Endometriosis

Module aims:

• Provide information regarding endometriosis, how it can be diagnosed and managed
• Highlight period pain influencing your daily life and athletic performance is not normal and indicate when to seek the advice of a doctor
• Normalise the conversation around menstrual dysfunction to improve athlete awareness, health and performance

What is endometriosis?

Endometriosis is a common and often painful condition affecting 1 in 9 women worldwide which occurs when the tissue that normally lines the uterus called the endometrium is found outside of the uterus.

It can affect the surface of the ovaries, fallopian tubes and the tissue lining the pelvis. Endometriosis deposits are also rarely found in other areas of the abdomen and uterus. These cells can alter the environment of the pelvis and reproductive tract causing a range of issues including pain, bowel and bladder changes, heavy periods and fertility issues.

What is the cause of endometriosis?

Unfortunately, despite its prevalence, the cause is not yet clear.

While there are many theories regarding the cause of endometriosis, the leading theory is that the condition is caused by “retrograde menstruation”. This theory suggests that the backward flow of menstrual bleeding through the fallopian tubes and into the pelvis might be the cause of endometrial cells implanting on abdominal organs.

Some researchers also suggest there may be a genetic component. This has been supported by a 2013 study from the National Institute of Health which found that women who have a first-degree relative affected by the disease have a seven-times-higher risk of developing it than women who do not have a family history of the condition*.

What are the signs and symptoms of endometriosis?

A certain amount of discomfort with periods may be normal; however, pain that stops you from living your everyday life or impacting your athletic performance is not normal.

The symptoms of endometriosis can vary from mild to severe, depending on where the stray endometrial tissue is located. The most common symptom is chronic pelvic pain, especially before and during your menstrual period. Other commonly reported symptoms include:

• Severe period pain – immediately before and during a period
• Pain during or after sexual intercourse
• Abdominal, back and/or pelvic pain outside of menstruation
• Abdominal pain at the time of ovulation
• Painful bowel movements or urination
• Excessive menstrual bleeding, with or without clots
• Irregular bleeding, with or without a regular cycle
• Premenstrual spotting
• Difficulty when trying to conceive

Please note, although pain is one of the most common symptoms, it is not a good indicator of the extent of the condition and should be investigated further. Some women may have no symptoms.

How is endometriosis diagnosed?

Although the condition can be suspected on ultrasound or MRI, the only way to definitively diagnose endometriosis is through a laparoscopy. A laparoscopy is a surgical procedure that involves inserting a long, thin telescope (laparoscope) into the abdomen through an incision near the navel. This allows the surgeon to look for signs of endometriosis and may take tissue samples for testing, as well as remove any endometriosis deposits if required.

If you experience any of the above symptoms, we encourage you to visit your general practitioner (GP) and seek a referral to a specialist gynaecologist for an accurate diagnosis.

How does it influence athletic performance?

The symptoms associated with endometriosis such as fatigue, abdominal pain, and heavy bleeding can seriously impact athletes of all levels, physically, mentally, socially, and economically. This can have substantial influences on your ability to train and compete.

If you believe you may be experiencing various symptoms that may indicate endometriosis, we encourage you to reach out to your medical team or specialised doctor at Ignite Athlete for further investigation.

When should I see a doctor?

If you think you may have endometriosis or have concerns about endometriosis influencing your life and athletic performance, we recommend you get into contact with a specialised women’s General Practitioner or gynaecologist through our Ignite Athlete portal anytime.

They will be able to discuss your medical history, as well as assess your individual circumstances and symptoms to determine whether further investigation or management is required. If you track your menstrual cycle, this log will be beneficial to bring to your appointment.

Summary

• Endometriosis is a common and often painful condition that affects 1 in 8 women, occurring when tissue that normally lines the uterus (the endometrium) is found in other areas of the body.
• Symptom type and severity can vary between athletes depending on where endometrial tissue is located. The most common symptoms are chronic pelvic pain, especially before and during your period.
• A certain amount of discomfort with periods may be normal; however, pain that stops you from living your everyday life or impacting your athletic performance is not normal.
• While it cannot be cured, there are many ways endometriosis can be treated with the most suitable treatment depending on your individual goals and circumstances.

Resources

• City Fertility – Endometriosis: What you need to know
• City Fertility – Endometriosis Q&A by Dr Lisa Harris, Brisbane fertility specialist
• City Fertility – Is there a link between endometriosis and fertility? by Professor Bill Ledger, Sydney fertility specialist