Pelvic Pain and Endometriosis: How Are They Linked?

Endometriosis causes at least 70% of all cases of chronic pelvic pain. Women struggling with the pain often discover that relief is hard to find.

If you’re searching for a solution, it’s time to meet with one of our specialists at Florida Pain Medicine. We offer interventional treatments that ease abdominal pain due to endometriosis, often providing long-lasting relief. 

Here’s what you need to know about endometriosis, why it causes pelvic pain, the reasons conventional treatments may not help, and interventional options.

About endometriosis

Endometriosis develops when tissues similar to the uterine lining (endometrium) grow outside the uterus. The condition usually begins when cells from the endometrium leave the uterus through the Fallopian tube during menstruation.

The cells attach to organs and begin growing, which creates patches of endometrial tissues. Endometriosis can develop on the:

• Outer uterine wall
• Ovaries
• Fallopian tubes
• Bladder
• Intestines
• Rectum
• Ureters (the tubes responsible for carrying urine from the kidneys to the bladder)
• Ligaments supporting the uterus
• Tissues lining the abdomen (peritoneum)

The uterine wall, ovaries, and Fallopian tubes are the most common sites for endometrial patches. 

Symptoms

Endometriosis is defined by pain. Women experience: 

• Chronic pelvic pain
• Severe period pain
• Pain during or after sex
• Abdominal and pelvic floor muscle cramping
• Pain when urinating or having a bowel movement

In addition to pain, endometriosis may also cause:

• Heavy menstrual bleeding
• Bleeding between periods
• Digestive problems (bloating, nausea, diarrhea, and constipation)
• Infertility (difficulty getting pregnant)

Roughly 40% of women with infertility have endometriosis.

Endometriosis and pelvic pain

 Endometriosis causes chronic and often severe pelvic pain. Here are seven reasons why:

1. Inflammation

 Most women have multiple patches of endometriosis, but it only takes one to cause widespread inflammation. 

The cells that make up endometriosis release inflammatory substances that get into the peritoneal fluids and affect the surrounding tissues. That isn’t, however, the only source of endometriosis-related inflammation.

2. Monthly bleeding

Endometrial patches behave just like the uterine lining because they respond to the hormones responsible for your monthly cycles. When you menstruate, the endometrial patches also bleed.

The blood stays in your abdomen, irritating the surrounding tissues, causing inflammation and swelling, and leading to scarring.

3. Adhesions

 Over time, scars cause adhesions, which make the adjoining organs and tissues stick together. Any activity that pulls on the tissues can cause pain because the organs can’t move freely. 

4. Nerves

After attaching to an organ, the endometrial cells grow new blood vessels and nerves. The nerves connect endometriosis to the central nervous system, so the patches alone can generate pain. Additionally, the nerves can also become inflamed and add to your pain.

5. Pressure

Endometrial growths can cause pain by pressing against the surrounding tissues and nerves.

6. Hypersensitivity

Chronic pain makes nerves overly active and hypersensitive. As a result, you feel more pain from the slightest trigger. Hypersensitivity also causes long-term changes in the spinal nerves, which translates into more pain.

7. Ovarian cysts

When endometrial tissues grow on the ovaries, they may form cysts (endometriomas). These cysts often cause sharp or dull, aching pelvic pain.

Treatment

Endometriosis treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs), hormonal medications, and surgery:

Hormonal medications 

Hormonal medications are the primary treatment for endometriosis, stopping the ovaries from producing hormones and suppressing menstrual periods. Medication slows the growth of endometriosis but doesn’t prevent new patches from forming.

Challenges: Hormonal medications may ease the pain for some women, but they don’t help everyone. When you stop taking the medication, your pain returns.

Surgery

Your healthcare provider may recommend minimally invasive surgery to remove the endometrial patches and release adhesions.

Challenges: Like medication, surgery may not relieve the pain for everyone. Patches deep within the pelvis may be difficult to remove, or some remnants may remain. Additionally, endometriosis frequently recurs. No matter the reason, pelvic pain returns within two years for eight out of 10 women.

Interventional medicine

When medications and surgery don’t help — or you want to try another option to avoid surgery — it’s time to learn about interventional procedures.

Interventional medicine precisely targets inflammation and the nerves responsible for your pain, making it an effective way to relieve chronic pain caused by endometriosis.

For example, nerve blocks and treatments like spinal cord stimulation stop pain signals from reaching your brain. Injecting a group of nerves near the spine with a local anesthetic and steroids provides long-lasting relief from chronic pelvic pain for many women.

Call Florida Pain Medicine today or book an appointment online to learn if interventional treatment may ease your chronic pelvic pain.