Endometriosis: often not just a painful period

Endometriosis is a common condition where tissue similar to the lining of the uterus grows in other parts of the body. This tissue often grows in the pelvic cavity (such as around your bladder, bowel, ovaries), but can be found in other areas of the body too. Endo can affect your whole body and often isn’t just contained to pain during your period.  

The most recognised symptoms of endo are heavy or irregular bleeding, painful periods, and/or pain during ovulation. However, symptoms of endo also involve the pelvic floor muscles, nervous system, and organs inside the pelvic cavity. Common pelvic floor symptoms include pain during or after sex, vaginismus/vulvodynia, and increased pelvic floor muscle tone. People with endo often also experience bowel symptoms such as constipation, pain with bowel movements, and irritable bowel syndrome – people with endo are around 2.5x more likely to be diagnosed with IBS. Bladder complaints are common too, with common concerns being urgency, frequency of urination, and pain with filling and/or emptying. Sometimes people with endo also demonstrate increased nerve sensitivity, fatigue (especially in the lead up to menstruation) and have a higher incidence of fibromyalgia. People with endo also have higher reported rates of anxiety and depression.  

This list of symptoms is not exhaustive as everyone’s experience with endo is different. Endo is currently diagnosed through laparoscopy (key-hole surgery) where a sample of tissue is taken. Improvements in imaging techniques such as transvaginal ultrasound (TVUSS) can reliably diagnose endo when it’s moderate to severe. However, because TVUSS can’t be used to diagnose mild or superficial disease, it can only be used to rule in endo but not rule it out.  

Your GP/Women’s Health Physiotherapist/Obgyn will be able to tell you they suspect endometriosis based on a thorough subjective examination where they will ask questions about your periods, bladder, bowel, and sexual function. Your health professional will validate your symptoms and discuss your treatment options.  

There are a range of treatment options available. From a surgical perspective, there is laparoscopy for excision (removal) of the endo tissue, pelvic floor botox (muscle relaxant) and fertility preserving treatments. Medical management often also involves the use of pain killers and anti-inflammatories. Hormonal contraceptives such as IUD or the pill can be used to help manage your symptoms too.  

Pelvic floor physiotherapy is useful in providing external and internal manual therapy e.g. massage/desensitising muscles and nerves of the pelvic floor, pain management, exercise advice, and management of bladder and bowel symptoms. Complementary therapies also include psychology, dietetics/nutrition, naturopathy, acupuncture, and massage.  

Know the symptoms and advocate for yourself! Having a good healthcare team to support you will make a world of difference on your endo journey.  


Written by Prue (Women’s Health Physiotherapist)