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  • Writer's pictureDr. Kelly Sammis, PT, CLT

Understanding Endometriosis

Updated: Mar 19, 2023

Endometriosis occurs when the type of tissue that normally lines the uterus, called the endometrium, is found in other locations of the body where it’s not supposed to be. Endometriosis is usually found in the lower abdomen or pelvis, but can appear anywhere in the body. Endometriosis is estimated to affect approximately 10-11% of reproductive-aged women. According to a study performed by the World Endometriosis Research Foundation (WERF) it is estimated to cost the US over $85 billion each year in medical costs and loss of work productivity, an economic burden similar to that of other chronic diseases such as diabetes, Chron’s disease and rheumatoid arthritis.

This study also showed that the health-related quality of life in women with endometriosis was decreased, noting severe and chronic pain was the most pronounced complaint. While pelvic pain is a marker of endometriosis, especially when associated with your menstrual period, it is not the only symptom.

Symptoms of endometriosis may include the following:

- painful periods

- excessive bleeding during or between periods

- pelvic pain

- bladder dysfunction

- bowel dysfunction

- sexual dysfunction

- infertility

- development of ovarian endometrial masses or tumors

- mental health impact

There is a wide range of variability in regards to the extent and type of symptom that each woman experiences and often these symptoms overlap with other diagnoses, making endometriosis difficult for health care providers to diagnose. The average diagnostic delay for endometriosis is 8.5 years.

How Does Endometriosis Happen?

There are many theories that exist to explain how endometriosis happens, although the exact cause is not certain. Possible explanations include the following:

1. Retrograde menstruation: This theory stands on the idea that when a woman has her period, some of the blood and tissue from the uterus travels out through the fallopian tubes and into the abdominal or pelvic cavity. These displaced cells stick to other tissues where they will grow and continue to thicken and bleed over the course of each menstrual cycle. Interestingly, nearly all women have some degree of retrograde menstruation, but not all will get endometriosis, suggesting a possible genetic or immune system component.

2. Induction theory: This theory proposes that hormones or immune factors promote transformation of peritoneal cells (the cells that line the inner surface of your abdomen) into endometrial cells.

3. Embryonic cell transformation: Along the same lines as the induction theory, this proposes that hormones may transform embryonic cells (cells in the earliest stage of development) into endometrial cells during puberty.

4. Endometrial cell transport: This theory explains that the cells from the lining of the uterus travel through the blood vessels or through the lymphatic system to reach other organs or body areas.

5. Surgical scar implantation: It has also been suggested that endometriosis can spread at the time of surgery. For example, a woman with endometriosis that undergoes a hysterectomy or cesarean section could inadvertently have some endometriosis cells spread to the abdominal cavity or attach to the surgical incision.

6. Immune system disorder: The possibility that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that’s growing outside of the uterus.

Why Does It Hurt?

Misplaced endometrial tissue is triggered by the same hormonal changes that trigger your period to come. This causes the tissue to shed, or bleed, regardless of it’s location in the body. When this shedding occurs, it is irritating to the nerves and surrounding tissues in the region where the endometrial cells have been transported.

Over time, this shedding leads to chronic inflammation and scar tissue/adhesions. This can progress and worsen over time if left untreated.

Traditional Treatment Approaches

Traditionally, endometriosis is treated with medication and surgery. Clinicians will typically initiate treatment with the use of pain medication, anti-inflammatory medication and hormone therapy. If these do not offer symptom relief, typically a laparoscopy is performed to remove endometriosis implants.

Holistic Treatment Approaches

It is my opinion that we should also consider additional conservative treatment approaches prior to surgical intervention which may include treatments with a pelvic health therapist, acupuncturist, naturopath or functional medicine practitioner, massage therapist or other healthcare professional specializing in abdominal massage techniques (Arvigo or Mayan Abdominal), nutrition counseling and/or herbal medicine approaches.

Overall the treatment goals should be:

- reduce inflammation

- reduce oxidative damage

- balance hormones

- detoxify

- treat pain

- relieve adhesions

A pelvic health therapist can assist with techniques to treat pain, neuromuscular imbalances and tissue adhesions in the body. Techniques such as dry needling therapy have been shown to reduce biochemicals in the tissues and surrounding environments which can help to reduce inflammation and reduce inflammatory cascades in the tissues. This technique has been integral in seeing success with my clients who are experiencing symptoms associated with endometriosis.

It is also suggested that adopting an anti-inflammatory diet may assist with healing tissues and preventing worsening of endometriosis.

Herbal Medicine Approach

There are many herbs and supplements that can help reduce the overall number of endometrial implants in your body, but this will certainly take time. It take about 6-12 months to see a reduction in the implants themselves, but you should start seeing results within the first 2-4 weeks in regards to pain relief with an herbal approach to treatment.

To see a list of suggestions, please head over to the handouts page of the website or send a message to schedule a consultation!

To health + wellness for your pelvis,


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