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Updated Endometriosis Guidelines | Image Courtesy of Emma Simpson via Unsplash
Updated Endometriosis Guidelines | Image Courtesy of Emma Simpson via Unsplash

What Do Updated Endometriosis Guidelines Mean to You?

A variety of treatments are available for endometriosis and its symptoms. They include pharmacological treatments, surgical treatments, acupuncture, electrotherapy, nutritional changes, psychological therapies and of course, pelvic floor physical therapy.

The World Health Organization (WHO) states that Endometriosis affects 190 million (10%) of women of reproductive age worldwide. It occurs when uterine-like tissue (similar to, but not the same as) grows outside of the uterus. Currently there is no known cause or cure, however various treatments exist to manage symptoms. Currently, diagnosis of endometriosis can be delayed up to 8-10 years after initial symptoms onset. This happens for a variety of reasons, including limited access to health care or knowledgeable practitioners, poor awareness of or minimization of symptoms.  In addition to the potentially debilitating symptoms of endometriosis, the socioeconomic cost of this disease is comparable to those of other chronic diseases such as diabetes mellitus.

Common Endometriosis symptoms include:

  •       Dysmenorrhea (Painful menstrual periods)
  •       Chronic pelvic pain
  •       Infertility
  •       Dyspareunia (painful intercourse)
  •       Dysuria (painful or difficult urination)
  •       Dyschezia (painful or difficult bowel movements)
  •       Heavy menstrual bleeding
  •       Pelvic inflammatory disease
  •       Irritable bowel syndrome
  •       Fibrocystic breast disease

Retrospectively, studies show the more symptoms one has, the increased likelihood of endometriosis.

Most recently, the ESHRE (European Society of Human Reproduction and Embryology) has updated some guidelines for some approaches to diagnosing and treating those with endometriosis.

A faster diagnosis and therefore earlier treatment will likely increase quality of life, decrease overall costs of managing the disease and potentially manage the progression of the disease. Although the gold standard for diagnosis has always been a laparoscopic evaluation (and excision to remove it), ESHRE is suggesting diagnosing endometriosis prior to laparoscopy to begin treatment sooner in individuals suffering from the symptoms. 

Clinical evaluation is recommended, and some imaging techniques (MRI and ultrasound) have been found to have increasing efficacy detecting only some types of endometriosis. This isn’t to suggest one shouldn’t get laparoscopic confirmation; laparoscopy should be discussed with your doctor considering access to experienced practitioners, availability to financial/insurance resources and operative risks to the individual.  

Updates for treatment for endometriosis pain

  • Gonadotropin Releasing Hormone (GnRH) agonist and/or antagonist are recommended for pain control since endometriosis is a hormone driven condition. There is no evidence that these medications negatively affect disease progression. Attention to fertility concerns must be addressed when taking these medications.
  • NSAIDs may be offered to reduce endometriosis-associated pain. There is no evidence NSAIDs influence disease progression. Attention must be given to possible gastrointestinal or fertility side effects, particularly if taken continuously.

Updates for Endometriosis Treatments for Infertility

  • Use of GnRH agonist for 3-6 months to downregulate ovarian function to improve fertility, including assisted techniques like in vitro fertilization is no longer recommended due to unclear benefits.
  • Use of the Endometriosis Fertility Index (EFI) may be used pre or post-surgery to help determine with your provider fertility management options, assisted reproduction technologies or surgery.

Updates to Prevent Endometriosis Recurrence

In the literature, recurrence varies from 0%-89.6% which varies due to a variety of factors including the definitions of recurrence, length of follow up, study design, stage of the disease etc. Risk factors for recurrence include surgery related factors and personal factors (family history, age at surgery).

  • Hormone treatments are recommended with hormonal contraceptives for at least 18-24 months after surgery to prevent recurrence.
  • Assisted reproduction technologies doesn’t increase recurrence in those with deep endometriosis.
  • When considering surgery, discuss with your doctor: “When surgery is indicated in women with an endometrioma, clinicians should perform ovarian cystectomy, instead of drainage and electrocoagulation, for the secondary prevention of endometriosis-associated dysmenorrhea, dyspareunia, and nonmenstrual pelvic pain. However, the risk of reduced ovarian reserve should be taken into account.”

Considerations/Updates Regarding Endometriosis in Adolescence:

Symptoms/conditions to alert you of the possibility of endometriosis in adolescence include:

  •       Family history of endometriosis
  •       Obstructive genital malformations
  •       Early onset of menstruation
  •       Short menstrual cycle

Be attentive to missed school or activities in a cyclical pattern or necessity for oral contraceptives for dysmenorrhea (painful periods).

We are part of a multidisciplinary team to help with the symptoms of endometriosis. Our therapists care about improving your quality of life and helping to reach your goals, whether it be reducing bladder pain, having painfree intercourse or reducing your cyclic and noncyclic pain. We also look at managing your pain from a whole body lens, understanding how one pain begets more pain. Give us a call or message us to schedule today.

 References:

  1. https://www.who.int/news-room/fact-sheets/detail/endometriosis
  2. Kalaitzopoulos DR, Samartzis N, Kolovos GN, Mareti E, Samartzis EP, Eberhard M, Dinas K, Daniilidis A. Treatment of endometriosis: a review with comparison of 8 guidelines. BMC Womens Health. 2021 Nov 29;21(1):397. doi: 10.1186/s12905-021-01545-5. PMID: 34844587; PMCID: PMC8628449.
  3. 2022 ESHRE (European Society of Human Reproduction and Embryology) Endometriosis Guideline Development Group. www.eshre.eu/guidelines

What Our Patients Have to Say

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Testimonial by A.B.

Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
-- A.B.

Testimonial by Carolina J.

I had tried Pelvic Floor Physical Therapy before (with another PT) and I had a really bad (painful) experience. A friend of mine and fellow patient, told me about Heather, Laureen and Femina PT (née Fusion Wellness & Physical Therapy) and I decided to try again. I am so happy I did! Femina PT have, literally, changed my life. I was able to do again things I couldn't do for over 10 years!! Their bedside manners are impeccable, their knowledge and understanding make me feel comfortable to recommend this place to anyone in pain. Specially if you have Endometriosis. 100% recommended!!

-- Carolina J., 12/28/16 via Yelp!

Testimonial by M.M.

A personal journey and testimonial from one of my patients:

My husband and I were married for 5 years before we were able to have intercourse due to my vaginismus. There was nothing traumatic in my past but for some reason, even though I wanted sex, I mentally avoided "that area" of my body and didn't even admit to myself that there was a problem for a long time, even though I was never able to put tampons in. Once I finally opened my eyes up to the fact that I had a problem, I had a surgery that was supposed to fix the issue.

Read more: Testimonial by M.M.

Testimonial by R.H.

No one could tell me why I was having pain during sex--sharp pain, not just uncomfortable, pain. I was referred to Heather Jeffcoat after researching several different options. I had seen a specialist who told me physical therapy would not help and my only option was surgery. I really didn't want to go that route, so when we got a referral, I decided to try it--it can't hurt, I thought. I am so glad I did. She diagnosed the problem right away, which was a relief in itself.

To know why I was having pain eased my mind immensely. And to hear that she could fix it without surgery was another relief. She said she could fix the problem in 6 weeks. I think it was actually 4 for me. She was very methodical, and treated me as an intelligent human being capable of participating in my own recovery. I would absolutely recommend her to anyone. She did not try to prolong my session numbers, she worked hard to accommodate my schedule (and the fact that I had to bring a baby to sessions), and she was completely honest the entire time. It is so hard to find someone with these characteristics, much less a professional who is so good at what she does. She has my highest respect.

-- R.H.

Testimonial by Alexandra B.

Heather is without exaggerating AMAZING! After years of trouble with a certain part of my body, in no time, she made everything change back to equilibrium and to what would be considered normal. She explains everything in detail and therefore gives you a better understanding of why things are the way they are, and how you can work towards turning things around. I would highly recommend Heather for any type of Physical Therapy. She has created her own "Method/Therapy" through years of studying (with some of the greatest practitioners), practice and breaking down the issues of her past patients, enabling her to fine tune her own system. I'm so thankful to have found her, and I'm especially grateful for the quick recovery I've achieved, after years of distress. If you cannot afford her, I recommend you purchase her book. Although it may not be Heather in person, it can still help you to get on the right path to recovery!

-- Alexandra B., 5/20/2015 via Yelp!

Testimonial by T.C.

While pregnant with my twins, Heather took care with keeping me on my feet and pain free. She saved my back, my sanity and the holidays! I would recommend her to every “mom” looking to stay on her feet during pregnancy and post-partum.

-- T.C.

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