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Endometriosis Facts: What You Need to Know
by Tara Galles, MS, OTR
Natalie had suffered with severe menstrual cramping ever since puberty. In her early 20’s, she was diagnosed with endometriosis. Working a full-time job, she budgeted her sick days carefully, knowing she could be wrenched into a fetal position on her sofa with hope that the ibuprofen and hot water might cut the pain this month. She felt brushed off by decades of doctors handing her prescriptions for pain peppered with the recommendation to lose weight. At age 46, Natalie was recommended for a hysterectomy.
by Tara Galles, MS, OTR
Natalie had suffered with severe menstrual cramping ever since puberty. In her early 20’s, she was diagnosed with endometriosis. Working a full-time job, she budgeted her sick days carefully, knowing she could be wrenched into a fetal position on her sofa with hope that the ibuprofen and hot water might cut the pain this month. She felt brushed off by decades of doctors handing her prescriptions for pain peppered with the recommendation to lose weight. At age 46, Natalie was recommended for a hysterectomy.
Women over 40 are less likely to receive information about alternative treatments to hysterectomy.
A 2015 the American Journal of Obstetrics and Gynecology study reported that women over 40 were less likely to be recommended for alternative treatment options prior to hysterectomy, and 38% of women over 40 who had hysterectomies had unsupported pathology, justifying surgery including pain from endometriosis [source]. More than 400,000 U.S. women have hysterectomies each year [source]. While that number is decreasing, it’s estimated that 68% of these surgeries are done for benign conditions.
Research reveals that hysterectomies are overutilized for endometriosis.
Natalie did a little research and learned that endometriosis was a benign disease. Therefore, she felt hysterectomy was a drastic option that would require her to take significant time off work, not to mention the financial cost and time to rehabilitate. She understood that her uterus was a perfectly healthy organ. It was the endometrial tissue spread throughout her abdominal and pelvic regions that was causing her pain, not her uterus. She casually asked me why doctors don’t recommend harvesting the healthy testicles of men with groin pain. Good question!
Medical and surgical treatment for endometriosis often provide little relief and can even be dangerous.
Up to 15% of reproductive aged women are impacted by endometriosis. Symptoms range from mild discomfort to intolerable pain. There is no cure or long-term treatments for endometriosis, and surgeries are repeated often with little relief [source]. A lot of women end up taking opioids. In 2018, Obstetrics and Gynecology estimated that 25% of ob-gyns prescribe opiods for endometriosis [source]. A 2019 Obstetrics and Gynecological study revealed that women with endometriosis were almost four times as likely to take potentially dangerous doses of opioids, equivalent to 100 milligrams of morphine or more [source]. Opioids can also have fatal effects when combined with benzodiazepines, which women with endometriosis frequently take for anxiety.
Pelvic floor therapy is a safe and valid treatement for pain from endometriosis.
According to Natalie’s MRIs, the endometrial tissue was spread throughout her pelvic and abdominal region. Intuitively, Natalie felt a hysterectomy would not resolve her pain. How could they remove all that endometrial tissue? She grew increasingly frustrated with multiple gynecologists who continued to write her prescriptions to manage pain while suggesting she have a hysterectomy (and yes, they suggested she lose weight). After a bit more of online research, she learned about pelvic floor therapy and asked her family physician for a script to try therapy.
Visceral manipulation remodels endometrial scarring and has successfully reduced pain from endometriosis.
When Natalie walked into my clinic, she could barely walk. She waddled from the pain, and her affect was flat. She reported that she could not exit her car without picking up her left leg and lifting it out. An evaluation of her hip strength validated this complaint. Light touch to her hard and bloated abdominal produced a heightened pain response. She also had multiple cesarean sections scars, which proved to be contributing to the pain. We started treatment with very gentle visceral manipulation. The endometrial tissue had created myofascial scarring that caused her internal organs to “stick” together, so they were like one solid rock and painful! As the manual treatment broke up the scaring, her pain slowly dissolved, and her belly became softer and flatter. We also discovered that her cesarean section scars had adhesions to the uterus. We were able to successfully release these in therapy, which provided significant relief.
Back pain, hip pain, and pelvic pain are typically interrelated with endometrial pain.
Not only did Natalie’s abdominal and pelvic pain decrease, but her back pain was decreasing as well. Natalie soon discovered that the endometrial pain had masked some underlying hip and back issues, so we continued therapy to resolve these. After six visits of manual treatment, her flat affect was replaced by a pleasant smile and she was able to start taking light walks and wear jeans again. As a therapist, I immediately prescribed a home exercise program as soon as she could tolerate it.
You don’t have to live with the painful and embarrassing symptoms from endometriosis.
Endometriosis is a leading cause of infertility and sexual dysfunction. It also is associated with an elevated risk for developing depression and anxiety [source]. Endometriosis is also a predictor of absenteeism and loss of household income [source]. After eight therapy visits, Natalie voiced her frustration for having to live in pain for so long, even though the treatment was easy! Why didn’t anyone tell her about therapy? Natalie’s frustration was similar to other women I have treated for endometriosis. I often tell them the pain is in their pelvis, not their head. Women do not have to live with the painful and embarrassing symptoms from endometriosis. However, like Natalie, they must decide to Take CONTROL! of their issue and talk with their physician or nurse practitioner about trying therapy.
You can feel like a natural woman again by seeking pelvic therapy for endometriosis.
Natalie was released from therapy after ten visits. Her pain was 90% better. She could get out of the car without having to lift her leg, she could tolerate prolonged sitting, and she was able to take 1-2 mile walks without pain. She didn’t dread her menstrual cycle anymore and didn’t have to keep her sick days to use for days when the cramps were too painful. In therapy, she learned how to perform visceral manipulation to keep the endometrial tissue mobile, so it did not create painful scarring again. Natalie reported decreased anxiety and a renewed interest in sexual activity. She felt vindicated in knowing that her excess fat was not the cause of her pain and that she had been able to Take CONTROL! of the endometriosis.
Like so many women who suffer with endometriosis, Natalie thought she would always have to live with her painful “endo belly” and was even considering a hysterectomy that was not necessary! Women’s pelvic floor therapy is a validated treatment option for endometriosis [source]. While pelvic floor physical and occupational therapists are not fertility clinicians, women have found that pregnancy can be a positive side effect of mobilizing endometrial scarring in therapy. This was the case last year with two of my younger patients with endometriosis.
A pelvic floor therapy evaluation can identify specific pelvic structures causing pain, which is often a muscle or old scar tissue, and not the uterus itself. Women are often surprised and relieved that pain can be reduced and manually treated as soon as the first visit. They are also pleased that they are not forced to rely on pain medications or undergo surgery.
If you are struggling with pain from endometriosis, decide to Take CONTROL! Talk with your provider about trying pelvic floor therapy and call us at 765.319.8420 to make your appointment. You can feel like a natural woman again, even with endometriosis.
Patient name and details modified to protect confidentiality. Story used with permission.
Tara Galles, MS, OTR
Tara Galles, MS, OTR, is owner of You’re in CONTROL! With over 20 years of clinical experience she compassionately moves each woman to take CONTROL! of their body and rehabilitates them to feel like a natural woman again. As a mother of four children she also understands what it’s like to be a pelvic rehab patient. You may contact Tara about your pelvic issue at (765) 319-8420, or make an appointment using the button at the top of the page.