Painful periods and intercourse pain have the potential to disrupt a woman’s life, from her daily activities to relationships. If you regularly experience menstrual and intercourse pain, your symptoms may be caused by uterine fibroids or endometriosis. While there are some similarities in the symptoms, diagnosis and treatment of these two conditions, there also a number of differences that distinguish endometriosis and uterine fibroids.
Regardless of its cause, there is no reason to continue to live with debilitating pelvic pain. Yet, many women continue to do so. In fact, a recent study in the Journal of Minimally Invasive Gynecology suggests that only a fraction of women who experience pelvic pain report it to their physicians — a troubling statistic.
Uterine fibroids (also called myomas) are noncancerous growths of the uterus that often develop during a woman’s childbearing years, according to the Mayo Clinic. Originating in the smooth muscular tissue of the uterus (myometrium), firboids can range in size from seedlings that are undetectable by the human eye to bulky masses that may distort and enlarge the uterus.
While some women never know that they have fibroids due to a lack of symptoms, others report very painful menstruation and persistent pain with intercourse. The two main treatment categories used for fibroids are medications and surgery. Commonly-used medications include gonadotropin-releasing hormone (Gn-RH) agonists and the progestin-releasing intrauterine device (IUD). They work by targeting the hormones that regulate a woman’s menstrual cycle, helping alleviate symptoms such as heavy menstrual bleeding and pelvic pressure. While these medications do not eliminate fibroids, they may help reduce their size.
Fibroids are typically diagnosed via imaging tests, such as MRI, ultrasound or hysterosonography, in women who have symptoms. But in many cases, the fibroids are incidentally discovered during routine pelvic exams in which the doctor may feel irregularities in the shape of a woman’s uterus.
There are a number of surgical procedures for the removal of fibroids. Traditional approaches include myomectomy and hysterectomy. In a myomectomy, the surgeon makes one or more abdominal incisions and removes the fibroids. However, fibroid seedlings undetected by the surgeon during myomectomy may grow and cause symptoms later on. The only surgical procedure that has not been associated with recurrence of fibroids is hysterectomy, or complete removal of the uterus.
Unfortunately, both hysterectomy and myomectomy carry the risk of adhesion formation. Immediately after the urgery, tiny strands of collagen rush to the site that has been cut to help begin the healing process. They create powerful adhesive bonds that have a strength of 2,000 pounds per square inch and can bind tissues or structures together to cause pain. In addition to causing pain, adhesions can affect the function of the reproductive structures, affecting a woman’s ability to conceive.
Endometriosis, or endo for short, is a condition that affects a woman’s uterus. Normally, the female body sheds the endometrium, or uterine lining, during monthly menstruation. In girls and women with endo, the body retains some of these menstrual fluids, which then abnormally implant onto areas outside of the uterus. Accumulating on pelvic organs such as the bladder, bowel, ovaries and cul de sac, endometrial implants can cause adhesions, scarring and painful nodules to form.
Similar to uterine fibroids, endometriosis can result in significant pain during menstruation and intercourse. However, endometriosis may take up an average of 10 years to diagnose after symptoms start. This is partly due to the fact that many women confuse their symptoms with severe menstrual cramps. Physicians may attempt to diagnose endometriosis using an ultrasound or MRI; however, exploratory surgery (laparoscopy) is the only way of obtaining a definitive diagnosis.
To completely remove endometrial implants, laparoscopic excision must be performed. Other surgical techniques for the treatment of endometriosis include surgical ablation, cauterization, fulguration or vaporization through the laparoscope. These approaches remove endometriosis on the surface of pelvic organs and tissues but do not penetrate structures as deeply as laparoscopic excision. While these forms of partial removal may provide temporary relief, studies report a recurrance rate of 40-60% within the first year following these procedures.
Like myomectomy and hysterectomy, these surgical procedures are linked to the formation of post-surgical adhesions and the associated complications described above.
Clear Passage Physical Therapy has over 20 years experience treating the chronic pelvic pain and adhesions caused by endometriosis, hysterectomy and myomectomy.
Our therapists treat these conditions naturally, without drugs or surgery. Request a free phone consultation to learn more.