* note. Endometriosis affects individuals born with a uterus. We will be using the term women in this blog but acknowledge that endometriosis affects women, trans men, and non-binary individuals.
March is endometriosis awareness month. Endometriosis happens when cells similar to the cells lining the uterus grow inside the abdominal cavity. Hallmarks of endometriosis include severe abdominal pain often associated with the menstrual cycle, heavy periods, dyspareunia (pain with vaginal penetration), irritable bowel syndrome, migraines, brain fog, infertility and fatigue (Tennfjord et. al, 2021).
Despite endometriosis affecting 10% of women*,it takes an average of eight years to diagnose. Treatment includes medical management, pelvic floor physical therapy, mental health support, and laparoscopic excision (Tennfjord et. al, 2021).
Endometriosis is an inflammatory condition. The pain and distress from that inflammation is absolutely real. When people live in pain for a long time, a phenomenon called sensitization can take place.
Explained simply, the nervous symptom creates more neural connections that are receptive to pain. Not only do more pain receptors pop up, these receptors feed into the spinal cord and can send signals out to neighboring areas. For example, it’s very common for people living with endometriosis to also experience musculoskeletal pain (Aredo et. al, 2017).
As pelvic floor physical therapists, we unfortunately cannot change the endometriosis lesions themselves, but we address the fascia and muscular effects from the disease and help our patients find strategies to calm the nervous system, hence addressing the sensitization.
If you suffer from pelvic floor dysfunction, we highly recommend Susie Gronski’s “In your pants” Podcast. She has a wealth of knowledge and brings on great experts from the pelvic floor and pain world.
Her episode from several months back featured Dr. Rachel Zoffness, a pain expert. Dr. Zoffness wrote a workbook for management of chronic pain called The Pain Management Workbook.
The episode can be found here https://www.youtube.com/watch?v=5plI0guUJkc and her book can be found here https://www.amazon.com/Pain-Management-Workbook-Powerful-Mindfulness/dp/1684036445/ref=sr_1_1?gclid=Cj0KCQiAjbagBhD3ARIsANRrqEvgllSkE8wT5xFj6mK-n48iBXbLK53Shz5UYHwP6TGQ64oRSWoqRlsaAtAsEALw_wcB&hvadid=526277223033&hvdev=c&hvlocphy=9067609&hvnetw=g&hvqmt=b&hvrand=6291279526392596053&hvtargid=kwd-1301329534690&hydadcr=15523_10340803&keywords=dr+rachel+zoffness+book&qid=1678664812&sr=8-1/.
Zoffness offers several creative strategies for calming the nervous system and addressing sensitization. In one activity, Zoffness suggests creating a recipe for a good and bad pain day.
For endometriosis awareness month, we’ve created our own little recipe activity for a better pain day inspired by Zoffness.
Try filling out the chart below to find some strategies to calm your nervous system during a flare.
| Sleep (how many hours?, quality, what can I do to improve upon my sleep hygiene) | |
| Movement (Stretching? A light walk with music on? What kind of movement do I like?) | |
| Diet (What foods make me feel good? What is the best environment for me to eat a meal in?) | |
| Relaxation (Do I like to meditate? Does heat or ice soothe me? Are there any songs that empower me) | |
| Self mobilizations (Are there any techniques that my pelvic floor physical therapy has taught me? Deep pressure? Light touch? What feels good for my sensory system? | |
| Support (Who is around me when I feel my best?) |
Here is an example chart if you’re stumped
| Sleep (how many hours?, quality, what can I do to improve upon my sleep hygiene) | 7.5 hours seems to be my sweet spot, waking up before 7, colder room, socks on, read for 30 minutes before bed |
| Movement (Stretching? A light walk with music on? What kind of movement do I like?) | I like child’s pose, foam rolling feels good, keeping my walks to 30 minutes or less generally is better |
| Diet (What foods make me feel good? What is the best environment for me to eat a meal in?) | Anything that I cook at home, I feel better when I eat my lunch and have a podcast on instead of working through lunch on my computer, sitting at the kitchen table is better than the couch |
| Relaxation (Do I like to meditate? Does heat or ice soothe me? Are there any songs that empower me) | I prefer heat for sure, meditation isn’t my thing but I do like to do some deep breathing with my music on |
| Self mobilizations (Are there any techniques that my pelvic floor physical therapy has taught me? Deep pressure? Light touch? What feels good for my sensory system? | My pelvic floor PT taught me how to find my ileocecal valve and breathe. This usually feels good and can help stimulate some digestion which is an added plus |
| Support (Who is around me when I feel my best?) | My childhood friend is always super positive and a great listener. I feel like I can call her up at any point and be in a better mood after chatting |
No question endometriosis is painful. One of the most challenging feelings we can experience as human beings is the sense of no control over our pain at all.
In addition to treating the physical symptoms of endometriosis, we want our patients to feel like they have tools in the toolbox to manage endometriosis flares.
Tapping into different parts of the sensory system is one way to start soothing your nervous system and improving quality of life with endometriosis.
Aredo, J. V., Heyrana, K. J., Karp, B. I., Shah, J. P., & Stratton, P. (2017). Relating Chronic Pelvic Pain and Endometriosis to Signs of Sensitization and Myofascial Pain and Dysfunction. Seminars in reproductive medicine, 35(1), 88–97. https://doi.org/10.1055/s-0036-1597123
Tennfjord, M. K., Gabrielsen, R., & Tellum, T. (2021). Effect of physical activity and exercise on endometriosis-associated symptoms: a systematic review. BMC women’s health, 21(1), 355. https://doi.org/10.1186/s12905-021-01500-4