chronic pelvic pain
  • Period-related pain (dysmenorrhea)
  • Pain during or after sexual activity
  • Period-related or cyclical bladder and/or bowel symptoms
  • Infertility or subfertility


THE IMPACT OF ENDOMETRIOSIS ON CANADIANS

Around 1 million Canadians are affected by endometriosis (Wahl, Yong, Bridge-Cook, & Allaire, 2021), and the economic implication is estimated at $1.8 billion a year (Levy, Osenenko, Lozano-Ortega, & Sambrook, 2011).

There is a significant personal burden on those with endo, including lost time at work and school, loss of social activities and relationships, and a significant impact on mental, physical, and sexual well-being (Kuznetsov et al., 2017).

Unfortunately, diagnostic delay can further exacerbate the burden of endometriosis. Canada has an average delay of 5.4 years (Singh, Soliman, Rahal, & Robert, 2020), and global estimates can be as high as ten years (Kuznetsov et al., 2017). Numerous geographic, socioeconomic, and demographic inequalities contribute to this delay (Wahl, Yong, Bridge-Cook, & Allaire, 2021; Singh, Allaire, Al-Nourhji, & Bougie, 2024).

The stigma around discussing menstruation and a lack of education for young people about normal and abnormal period symptoms both contribute to delays in seeking care. Healthcare providers, along with family and friends, may also be dismissive of symptoms or pin them on mental health issues like depression or anxiety. Recently, there has been a shift away from invasive diagnostic methods such as laparoscopy in favour of non-invasive imaging modalities that should assist in reducing the delay between symptom onset, diagnosis, and treatment (Avery, Deslandes, Freger, & Leonardi, 2024; Giudice, 2024; Zhang, He, & Shen, 2020).

TREATMENT OPTIONS

A thorough medical history, external and/or internal pelvic exam, and imaging are typical first steps in identifying and beginning intervention (Allaire, Bedaiwy, & Yong, 2023; Kuznetsov et al., 2017). Anti-inflammatories, hormonal contraception, progestin pills, or intrauterine systems may be prescribed. Depending on the severity of the endometriosis and whether or not someone has succeeded with conservative treatment surgical intervention is also an option (Becker, Bokor, Heikinheimo, & Horne, 2022).

Access to gynecological services with expertise in diagnosing and managing endometriosis is ideal. This can include advanced imaging, a pain management team, fertility services, skilled physicians in laparoscopic surgery, colorectal surgeons, urologists, and specialist nurses (Kuznetsov et al., 2017).

In addition, other allied health professionals are well placed to address mental health, physical health, pain coping skills, and other lifestyle factors that are individual to the person and their goals. This can include exercise, nutrition, sleep, and stress management under the guidance of physiotherapists, registered dieticians, and psychologists.

Explore these additional resources for more information:

The Endometriosis Network Canada

EndoAct Canada

Interested in learning more? Contact Great North Physiotherapy to book an appointment with Sophie Szczesniak. Book online at www.greatnorthphysio.ca or call 905-467-1440 to speak with a team member.

Always consult a healthcare professional before starting a new exercise routine and prioritize consistency and good form for optimal benefits.

REFERENCES

Allaire, C., Bedaiwy, M. A., & Yong, P. J. (2023). Diagnosis and management of endometriosis. Canadian Medical Association Journal, 195(10), E363–371. https://doi.org/10.1503/cmaj.220637

Avery, J. C., Deslandes, A., Freger, S. M., Leonardi, M., Lo, G., Carneiro, G., Condous, G., Hull, M. L., Hull, L., Carneiro, G., Avery, J., O’Hara, R., Condous, G., Knox, S., Leonardi, M., Panuccio, C., Sirop, A., Abbott, J., Gonzalez-Chica, D., ... Jenkins, M. (2024). Non-invasive diagnostic imaging for endometriosis part 1: A systematic review of recent developments in ultrasound, combination imaging, and Artificial Intelligence. Fertility and Sterility, 121(2), 164–188. https://doi.org/10.1016/j.fertnstert.2023.12.008

Becker, C. M., Bokor, A., Heikinheimo, O., Horne, A., Jansen, F., Kiesel, L., King, K., Kvaskoff, M., Nap, A., Petersen, K., Saridogan, E., Tomassetti, C., van Hanegem, N., Vulliemoz, N.,Vermeulen, N., Altmäe, S., Ata, B., Ball, E., Barra, F., ... Yazbeck, C. (2022). ESHRE guideline: Endometriosis. Human Reproduction Open, 2022(2). https://doi.org/10.1093/hropen/hoac009

Giudice, L. C. (2024). Advances in approaches to diagnose endometriosis. Global Reproductive Health, 9(1). https://doi.org/10.1097/grh.0000000000000074

Kuznetsov, L., Dworzynski, K., Davies, M., & Overton, C. (2017). Diagnosis and management of endometriosis: summary of NICE guidance. BMJ: British Medical Journal, 358(8120). https://doi.org/10.1136/bmj.j3935

Levy, A. R., Osenenko, K. M., Lozano-Ortega, G., Sambrook, R., Jeddi, M., Bélisle, S., & Reid, R. L. (2011). Economic burden of surgically confirmed endometriosis in Canada. Journal of Obstetrics and Gynaecology Canada, 33(8), 830–837. https://doi.org/10.1016/s1701-2163(16)34986-6

Singh, S. S., Allaire, C., Al-Nourhji, O., Bougie, O., Bridge-Cook, P., Duigenan, S., Kroft, J., Lemyre, M., Leonardi, M., Leyland, N., Maheux-Lacroix, S., Wessels, J., Wahl, K., & Yong, P. J. (2024). Guideline no. 449: Diagnosis and impact of endometriosis – a Canadian guideline. Journal of Obstetrics and Gynaecology Canada, 46(5), 102450. https://doi.org/10.1016/j.jogc.2024.102450

Singh, S., Soliman, A. M., Rahal, Y., Robert, C., Defoy, I., Nisbet, P., & Leyland, N. (2020). Prevalence, symptomatic burden, and diagnosis of endometriosis in Canada: cross-sectional survey of 30 000 women. Journal of Obstetrics and Gynaecology Canada, 42(7), 829–838. https://doi.org/10.1016/j.jogc.2019.10.038

Wahl, K. J., Yong, P. J., Bridge-Cook, P., & Allaire, C. (2021). Endometriosis in Canada: It Is Time for Collaboration to Advance Patient-Oriented, Evidence-Based Policy, Care, and Research. Journal of Obstetrics and Gynecology Canada, 43(1), 88-90. https://doi.org/10.1016/j.jogc.2020.05.009

Zhang, X., He, T., & Shen, W. (2020). Comparison of physical examination, ultrasound techniques and magnetic resonance imaging for the diagnosis of deep infiltrating endometriosis: A systematic review and meta‚Äźanalysis of diagnostic accuracy studies. Experimental and Therapeutic Medicine, 20(4), 3208-3220. https://doi.org/10.3892/etm.2020.9043

Sophie Szczesniak - MScPT, BA (Hons)

Sophie Szczesniak - MScPT, BA (Hons)

Pelvic Health & Orthopedic Physiotherapist

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