Endometriosis is an often painful condition where part of the lining of the uterus is found on ovaries, or the bowel and bladder, and other places, even outside the pelvis.

Ten percent of women have endometriosis. It can cause infertility, painful periods, pain with sex, bladder, bowel, and back symptoms, even blood in urine and stool. The lining cells can plant on the diaphragm and cause chest wall pain and shortness of breath. As with most pain problems, there is often fatigue.

Most likely it occurs after cells have passed through fallopian tubes into pelvic cavity. Estrogen stimulates inflammation and causes scarring and adhesions.

Most commonly seen in thin women, women with no children, those who’ve had their first period early in life, heavy and painful flow with usually a short cycle. Often mothers have had similar problems.

It can get worse over time, or stay the same and even get better. Lowering inflammation and understanding and working on Central Sensitization has been found to improve endometriosis.

Early treatment can prevent chronic pain. Sometimes tender nodules can be felt on exam. Pelvic transvaginal (a ‘wand’ introduced inside the vagina by the patient’) ultrasound can be helpful.

NSAID (non-steroidal anti-inflammation) drugs may help pain. Cyclical or continuous oral contraceptive drugs or progestin-only medications, subcutaneous implants, or intra-uterine devices (especially those with levonorgestrel-releasing system with GnRH agonists) can help. A gynecologist can prescribe more specialized medications. Surgery can also be effective.

When the condition has been present for a long time, chronic pain is present. As in any chronic pain condition, pain education, physiotherapy, pelvic exercises, mindfulness, cognitive-behavior therapy and other chronic pain management tools are necessary to manage the pain – bio(biology)psycho(psychology)social approach.