Hello and welcome back to Making Sense of Women's Health. I am Roberta Bass and I am a women's health physiotherapist, a Pilates instructor, remedial hypnotist and menopause mentor. March is endometriosis awareness month. So today we are diving into this condition that affects one in 10 women.

If you have ever struggled with chronic pelvic pain, painful periods, bloating or discomfort during intercourse, you may be dealing with more than just normal period pain. Endometriosis is a condition where tissues similar to the uterine lining grow outside the uterus, leading to inflammation, scarring and severe pain.

Despite how common it is, many women go undiagnosed for a long time and this is average of seven to nine years. Often they are told that the pain is just part of being a woman. So in today's episode, I'm going to break down what endometriosis is, why it happens, how it impacts pelvic health and what you can do to manage the symptoms using my sense method and some additional evidence-based approaches.

So let's get started. Firstly, what is endometriosis?

Endometriosis is a chronic inflammatory condition where tissues similar to the lining of the uterus grow outside the womb.

Unlike normal uterine lining, this tissue doesn't shed properly and this leads to pain, scarring and adhesions. It's often found around the ovaries and fallopian tubes, on the outside of the uterus, the bladder and the bowel and particularly there's like a little pocket between the two that these deposits sit on the pelvic ligaments and the peritoneum. In some cases, it actually goes up to the diaphragm and the lungs.

Symptoms generally start with painful periods. They can be severe, they can get worse as a woman gets older and often normal pain relief doesn't relieve it.

You may also be getting heavy bleeding during periods as well. You may be getting pain outside of the periods. So often the condition starts being cyclical, so coming with a period, but then the pain starts to be outside of that time. You may be getting painful intercourse.

Bloating is quite common and is often known as an endo belly. Painful bowel movements or urination. Fatigue, low energy and often causes difficulty conceiving. And many women experience symptoms for years before they get a diagnosis as it's often just dismissed as bad periods. And the number of women that I have seen over the years that I suggest may need to get some investigation because they are struggling with all of these symptoms and they are just dismissed or they just think it's normal, which is why it takes so long to get diagnosed.

For many years, surgery has been seen as the gold standard for treating endometriosis that is to have excision surgery to remove the lesions. And some women find this to be effective, but some has shown that many women continue to have persistent pelvic pain even after the endometriosis tissue has been removed and this is thought to be caused by a condition called central sensitisation.

I would always suggest to try conservative management strategies first, such as physiotherapy, dietary changes, and lifestyle interventions.

So while these approaches do not cure endometriosis, studies have shown that many women can experience a significant reduction in pain and an improved quality of life.

In more severe cases, surgery may be offered, particularly when other methods have not provided adequate relief. Studies have shown that approximately 67 % of women report reduced pain after surgery, with 71 % expressing satisfaction with the treatment outcomes. However, as mentioned previously, not all women find surgery curative.

and many continue to have these symptoms caused by the central sensitisation. This occurs when the nervous system becomes hypersensitive to pain. So even when the original cause of the pain has been treated, long-term inflammation and nerve irritation cause the brain and spinal cord to amplify pain signals. This can lead to chronic pain that persists

even though the disease has been removed surgically.

So what are the signs of central sensitization? So pain that persists even after surgery, increased sensitivity to touch and pressure in the pelvic area, pain spreading beyond the original site of the endometriosis, heightened pain response to normal non-painful stimuli. This might be gentle pressure that causes pain. More than just pain,

It could also cause things like fatigue and brain fog, emotional distress, causing problems linked to anxiety, low mood. So regardless of whether surgery is performed, we need to calm the nervous system. And this is essential for comprehensive endometriosis management.

Central sensitization is present in many chronic pain conditions and we need to understand its effect in order to confidently manage endometriosis. So the SENSSE method which I have created provides a structured approach that supports both the physical but also the neurological aspects of many different conditions including endometriosis.

So by addressing subconscious patterns, empowering individuals to take control of their own health and focusing on certain lifestyle changes, the method helps to reduce symptoms, improve function and promote long-term wellbeing. So starting with our subconscious. Since pain is both a physical and neurological experience,

working with the subconscious mind can help reduce central sensitization. The control method, if you haven't listened to my episode on the control method go back and listen to it, but this helps to retrain the subconscious mind and how it responds to pain.

This can help to reduce that heightened pain sensitivity. Cognitive behavioural therapy is another way to do this and this has been proven to help people with chronic pain because you reframe those negative pain associations. Journalling can really help because we can identify the stresses. Go back and listen to my episode about stress and pain because that is really relevant to endometriosis.

but journaling is a great way to work out what may be flaring up the pain response.

So empowerment, it's understanding your body, understanding what treatment options there are. So using a pain journal to track your symptoms and identify patterns can be really useful. And if you're gonna go and see a healthcare professional, that is useful to take with you because they can see where the pain is worse, what might be triggering it.

making sure that you are advocating for yourself if you are going to see a healthcare professional. We don't want you to be dismissed, we want you to see a specialist in endometriosis care because they will understand the symptoms better. Sometimes joining a community can be helpful, talking to other women with the same problems can empower you and help with your emotional wellbeing as well.

Coming on to the next stage is nutrition. So there's many ways that you can support your hormonal balance and also reduce inflammation with your diet. Thinking about an anti-inflammatory diet, so increasing your omega-3, so our good healthy fats, so our salmon, flax seeds, walnuts can help reduce inflammation. Cutting out or reducing processed food, refined sugar and red meat.

they can all worsen your symptoms. Having vegetables such as broccoli, kale, cauliflower, they can help you metabolize excess estrogen, making sure that your bowels are healthy because if our bowel movements are good and regular that again helps us to get rid of any excess estrogen. It may be worth considering reducing gluten and dairy. So some women do find

that they have intolerances to certain foods, often gluten and dairy. This can cause more inflammation and cause discomfort within the digestive system itself. We also want to make sure that we've got a healthy gut microbiome because this will support hormonal balance. So it might be that you include some probiotics and prebiotic rich foods or supplements. Make sure that

are getting the right ones and you discuss that with a healthcare professional if you are having supplements, but including certain foods such as yogurt, sauerkraut can help to improve the microbiome as well.

The next thing we need to think about is our sleep. I've done a few episodes on sleep so I won't go into this in too much detail, but our sleep is really important for repairing our body and helping our minds with our memories, help with stress relief, help with weight, help with our hormone balance. We need to make sure that we are prioritising our sleep.

Go back and listen to the other episodes about sleep. We want to make sure we have a good wind down routine, addressing anything that's causing our sleep to be disrupted, whether that is pain, whether that's the environment, whether that is stress. We need to try and prioritise our sleep. Stress management. So our stress management and sleep are quite interlinked. If we are stressed, we don't sleep. If we don't sleep, we are stressed.

we need to address both of those things. Cortisol is our stress hormone and if our stress levels are high that's going to increase our inflammation, it's also going to increase our pain sensitivity and it's going to worsen our sleep. So we need to make sure we are working on our stress management. Again, I've done episodes on this before but having some form of meditation or mindfulness, going for a walk in nature.

doing some breathing exercises. So breathing exercise is actually really helpful for your pelvic health as well. So doing some abdominal breathing using our diaphragm and our stomach expands as we inhale and then drops down as we exhale that helps get our pelvic floor moving as well. So that's really important. Exercise is also key. So general exercise.

is beneficial for our mental health, our sleep, our stress, but also specific exercises for stretching out any tight structures. If we get adhesions, that's where everything gets a little bit stuck together inside. So it's stretching out those structures, working on the core, working on our pelvic floor. Again, coming to see me or someone similar, Women's Health Physio can assess what's going on with the pelvic floor.

often it's overactive and we need to do lots of relaxation and stretches, but doing whole body strength training can be really beneficial. But I would highly recommend coming to see someone like myself because then we can guide you in the right kind of exercise. But to start with any exercise is good. Get moving, do as your pain will allow.

address any barriers if that's pelvic health problems, if that's joint pain problems, try and get those addressed. Other things outside of the sense method that may be worth considering, more medical based things is hormonal therapies. Now the GP often will put people on birth control pills or using coils and this can help

reduce the heavy periods. It can sometimes help with the pain as well. Sometimes you'll be given medication that may reduce your estrogen and then that can help reduce the endometrial tissue. That then puts you in kind of like a medical menopause so there may be other issues with that but that could be an option. Standard pain relief using some NSAI so anti-inflammatories.

might be an option. Obviously, you shouldn't be taking them for long time without having something to protect your stomach. Talk to the GP about taking any medication, but they can be helpful. The GP may also put you on some medication to help with nerve pain like amitriptyline or gabapentin. Again, discuss with the GP. We've spoken about surgical options before. I would always go down to conservative management first.

But if that doesn't work, then you may also need to think about surgery. So the gold standard, as I said before, is the laparoscopic. So that's where they put like little keyhole surgery, put little cameras in, and they try and take away those little deposits. They try and get all of them. They don't always, but that's the idea is to remove most of the deposits. It depends how bad the adhesions are.

and other factors to see how effective that will be. Sometimes in severe cases, they may suggest a hysterectomy. Now, this isn't a cure for endometriosis, but if you have adenomiosis, this is where you've got similar tissues that form within the muscle of the uterus, so you may have that as well, then hysterectomy may well be the best or only option.

However, it doesn't remove those deposits elsewhere. if they're just doing hysterectomy and not trying to get rid of those endometriosis pockets elsewhere, then you may still get the problems. And the other issue with a hysterectomy is if they're leaving the ovaries behind, they're likely to fail.

We don't have as much support above keeping everything up inside so you may develop prolapses or if they're taking away the ovaries or if they fail, then you're forced into menopause that has many other issues and symptoms of it.

And as we've mentioned previously, even if you have surgery, you may still be getting this problem with central sensitisation, which is where the sense method and calming down the nervous system is really important. Once you hit menopause, our estrogen levels start to drop, so your symptoms may reduce because it is the estrogen which is feeding these endometrial-like cells.

can sometimes still persist, particularly in women that are taking HRT. So research does suggest that taking estrogen only HRT has been linked to higher risk of the recurrence of endometriosis if there's any residual disease. If you've had surgery and you've had your uterus removed, that is probably what you'd be offered, is that estrogen only.

If you still have a uterus, you should be having a combined HRT. So you should be having some progesterone as well as the estrogen because we need to protect that endometrial layer so that it doesn't develop into endometrial cancer. But if you've had a hysterectomy, which is often one of the treatments offered, it's still worth

considering having some progesterone as well as estrogen if you are taking HRT, because then you can balance that. It's when you've got too much estrogen that those endometrial pockets may start to reform and cause you more problems. So make sure that if you are on HRT and you have endometriosis or a history of that, you are offered the combined approach. But obviously discuss that with your GP if you're going on to any medication.

and ensure that they know even if you've had surgery and you've had it all taken out that they know that that is the case.

As you've heard from all the science and all of the management options, endometriosis is a really complex condition and it affects both the body and the nervous system. Today has just been a whistle stop tour, but by combining the sense method with medical treatments, whether that's surgery or medication, it can help manage both the disease and that central sensitisation for longer term relief.

So if you are struggling with endometriosis and you need personal support, I can help you. So whether that is through physio, whether that is through the control method or a mixture of everything, changing those lifestyle factors, I work with women to manage their symptoms and improve their quality of life. And I can do that online as well as in person. So do visit my website and book a consultation or email me to discuss your

symptoms and don't forget please do share this episode with anyone and everyone who might find it helpful. Take care and see you next time.