It’s not just about the Pelvis

Endometriosis is often described as a condition affecting the pelvic cavity. It involves endometrial tissue present outside of the uterus. This results in the most common symptoms experienced by women with Endometriosis like pelvic pain and infertility. Most lesions are located on the ovaries, fallopian tubes, outside of the uterus and the surrounding ligaments. However, we do see extra-pelvic lesions in about 12% of women, which have been seen on the abdominal wall, and even on the lungs and diaphragm.

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How is Endometriosis diagnosed?

One of the major concerns with Endometriosis is the time it takes for diagnosis. The golden standard is currently laparoscopic surgery, which can take up to 6-10 years. This means many women with this debilitating condition suffer for years before a diagnosis is made. This results in delayed treatment which can have a huge impact on these women’s’ quality of life.

As we continue to learn about endometriosis, the more complex we are discovering this disease is. It’s multifactorial. It is rooted in inflammation, it involves hormones, it involves the immune system, it involves alerted epigenetic expression, it involves neural changes, and changes in pain perception. Women with Endometriosis often suffer from much more than just pelvic pain – symptoms can arise from all systems of the body. A recent review published by The Lancet stated that:

“Endometriosis if now considered a systemic disease rather than a disease predominantly affecting the pelvis.”

Beyond Pelvic Pain

This is why women with Endometriosis suffer from much more than just pelvic pain. The neurological changes affect areas of the brain in charge of pain perception, and women can experience whole body pain and are more likely to have migraines. Brain remodeling changes can lead to mood disorders like anxiety and depression. Altered gene expression creates progesterone resistance, resulting in hormonal imbalances. Lesions themselves along with inflammation can cause digestive issues, including bowel changes like constipation or diarrhea. Inflammation alone in the body increases the risk of developing many other chronic conditions. Considering Endometriosis as a systemic condition sheds light on the complexities of diagnosing and effectively treating this condition.

If Endometriosis affects more than just the pelvis, it’s important to consider how this condition can impact the whole system. Investigations need to include a full-body approach to avoid delays in diagnosis and intervention. We also need to consider this when evaluating various treatment options – whether it be natural, pharmaceutical, or surgical. Inflammation needs to be addressed, hormones need to be addressed, the microbiome needs to be addressed, neural pathways and pain perception needs to be addressed, and the lesions themselves need to be addressed. Depending on the level of risk associated with various treatment options, treatment before surgical diagnosis should be considered in women with high clinical suspicion. When we understand the mechanisms behind the complex systemic changes in Endometriosis it opens avenues for earlier and more effective treatment, and improved quality of life for these women.

Resources:

PMID: 33640070

PMID: 29865779

PMID: 23634803

PMID: 24294950