Endometriosis & Painful Menstruation

People with endometriosis may have thicker round ligaments which may contribute to pain and infertility

Tightness in the round ligament can impact fertility by altering the shape of the uterus, hindering the path for successful implantation—a condition termed mechanical infertility. This tension can also disrupt blood flow🩸to the uterus and ovaries, contributing to pain, decreased hormonal production, and infertility

✨Pelvic floor physical therapy, utilizing techniques such as visceral mobilization, plays a role in addressing these issues✨

Endometriosis can involve thicker or more fibrous round ligaments, intensifying the pain and fertility challenges associated with the condition. As a pelvic floor physical therapist, I specialize in managing endometriosis symptoms and providing support for prehabilitation and rehabilitation around excision surgery. However, comprehensive care for endometriosis necessitates a collaborative, multidisciplinary approach🌟

Forward-leaning inversions may be beneficial for endometriosis 

Forward-leaning inversions can help increase blood flow to the pelvic region, which can alleviate pain and discomfort associated with endometriosis. Additionally, it can help reduce inflammation in the pelvic area and promote lymphatic drainage, which may help with the removal of excess fluid and waste products that can contribute to endometriosis symptoms.

The forward-leaning position can also help lengthen and release tension in the pelvic floor muscles, which can become tight and painful due to endometriosis.

✨Friendly reminder that pelvic floor physical therapy can help improve endometriosis symptoms✨

⚠️CAUTION: Avoid inversions during menstruation and obtain clearance from a healthcare provider before performing

Regular practice of forward-leaning inversions as part of a comprehensive treatment plan may help improve quality of life for those with endometriosis (this doesn’t replace pelvic floor PT)

Self-Lymphatic Drainage for Pelvic Pain

1. Diaphragmatic Breaths (Stimulating the Autonomic Nervous System): Breathe in and allow 360-degree ribcage expansion, with the belly rising slightly, the ribs moving laterally, and the chest remaining steady. Exhale slowly through your mouth. This helps stimulate the autonomic nervous system, influencing pain perception.

2. Clockwise Abdominal Circles with Light Touch: Gently make clockwise circles on your abdomen with light pressure. This aids in promoting lymphatic flow. 

3. Lymphatic Pumps: Perform gentle pumping motions just above the collarbone, at the armpit, and in the groin area. This helps facilitate lymphatic drainage and circulation.

4. Resisted Inhalations (Elastic Recoil): Place your hand on your abdomen. Inhale deeply, and as you reach the top of your breath, resist the urge to exhale immediately. Lift your hand off your abdomen, engaging elastic recoil for respiratory and lymphatic benefits.

5. Pelvic Floor Muscle Contractions (Coordinated with Exhale): Coordinate pelvic floor contractions with your exhale. These contractions act as a sump pump, aiding in lymphatic drainage, especially in the pelvic region where numerous lymph nodes are present.

6. Diaphragmatic Breaths (Enhancing Lymphatic Flow): Revisit diaphragmatic breathing to enhance lymphatic flow. Focus on creating a pressure differential during inhalation and exhalation, promoting the movement of lymphatic fluid while inducing deep relaxation.

Remember to perform each technique mindfully and listen to your body. If you experience any discomfort or have specific health concerns, it's advisable to consult with a healthcare professional before starting this self-lymphatic drainage routine.

This does not replace pelvic floor physical therapy. I highly encourage finding a therapist near you for an individualized treatment plan. Many people do not perform pelvic floor muscle contractions (kegels) correctly and not everyone benefits from performing them. 

TENS for Pain Relief

Transcutaneous Electrical Nerve Stimulation (TENS) may help alleviate pain associated with conditions like painful periods (dysmenorrhea) and endometriosis. TENS works by delivering mild electrical currents⚡️ through electrodes placed on the skin, which can modulate pain signals sent to the brain🧠 TENS can be applied to areas of the abdomen or lower back, which are common sites of discomfort during painful periods or in endometriosis cases.

There are two main frequencies used in TENS therapy:

1️⃣High frequency: This generates a tingling sensation that can provide short-term pain relief. It primarily affects A-beta nerve fibers, functioning in line with the gate control theory. While this method offers rapid relief, its effects tend to be short-lived🕚

2️⃣Low frequency: This frequency induces a more intense, tapping sensation that may be initially uncomfortable, but it can trigger the release of endorphins, the body’s natural pain-relieving chemicals. This results in pain relief that can last for hours🕧. Low-frequency TENS primarily targets A-delta and C nerve fibers, operating through the body’s opiate mechanism. It’s important to note that if a person is on opioid medications, the effectiveness of low-frequency TENS may be diminished

Consult with a physical therapist👩‍⚕️ before starting TENS therapy to ensure it’s appropriate for your specific condition and to receive guidance on proper usage

⚠️Don’t use TENS if you think you may be pregnant or have an implanted stimulator such as a pacemaker 

Dietary changes for managing endometriosis, fibroids, and painful menstruation

▪️Consume anti-inflammatory foods: Foods such as green tea, turmeric, ginger🫚, garlic, chamomile tea 🍵, and omega-3 fatty acids in foods such as salmon🐟, flaxseeds, walnuts, and chia seeds can help reduce inflammation in the body.

▪️Increase fiber intake: Eating a fiber-rich diet can help reduce estrogen levels / filter toxins, which can help alleviate endometriosis symptoms. Good sources of fiber include fruits, vegetables, whole grains, and legumes/beans🫘

▪️Consume cruciferous vegetables: Cruciferous vegetables such as broccoli🥦, cauliflower, cabbage, and dark leafy greens contain compounds that help the liver metabolize estrogen more efficiently. 

▪️Hydration: Staying well-hydrated💦 is important for overall health, and it may also help with symptoms of bloating and discomfort during menstruation. Aim for at least ½ your body weight (in pounds) in ounces of water per day spread throughout the day.

▪️Ensure you’re getting enough dietary magnesium, vitamin C and vitamin E. Magnesium sources include dark leafy green vegetables, whole grains, nuts, and seeds. Vitamin C sources include fresh fruit (especially citrus) or veggies such as kale, broccoli, sweet peppers, or beets. Vitamin E sources include nuts and seeds.

▪️Consider supplementing with vitamin D3☀️

▪️Choose organic and hormone-free foods: To limit exposure to environmental toxins and hormones, choose organic and hormone-free foods when possible.

▪️Avoid alcohol and excessive caffeine: Both alcohol and caffeine may increase estrogen levels and exacerbate endometriosis symptoms. However, green tea may decrease symptoms.

▪️Limit red meat and dairy: These foods may increase inflammation in the body and contribute to hormonal imbalances, which can worsen endometriosis symptoms. Consider replacing animal fats with plant-based fats such as avocado and nuts/seeds.

Since endometriosis is an estrogen-dependent disease, the anti-estrogenic effects of the phytoestrogens in foods such as flaxseeds and soy may help (as they appear to do in breast cancer). Seaweeds may also have anti-estrogen effects. Other foods that may help regulate estrogen include citrus fruits, green leafy & cruciferous vegetables, mushrooms, apples, beans, sesame seeds, and berries.

✨Every individual is unique and may respond differently to dietary changes. Work with a healthcare provider to create a personalized plan✨ 

WARNING: Vitamin K supplementation (cruciferous veggies are high in vitamin K!) is contraindicated when taking blood thinners like warfarin as vitamin K has a role in blood clotting. For those with thyroid issues raw cruciferous veggies can be a goitrogen. Avoid chamomile tea during the 3rd trimester of pregnancy.