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April 17, 2026

Endometriosis: beyond pain

Making the invisible visible: an integrative perspective on endometriosis

Endometriosis is a chronic gynecological condition that affects millions of women around the world. Despite how common it is, it remains poorly understood, underdiagnosed and too often minimized. Many women live for years with pain, fatigue, or digestive and urinary symptoms without receiving a clear explanation or appropriate support.

Talking about endometriosis is not only talking about painful periods. It means talking about inflammation, adhesions, pelvic pain, persistent fatigue, emotional impact, intimate life, fertility and quality of life. It also means recognizing the need for a broader, more human and more integrative approach.

In this article, we explore what endometriosis is, what its symptoms are, how it is diagnosed, what treatment options exist and why a multidisciplinary approach can be key to supporting each patient more effectively.

What is endometriosis?

Endometriosis occurs when tissue similar to the endometrium, which normally lines the inside of the uterus, appears outside it. This tissue can be found on the ovaries, fallopian tubes, peritoneum, intestine, bladder and, in some cases, in more distant areas.

During the menstrual cycle, this tissue also responds to hormonal changes. This means it can become inflamed, bleed and contribute to pain, local irritation, adhesions or cysts, even when it is located outside the uterus.

Definition and basic mechanism

What characterizes endometriosis is not only the presence of ectopic tissue, but the way this tissue interacts with the inflammatory system, the pelvic environment and the nervous system. This is why the disease can express itself in very different ways and have a very unequal impact from one woman to another.

Why is there not just one type of endometriosis?

Not all forms of endometriosis are the same. Lesions can vary in location, depth, extent and clinical impact. In addition, the intensity of symptoms does not always correspond to the quantity or size of the lesions. Some women have extensive involvement and few symptoms, while others experience significant pain despite apparently more limited lesions.

What types of endometriosis can occur?

The disease can present in different forms, and this diversity helps explain why each patient experiences endometriosis in a unique way.

Superficial or peritoneal endometriosis

This is located on the surface of the peritoneum and usually consists of superficial implants. Although it is sometimes associated with less deep forms, this does not necessarily mean that it has a lower clinical impact.

Ovarian endometriosis

In this case, the disease affects the ovary and can form endometriomas, cysts with characteristic contents. It is one of the best-known forms on imaging tests.

Deep endometriosis

Deep endometriosis refers to lesions that infiltrate beyond the surface and affect structures such as the uterosacral ligaments, the rectovaginal septum, the intestine, the bladder or the ureters. These forms can have a significant functional impact.

Extrapelvic endometriosis

This is less common, but it can appear outside the pelvis, for example in the diaphragm or thoracic cavity. These locations are less frequent, but they show how diverse the disease can be in its expression.

What can cause endometriosis?

Today, the exact cause of endometriosis is not fully known. It is considered a complex and multifactorial disease, in which several mechanisms probably act at the same time.

The theory of retrograde menstruation

This is one of the best-known hypotheses. It suggests that part of the menstrual flow moves upward through the fallopian tubes into the pelvic cavity, allowing cells similar to the endometrium to implant outside the uterus and proliferate under hormonal influence.

Other theories and contributing factors

Other explanations have also been proposed, such as coelomic metaplasia, lymphatic or blood-borne spread, and different mechanisms related to embryonic development. In addition, the role of genetics, the immune system, chronic inflammation and environmental factors is also being studied.

A complex and multifactorial disease

It is most likely that endometriosis does not have a single cause. Rather, it seems to arise from a combination of individual predisposition, hormonal context, inflammatory, immune and possibly environmental factors. This complexity explains why its evolution and clinical expression can vary so much.

What are the symptoms of endometriosis?

Endometriosis can cause very different symptoms, depending both on its location and on the body’s response to inflammation and persistent pain.

Pelvic pain and painful periods

Pelvic pain is one of the most common symptoms. It may appear during menstruation, around ovulation or become more constant. In many women, periods stop being simply uncomfortable and become disabling pain that interferes with work, rest, physical activity or social life.

Pain during sexual intercourse

Dyspareunia, especially deep dyspareunia, is another common manifestation. It may be experienced as pain, pressure, discomfort or an inability to have intercourse comfortably. This dimension often creates a great deal of loneliness and can affect not only the body, but also self-esteem, intimacy and the couple relationship.

Urinary and digestive symptoms

When the disease affects the bladder or digestive system, symptoms may include discomfort when urinating, urinary urgency, pain when passing stool, constipation, cyclic diarrhea, abdominal bloating or a feeling of pelvic pressure. Sometimes these symptoms are confused with other problems and delay diagnosis even further.

Fatigue and impact on daily life

Endometriosis is not only about pain. Fatigue is a very common complaint and may be related both to inflammation and to the physical, emotional and mental impact of living with persistent symptoms. When pain repeats itself, sleep worsens, attention becomes scattered and available energy decreases.

Endometriosis and infertility

The disease may also be present in women who consult because they have difficulty conceiving. However, endometriosis does not automatically mean infertility. Many women with endometriosis have spontaneous pregnancies, while others require specialized support depending on their situation.

Why can diagnosis take so long?

One of the major difficulties with endometriosis is delayed diagnosis. Many women spend years before being able to name what is happening to them.

Symptoms normalized for too long

Severe menstrual pain is still normalized far too easily. Phrases such as “it is normal for it to hurt” or “it will pass” continue to delay access to more precise assessments.

What role do examination and imaging tests play?

Diagnosis is based on clinical history, physical examination and, when indicated, tests such as transvaginal ultrasound or magnetic resonance imaging. These tools can be very useful for identifying ovarian cysts or deep lesions, although they do not always detect all forms of the disease.

The importance of high-quality clinical listening

Listening carefully to the type of pain, its cyclical rhythm, its functional impact and associated symptoms is an essential part of the diagnostic process. Very often, a good clinical interview already provides decisive guidance.

Endometriosis and pregnancy

There is a widespread belief that pregnancy “cures” endometriosis, but this is not correct. In some women, symptoms temporarily improve during pregnancy due to hormonal changes. However, this does not mean that the disease disappears.

Why pregnancy does not cure it

Pregnancy can modify the hormonal context and temporarily reduce pain, but it does not necessarily eliminate the lesions or resolve the underlying mechanism.

What can happen to symptoms?

After childbirth, with the progressive return of the menstrual cycle, symptoms may reappear. For this reason, rather than thinking of pregnancy as a treatment, it should be understood as a particular stage within a disease that still requires an individualized perspective.

What treatment options exist?

Treatment for endometriosis must be adapted to each woman, taking into account the intensity of symptoms, the location of lesions, the impact on quality of life, previous response to treatments and the desire for pregnancy.

Painkillers and pain management

Pain control is often part of treatment, with a progressive strategy depending on intensity and tolerance. But when pain becomes persistent, it is not enough to think only in terms of painkillers: it is also necessary to understand how the nervous system is responding and what impact pain has on daily life.

When surgery may be considered

Surgery may be considered in certain cases, especially when there are deep lesions, significant pain that does not respond well to other treatments or reproductive difficulties in specific contexts. This type of surgery requires specific expertise, and the indication should always be assessed with caution.

Why treatment must be individualized

There is no single valid strategy for everyone. Some women respond well to hormonal treatment, others need surgery, and many benefit from a complementary approach that helps reduce pain, improve function and restore quality of life.

Endometriosis and the biopsychosocial model of pain

Endometriosis is much better understood when viewed from a biopsychosocial perspective. Pain does not depend only on the visible lesion, but also on how the nervous system processes the experience, the emotional context, accumulated stress and the impact the disease has on daily life.

Pain is not only inflammation

Inflammation, adhesions and the involvement of certain tissues are important, but they do not explain all of the patient’s suffering on their own. When pain persists for a long time, the nervous system can become more sensitive and react more intensely.

The role of anxiety, stress and isolation

Anxiety, frustration, fatigue, the feeling of not being understood or the fear that pain will appear can increase the overall burden of the disease. This does not mean that the pain is “psychological”, but that body and mind are deeply connected.

Why an integrative perspective is key

Approaching endometriosis through the biopsychosocial model allows for more complete support. It is not only about “treating lesions”, but also about helping the patient recover safety, resources, understanding and adaptability.

What can a multidisciplinary approach provide?

At Aliantis, we understand that endometriosis requires more than an exclusively gynecological perspective. A multidisciplinary approach can complement medical treatment and help improve quality of life.

Pelvic floor physiotherapy

Physiotherapy can be very useful when there is pelvic pain, muscle tension, mobility changes or symptoms related to the pelvic floor. Manual work, re-education, breathing, muscle control and adapted movement can help reduce pain and improve function.

Osteopathy

Osteopathy does not aim to cure endometriosis, but it can support the patient in managing symptoms by helping work on mobility restrictions and tension in the pelvis, spine, diaphragm or abdomen, while improving global body perception.

Psychology

Psychology can offer valuable tools to manage the emotional impact of a chronic disease, relieve the feeling of isolation, improve the relationship with pain and strengthen coping resources. It can also be of great help when intimate life, the couple relationship or self-esteem are affected.

Nutrition

Nutrition can be part of support when the aim is to reduce inflammatory load, improve digestive tolerance and build sustainable habits. There is no universal diet for endometriosis, but personalization and a well-supported nutritional strategy can be highly valuable.

At Aliantis, we support endometriosis through a global perspective

At Aliantis Sitges, we believe that endometriosis should not be approached only through diagnosis or pain control, but also through support for the person as a whole. Our approach combines physiotherapy, osteopathy, psychology and nutrition to offer care that is more complete, more human and better adapted to each stage of the process.

We know that living with endometriosis can affect the body, mind, rest, work, social life and the relationship with oneself. For this reason, our goal is not only to relieve symptoms, but to help you recover resources, understanding and wellbeing.

Because making the invisible visible also means listening to what has been minimized for too long.

This blog article does not aim to generate new knowledge; it is based on the reading of scientific publications, blog articles and other texts.

Sources:

Organización Mundial de la Salud (OMS) – Ficha sobre endometriosis

Ministerio de Sanidad (España) – Guía de atención a las mujeres con endometriosis en el SNS

Fisterra – Guía clínica de endometriosis para profesionales

Instituto de Salud Carlos III – Endometriosis: revisión de la evidencia científica

ADAEC – Asociación de Afectadas de Endometriosis Crónica Estatal

AAEV – Asociación de Afectadas de Endometriosis de Valencia

Mayo Clinic – Endometriosis: síntomas y causas

Cadena SER – Endometriosis: una enfermedad crónica de difícil diagnóstico

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