Comprehensive Support Therapies for Endometriosis Management

For individuals living with cyclical or chronic endometriosis symptoms, can incorporating support therapies help in disease management?

Support Therapies

Endometriosis is a disorder in which tissue similar to the uterine lining begins to grow outside the uterus where it does not belong. Endometriosis support therapies involve a comprehensive approach to treatment. It involves non-invasive treatments to help manage symptoms that can include:

• Pelvic floor physical therapy
• Massage
• Medication
• Transcutaneous Electrical Nerve Stimulation
• Acupuncture
• Chiropractic

Pelvic Floor Physical Therapy – PFPT

• Endometriosis can cause or contribute to pelvic floor dysfunction, causing pain, urinary disorders, bowel problems, and painful sexual intercourse.
• Pelvic floor physical therapy improves the strength and function of the pelvic floor muscles.
• Example support therapies can include kegel exercises and biofeedback. (Christine Mansfield et al., 2022)

Therapeutic Massage

A physical therapist uses various pressures, stretching, and/or trigger point release. This helps: (Sylvia Mechsner, 2022)

• Release muscle tension
• Lower cortisol – stress hormone
• Improve circulation
• Release endorphins – the body’s natural painkillers

Medications

Nonsteroidal anti-inflammatory drugs or NSAIDs and hormonal contraceptives – birth control are the first line of treatment. Advil and Motrin are over-the-counter NSAIDs. If those don’t manage pain effectively, a healthcare provider may recommend prescription NSAIDs. (Sylvia Mechsner, 2022) Hormonal suppression agents or estrogen modulators are a second line of treatment for endometriosis and can include: (Christian M. Becker et al., 2022)

• Gonadotropin-releasing hormone agonists (GnRH)
• Antigonadotropic meds
• Aromatase inhibitors
• Selective estrogen receptor modulators (SERMs)

Other medications include:(Sylvia Mechsner, 2022)

• Valium – diazepam suppositories – Muscle-relaxing medications.
• Gabapentinoids – Medications that treat nerve pain.
• Antidepressants – these can increase the pain-reducing effect of other medications.

An endometriosis specialist. (Endometriosis Foundation of America. 2015) may suggest seeing a pain management specialist who provides nerve blocks or Botox injections. (Augusto Pereira et al., 2022)

Birth Control

Hormonal contraceptives suppress or regulate periods. They are effective for management, but not everyone can take them because of medical history, side effects, or fertility disorders and conditions. (Mert Ilhan et al., 2019) A healthcare provider can recommend alternative support therapies.

Transcutaneous Electrical Nerve Stimulation

• A transcutaneous electrical nerve stimulation utilizes a battery-operated device that delivers low-voltage electrical stimulation to nerve fibers through electrodes placed on the skin.
• Sessions are usually 15 to 30 minutes and work by disrupting pain signals. (Sylvia Mechsner, 2022)

Acupuncture

• Acupuncture is a therapy in which a practitioner inserts thin needles into specific acupoints on the body to promote the flow of energy and alleviate pain. (Nora Giese et al., 2023)

Chiropractic

• Chiropractic care focuses on spinal adjustments and alignment to enhance nervous system function, help alleviate pelvic discomfort and nerve pain – sciatica – and improve overall well-being. (Robert J. Trager et al., 2021)
• Non-surgical decompression could be recommended to gently stretch the spine, relieve pressure, and flood the spine with added nutrients.

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Movement Medicine: Chiropractic Care

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References

Mansfield, C., Lenobel, D., McCracken, K., Hewitt, G., & Appiah, L. C. (2022). Impact of Pelvic Floor Physical Therapy on Function in Adolescents and Young Adults with Biopsy-Confirmed Endometriosis at a Tertiary Children’s Hospital: A Case Series. Journal of pediatric and adolescent gynecology, 35(6), 722–727. doi.org/10.1016/j.jpag.2022.07.004

Mechsner S. (2022). Endometriosis, an Ongoing Pain-Step-by-Step Treatment. Journal of clinical medicine, 11(2), 467. doi.org/10.3390/jcm11020467

Ilhan, M., Gürağaç Dereli, F. T., & Akkol, E. K. (2019). Novel Drug Targets with Traditional Herbal Medicines for Overcoming Endometriosis. Current drug delivery, 16(5), 386–399. doi.org/10.2174/1567201816666181227112421

Becker, C. M., Bokor, A., Heikinheimo, O., Horne, A., Jansen, F., Kiesel, L., King, K., Kvaskoff, M., Nap, A., Petersen, K., Saridogan, E., Tomassetti, C., van Hanegem, N., Vulliemoz, N., Vermeulen, N., & ESHRE Endometriosis Guideline Group (2022). ESHRE guideline: endometriosis. Human reproduction open, 2022(2), hoac009. doi.org/10.1093/hropen/hoac009

Endometriosis Foundation of America. (2015). Seeking a doctor: finding the right endometriosis specialist. www.endofound.org/preparing-to-see-a-doctor

Pereira, A., Herrero-Trujillano, M., Vaquero, G., Fuentes, L., Gonzalez, S., Mendiola, A., & Perez-Medina, T. (2022). Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy. Journal of personalized medicine, 12(1), 101. doi.org/10.3390/jpm12010101

Giese, N., Kwon, K. K., & Armour, M. (2023). Acupuncture for endometriosis: A systematic review and meta-analysis. Integrative medicine research, 12(4), 101003. doi.org/10.1016/j.imr.2023.101003

Trager, R.J., Prosak, S.E., Leonard, K.A. et al. (2021). Diagnosis and management of sciatic endometriosis at the greater sciatic foramen: a case report. SN Comprehensive Clinical Medicine, 3. doi.org/doi:10.1007/s42399-021-00941-0