By Joanna Morris (Guest Post)
More than 830,000 (more than 14%) of Australian girls, women, and those assigned female at birth live with endometriosis at some point in their life, with the disease often starting in teenagers1. But what exactly is endometriosis?
Endometriosis is a chronic inflammatory condition where tissue similar to the lining of the uterus is found in other parts of the body. It is characterised by a broad variety of symptoms, and as the cause of disease is currently unknown - the symptoms are ever evolving. Let’s explore some of its common symptoms.
1. PELVIC PAIN
Endometriosis is often associated with chronic pelvic pain, a hallmark symptom of the condition. This pain can occur at any time throughout the menstrual cycle, vary in location, intensity and nature. The exact mechanisms underlying this pain are complex, involving inflammatory mediators, nerve sensitisation and abnormal tissue growth (location of the endometriosis tissue).
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2. DYSMENORRHEA
Dysmenorrhea, or painful menstrual periods, is a common symptom of endometriosis. It is characterised by severe cramping and pelvic pain before and during menstruation. This pain results from the presence of endometrial tissue outside the uterus, which responds to hormonal changes in the menstrual cycle. The tissue becomes inflamed and sheds, leading to intense pain as the body attempts to expel it. Prostaglandins, hormone-like substances that promote inflammation and uterine contractions, play a key role in the development of dysmenorrhea in endometriosis.
3. DYSPAREUNIA
Dyspareunia refers to pain experienced during sexual intercourse and is frequently reported by individuals with endometriosis. Factors contributing to dyspareunia include the location of endometrial lesions on or near the pelvic organs, pelvic muscle tension, sensitised nerves and heightened awareness in our nervous system. Psychological factors, such as anxiety and fear of pain, can exacerbate dyspareunia in individuals with endometriosis.
4. FATIGUE
Fatigue is a common symptom experienced by many individuals with endometriosis, significantly impacting their daily lives, but often misdiagnosed due to the non-specific nature of the symptom. The exact mechanisms underlying endometriosis-related fatigue are not fully understood, but several factors likely contribute to this debilitating symptom. Chronic pain and discomfort, often accompanied by poor sleep quality due to pain exacerbation at night, can lead to poor sleep patterns.
Moreover, the constant inflammatory response in the body, triggered by the presence of endometrial tissue outside the uterus, can induce a state of chronic low-grade inflammation. This persistent inflammation, along with hormonal imbalances associated with endometriosis, may contribute to feeling fatigued. Additionally, the emotional toll of managing a chronic condition, coupled with the stress of coping with pain and its impact on daily activities, can further contribute to the overwhelming sense of fatigue reported by individuals with endometriosis.
5. INFERTILITY
Endometriosis is one of the main causes of infertility in people assigned female at birth (PAFB). The condition can disrupt the normal functioning of the reproductive organs, including the ovaries, fallopian tubes, and uterus. Endometrial implants and scar tissue formation can block or distort the fallopian tubes, preventing the sperm from meeting the egg.
Inflammation caused by endometriosis may also interfere with the release of a mature egg or implantation of an embryo. The complex interplay of inflammatory mediators, altered immune response, and anatomical changes contributes to the reduced fertility observed in individuals with endometriosis.
6. GASTROINTESTINAL SYMPTOMS
Endometriosis can affect the gastrointestinal tract, leading to symptoms such as bloating, constipation, diarrhoea, and abdominal pain. Endometrial tissue outside the uterus can adhere to the portions of the bowel, causing inflammation and functional disturbances.
Moreover, the release of inflammatory factors in the pelvic cavity can irritate nearby organs, leading to gastrointestinal symptoms. The intricate network of nerves connecting the reproductive and gastrointestinal systems further contributes to the overlap of symptoms, making the diagnosis and management of endometriosis challenging, for example, endometriosis is commonly misdiagnosed as irritable bowel syndrome.
7. URINARY SYMPTOMS
Endometriosis can also impact the urinary system, giving rise to various urinary symptoms such as urgency, frequency, and pain during urination. The proximity of endometrial implants to the bladder can lead to inflammation and irritation, causing discomfort and a frequent urge to urinate.
In some cases, endometriosis lesions can adhere to the urinary tract, leading to the formation of fibrous bands that restrict the bladder's capacity. Additionally, the chronic inflammatory environment created by endometriosis can affect the nerves regulating bladder function, further exacerbating urinary symptoms.
8. MENTAL HEALTH CHALLENGES
Endometriosis not only affects the body physically but can also significantly impact mental health. Chronic pain, unpredictable symptom flare-ups, and the challenges associated with diagnosis and treatment can lead to emotional distress, anxiety, and depression. Living with a chronic condition like endometriosis can cause feelings of helplessness and frustration, often leading to a reduced quality of life. The constant battle with pain and discomfort can lower self-esteem and self-confidence, making it difficult for individuals to engage in social activities, attend work or maintain relationships. Additionally, the uncertainty surrounding fertility and concerns about the future can contribute to significant emotional strain. It is crucial for healthcare providers to recognise the intricate connection between endometriosis and mental health and offer appropriate support, including counselling and therapy, to help individuals cope with the psychological challenges associated with this condition.
In summary, endometriosis is a condition with a broad range of symptoms, impacting the entire body. The fluctuations in symptoms and unpredictable nature of the disease can place a huge burden on an individual and impact both their physical and mental health. It is important to treat this disease from a surgical, medical and holistic point of view, placing the individual's goals at the centre of care.
ABOUT THE AUTHOR
Jo is a dedicated Continence and Women's Health Physiotherapist and co-founder of digital health platform, Matilda. Specialising in endometriosis, pelvic pain and sexual dysfunction, Jo built Matilda with Dr Kevin Wernli (PhD) to provide holistic care, symptom optimisation, reducing time to optimal care, and minimising costs for people with endometriosis. Jo is passionate about getting Matilda into the hands of people who need it, empowering them to live a better life.
Matilda is a digital health platform, chasing the vision of improving the lives of the 190 million people living with endometriosis, around the world, using technology. Matilda does this by offering affordable access to holistic care. Born in 2022, Matilda is the creation of Pelvic Health Physiotherapist, Joanna Morris, and Persistent Pain Physiotherapist, Dr Kevin Wernli (PhD). Matilda offers people the ability to track their symptoms and lifestyle habits to better understand their condition, learn from an interactive, evidence-based resource library, attend live and on-demand classes with specialised holistic care clinicians, and access a community of endo-warriors to support them on their journey.
Riding the waves of the success following our first version, we’re very close to releasing the highly anticipated next version (it may even be released by the time you’re reading this!). To show our support for you and fellow Australian businesses using natural and sustainable methods like Zea, Matilda is offering you 30% off a yearly Matilda membership during a special presale event. Just visit https://www.matilda.health/zea to redeem.
REFERENCES
- Endometriosis Australia. https://endometriosisaustralia.org/
