Endometriosis: Understanding the Condition and Finding Support by Kathryn Melvin APA Women's Health Physiotherapist

Endometriosis is a chronic and often overlooked condition, affecting approximately 1 in 9 women in Australia. Despite its prevalence, diagnosis can take years, and many people struggle to access appropriate care.

It is now time to shine a light on this condition, empower individuals with knowledge, and advocate for better research, treatment, and support.

What Is Endometriosis?

Each month, the body builds up the uterine lining (endometrium) in preparation for pregnancy. If pregnancy does not occur, this lining breaks down and sheds—resulting in menstruation.

For those with endometriosis, tissue similar to the endometrium grows outside the uterus,

commonly in areas such as:

• The ovaries and fallopian tubes

• The pelvic lining and bowel

• The bladder and, in rare cases, distant organs

These cells respond to hormonal changes just like the uterine lining. However, since they are outside the uterus, they have no way to properly shed, causing inflammation, pain, and scarring.

What Causes Endometriosis?

While the exact cause remains unclear, several theories provide insight into why endometriosis develops:

- Retrograde Menstruation – Some menstrual tissue flows backward into the pelvic cavity instead of exiting the body.

- Cell Transformation (Metaplasia) – Certain cells change into endometrial-like tissue due to hormonal or genetic influences.

- Immune System Dysfunction – The body fails to clear misplaced tissue, allowing it to grow and cause inflammation.

- Genetic Factors – A family history of endometriosis increases risk. Early intervention and treatment can improve symptoms and quality of life.

How Long Does It Take to Be Diagnosed?

Endometriosis is notoriously difficult to diagnose, with an average delay of 7–8 years. Some factors contributing to this delay include:

- Symptoms overlapping with conditions like IBS or pelvic inflammatory disease.

- Period pain being dismissed as normal by doctors, family, or society.

- The need for specialized imaging or laparoscopy, which is not always easily accessible.Increasing awareness and education can help individuals seek care sooner and receive appropriate treatment earlier in their journey.

Symptoms of Endometriosis (and Why They Happen)

Symptoms vary widely, but common signs include:

Pelvic Pain

- Why it happens: Inflamed tissue irritates nearby nerves, leading to persistent, sharp, or deep pain.

Painful Periods (Dysmenorrhea)

- Why it happens: Endometrial-like tissue sheds and bleeds, but since it cannot leave the

body like normal menstruation, it can become trapped, and inflammation builds over time.

Pain During Intercourse (Dyspareunia)

- Why it happens: Adhesions pull on pelvic structures, causing discomfort, particularly with deep penetration. In addition pelvic floor muscle become tight or hypertonic due to ongoing pain

Heavy or Irregular Bleeding

- Why it happens: Hormonal fluctuations and irregular tissue growth disrupt normal menstrual cycles.

Bowel and Bladder Issues

- Why it happens: If endometriosis affects the bowel or bladder, it can lead to constipation, bloating, urinary urgency, or pain.

Fatigue

- Why it happens: Chronic inflammation, hormonal imbalances, and pain place a significant strain on the body.

Who Can Help?

Managing endometriosis requires a multidisciplinary approach. Different healthcareprofessionals provide support in unique ways:

Gynecologist

- Diagnoses endometriosis via laparoscopy.

- Prescribes hormonal treatments or pain management strategies.

- Performs surgery to remove endometrial-like tissue when necessary.

Pelvic Health Physiotherapist

Pelvic health physiotherapy plays a key role in reducing pain, improving movement, and restoring function. It can help with:

- Pelvic Pain: Manual therapy, breathing exercises to ease muscle tension and nerve sensitivity.

- Painful Intercourse: Pelvic floor relaxation techniques, desensitization exercises, and guidance on comfortable positioning.

- Bowel & Bladder Issues: Strategies for constipation, urinary urgency, and improving pelvic muscle coordination.

- Exercise Therapy: Gentle movement, strength training and optimising your exercise routine to your menstrual cycle to support your exercise goals without increasing pain

Dietitian

- Advises on anti-inflammatory nutrition to minimize symptom flares.

- Supports gut health, especially for those with bloating or digestive issues.

Psychologist

- Offers mental health support, addressing the emotional impact of chronic pain.

- Helps with pain management strategies and coping techniques.

Other Specialists

Depending on symptom severity, individuals may also benefit from seeing:

- A fertility specialist (for those trying to conceive).

- A naturopath (for complementary therapies).

- A pain specialist (for targeted pain relief).

Endometriosis and Fertility:

One of the biggest misconceptions about endometriosis is that it always leads to infertility.

While endometriosis can impact fertility, it does not mean that everyone with the condition will struggle to conceive.

What Do the Numbers Say?

- 1 in 6 people globally experience infertility for various reasons, not just endometriosis. With 1 in 9 women having endometriosis, this has a huge impact in how many women with fertility issues will be diagnosed with endometriosis. With these figures we must consider

Correlation vs. Causation between endometriosis and infertility.

Endometriosis is associated with infertility, but that does not mean it directly causes it in every case. Factors like inflammation, adhesions, and hormonal imbalances can affect conception, but many individuals with endometriosis go on to have healthy pregnancies.

Many individuals with endometriosis conceive naturally or with fertility assistance.

What lifestyle changes helps?

- Gentle exercise to reduce inflammation.

- Dietary adjustments(anti-inflammatory foods).

- Stress management (meditation, therapy).

Can endometriosis spread to other organs?

Yes, in rare cases, endometrial-like tissue has been found in the bowel, bladder, and even

the lungs.

Why raise awareness??

- To encourage earlier diagnoses.- Advocate for better treatment options and research funding.

- Support individuals living with endometriosis by providing education and care.

Spreading accurate information helps reduce stigma, encourages earlier intervention, and empowers people to seek the care they deserve.

Positive Developments in endometriosis research, funding, and treatment options:

Increased Funding & Research

- The Australian Government has committed $87.2 million to improving endometriosis diagnosis, treatment, and awareness

- Endometriosis Australia received $1.3 million in government funding in 2024 to support research, workplace education, and patient resources

References:

1. Zondervan KT, Becker CM, Koga K, Missmer SA, Taylor RN, Viganò P. Endometriosis. Nature Reviews Disease Primers. 2018;4(1):9.

2. Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: Pathogenesis and treatment. Nature Reviews Endocrinology. 2014;10(5):261-275.

3. Rogers PA, D’Hooghe TM, Fazleabas A, Gargett CE, Giudice LC, Montgomery GW, Rombauts L, Salamonsen LA. Priorities for endometriosis research: Recommendations from an international workshop. Reproductive Sciences.;16(4):335-346.

4. Australian Institute of Health and Welfare (AIHW). Endometriosis in Australia. Report published 2021

5. Australian Government Department of Health and Aged Care (2024) *What we’re doing about endometriosis*, available at: [6](https://www.health.gov.au/topics/chronic-conditions/what-were-doing-about-chronic-conditions/what-were-doing-about-endometriosis) (Accessed: 10 April 2025).

6. Endometriosis Australia (2025) *Understanding Endometriosis*, available at: [1 (https://endometriosisaustralia.org/) (Accessed: 10 April 2025).