Endometriosis 101
by Trudy Pacifico, PT
What Is Endometriosis?
Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus. These growths, called lesions, typically develop in the pelvis and abdomen.
Common locations include:
- Pelvis & abdomen: pouch of Douglas (space between uterus and rectum), uterosacral ligaments, ovaries, fallopian tubes, pelvic lining
- Less common: bladder, rectum, vagina, intestines, appendix, spinal nerves
- Rare cases: kidneys, lungs, diaphragm, brain
These lesions respond to monthly hormonal changes. When estrogen rises, the lesions can grow and thicken, just like the uterine lining. But because this tissue is outside the uterus, it has nowhere to go when it breaks down, leading to inflammation and irritation in surrounding areas.
Over time, this can cause:
- Adhesions: bands of sticky scar-like tissue that make organs stick together
- Scarring: thickening or stiffening of tissue after repeated inflammation
- Internal bleeding: small amounts of bleeding in the pelvis, triggering pain and swelling
These changes can lead to pelvic pain, cramping, bloating, and other symptoms commonly associated with endometriosis and adenomyosis.
Important: Endometriosis is not just a menstrual or gynecological issue. It’s a complex, systemic inflammatory condition that can be debilitating.
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Statistics
- Endometriosis affects roughly 1 in 10 women in the U.S.
- There is no known cause or cure, though treatment can manage symptoms.
- Due to gaps in research and education, symptoms are often misdiagnosed or dismissed, leading to diagnosis delays of 7–10 years.
Imagine experiencing severe pain daily, navigating other symptoms, and spending years searching for answers. This is the reality for millions of women.
Symptoms
Symptoms vary widely. Some women may experience several, all, or none:
- Abnormal periods
- Painful periods
- Pain with intercourse
- Pain with urination or bowel movements
- Fatigue
- Gastrointestinal distress
- Low back or leg pain
- Infertility
Severe symptoms don’t always correlate with severe disease—and vice versa.
Physical therapy is a highly recommended treatment for many types of chronic pain, and endometriosis is no exception.
Stages of Endometriosis
ASRM Staging (American Society of Reproductive Medicine)
- Stage I (Minimal): few superficial implants (1–5 points)
- Stage II (Mild): more and deeper implants (6–15 points)
- Stage III (Moderate): many deep implants, small ovarian cysts, filmy adhesions (16–40 points)
- Stage IV (Severe): many deep implants, large ovarian cysts, dense adhesions (>40 points)
Note: This system doesn’t reflect pain, fertility issues, or lesion location.
EndoFound Classification (Endometriosis Foundation of America)
- Category I – Peritoneal Endometriosis: minimal, affects abdominal lining
- Category II – Ovarian Endometriomas (“Chocolate Cysts”): may rupture and spread
- Category III – Deep Infiltrating Endometriosis I (DIE I): affects pelvic organs, can distort anatomy
- Category IV – Deep Infiltrating Endometriosis II (DIE II): affects organs inside and outside the pelvis
What Causes Endometriosis?
Unfortunately, the exact cause is unknown, mostly due to lack of research, funding, and focus.
Some leading theories include:
- Retrograde menstruation: menstrual blood flows backward through fallopian tubes, allowing endometrial cells to implant outside the uterus
- Immune system dysfunction: antibodies against endometrial cells trigger inflammation and tissue damage
- Genetic factors: family history increases risk up to sevenfold
- Genetic/epigenetic abnormalities: lesions may arise from endometrial, bone marrow, or stem cells
How Is It Diagnosed?
- Clinical symptoms and imaging often strongly suggest endometriosis
- Laparoscopy remains the gold standard for definitive diagnosis
- Ultrasound and MRI help detect endometriomas and deep infiltrating lesions, but small peritoneal implants may be missed
How Is It Treated?
- Medication: to regulate hormones and manage symptoms
- Surgery: excision of lesions if symptoms persist despite medical management
When to Seek Help
Many people with endometriosis spend years being told their symptoms are “normal.” While some discomfort during a menstrual cycle can be common, severe or persistent pain is not something you have to simply live with.
You may want to speak with a healthcare provider if you experience:
- Period pain that interferes with work, school, or daily activities
- Pain with intercourse
- Pain with bowel movements or urination, especially during your cycle
- Chronic pelvic pain or persistent low back pain
- Significant fatigue around your cycle
- Difficulty becoming pregnant
If these symptoms sound familiar, you are not alone, and your concerns deserve to be taken seriously. Seeking care from knowledgeable providers, including gynecologists and pelvic floor physical therapists, can help you better understand what’s happening in your body and explore treatment options that may improve your quality of life.
How Pelvic Floor Physical Therapy Can Help
Pelvic physical therapy can be a game-changer for managing endometriosis symptoms. Endometriosis often causes pain not just internally, but also through tension in the pelvic floor, hips, and lower back.
A pelvic PT can help:
- Relax tight muscles
- Improve posture
- Guide gentle stretches and breathing techniques
Final Thoughts
Endometriosis affects millions worldwide, yet it remains misunderstood and under-researched. Educating yourself, seeking care from knowledgeable providers, and connecting with others who understand your experience can make a meaningful difference.
You deserve to be heard, supported, and taken seriously. Advocate for yourself, fight for the care you need, and consider working with a pelvic floor physical therapist. You don’t have to face this alone.
Where to Learn More About Endometriosis
Endometriosis Foundation of America (EndoFound)
https://www.endofound.org/
Endometriosis Association
https://endometriosisassn.org/
Endometriosis.org
https://endometriosis.org/
Endometriosis Research Center
https://www.endocenter.org/
References
Advanced Gynaecology Melbourne. (n.d.). Stages of endometriosis. https://www.advancedgynaecologymelbourne.com.au/endometriosis/stages
Endometriosis Foundation of America. (n.d.). Endometriosis. https://www.endofound.org/endometriosis
Seckin Endometriosis Center. (2024, November 12). How to understand endometriosis: A guide to the basics and beyond. https://drseckin.com/how-to-understand-endometriosis-a-guide-to-the-basics-and-beyond/
Visit JAG Physical Therapy for more details or simply contact us. You can book an appointment for an evaluation here.
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