Screening for Endometriosis

Beth Safarian, PT, MSc. PT, BSc

At the clinic, we have a lot of clients coming in with dysmenorrhea (also known as painful periods). Whenever someone comes in with this complaint, it is important that we screen them for endometriosis. Throughout the world, the delay between the onset of symptoms and endometriosis diagnosis is between 6 and 10 years. Doing a thorough screening may allow someone to start the process of investigating and potentially save of them years of being undiagnosed without proper treatment.

Below are a list of signs and symptoms that could be indicative of endometriosis:

Pelvic Pain

While it is normal and common to experience menstrual cramps before and/or during your period, we start to wonder if more might be happening when the pain is more widespread. There may be complaints of pain that radiates into the lower back, ribs, upper abdomen, pelvis and/or lower extremities. A common pain pattern is for the pain to have begun as more cyclic. For example, the pain is only present during ovulation and menstruation. As time goes on, the pain may become more constant throughout the menstrual cycle. The pain is often so high that it is common for patients to require pain management such as Ibruoprofen, Tylenol or Naproxen. Many people have also been prescribed an oral contraceptive pill to manage their pain.

Bladder Dysfunction

Endometriosis can also have effects on the bladder which can mimic interstitial cystitis and bladder pain syndrome. For example, patients may present with pain with a full bladder, pain during urination (dysuria), incomplete emptying, urinary frequency, urgency and/or nocturia. .

Bowel Dysfunction

A common area of the body that endometriosis can be found is between the uterus and the rectum (recto-uterine pouch). This may present as rectal pain before and/or during defecation (dyschezia), bloating, constipation and/or diarrhea.

Dyspareunia

Painful intercourse, particularly with deep penetration, is a common sign of endometriosis. This is due to adhesions that limit the movement and mobility of the cervix. It can result in a sharp/stabbing pain during intercourse, as well as a cramping pain afterwards. This pain might lead to developing tension in the pelvic floor muscles which then creates difficulty with insertion and increased pain throughout intercourse.

Fertility Challenges

Endometrial growth can block the fallopian tubes and affect the ovaries which can prevent someone from being able to get pregnant. Fertility is typically affected in about 30-40% of people with endometriosis.

Additional indicators that may support the diagnosis of endometriosis:

• Family History - There is a strong genetic component to endometriosis
• Quality of Life Impacts - Patients will often miss out of on work and social commitments such as missing school, work or appointments. Dealing with persistent pain also affects mental health leading to depression and anxiety.

While it is common to see these symptoms in conjunction with endometriosis, it is necessary that your health care team rule out any gastrointestinal and genitourinary diseases, infections or conditions that could be the cause as well. If you are concerned that you may have endometriosis, the first step you can take is talk to your family doctor so the appropriate tests and referrals can be made.

If you have been given a recommendation from your doctor to consider trying pelvic physiotherapy, come see one of our experienced physiotherapists today and start feeling better soon.