Signs of Endometriosis

Symptoms and Signs of Endometriosis: As we may all be familiar with classic smptoms of endometriosis, the signs and the findings of endometriosis are  easily validated  on expert phycisial evaluation performed by us..
Let us review the the classic symptoms and signs  of endometriosis.
Number one cardinal symptom is painful periods, dysmenorrhea,  around and during menstruation.The painful periods  due to  endometrioiisis is unique. It lasts more than two days, usually crampy( killer in nature) particularly goes back to during adoloscent years.Later these painful periods are  accompanied by achyness  
with constant discomfort. It may progress into further crdinal symptoms of endometriosis.
The second cardinal  symptom of    is gastrointestinal triad of bloatiness, gassiness, and cramps  associated with or without diarrhea, and  constipation which is more pronounced   around menstruation. 
The third  and fourth cardinal symptom of endometriosis are painful sex and painful bowel movements, These symptoms  point to a deeper involvement of recto vaginal septum and  pelvic lateral walls. The forth cardinal symptoms is painful sex, wahich at times positional.Similarly again due to deeper involvement painful bowel movemnts and .Painful sex and painful bowel movements have different series of sympotomatology when the lateralpelvic  walls are effected at the deeper levels, along with uretrs and arteries  the nerves are effecte.
This is called neuropathy, fifth cardinal symptom of endometriosis! The nerves may be directly involved or  stimumulated mostly by surrounding pathology due to swellind and scarring that changes the microcosm of retroperitoneum as well as direct involvement of the nerves. Symptoms naturally differs from one patient to another according to exact location.From changes of sensory feelings to radiating pain to the back, lumbosacral area, inner thigh and along the tract of sciatica nerve. Some of these patience can not cross their legs and even their walking and gait are influenced.

 Last but very frequent and most elusive symptom  of endometriosis is  infertility, diffuculty to concieve, and difficulty to hold pregnancy. Due to its silent nature,  lets call infertility  the cardinal symptom 0 of Endometriosis. Complex immunobiological factors both at cellular and antibody levels are involved. Inflammatory toxins in the forms of kinins do not allow sperm and egg naturally mate! endometriosis visibly cause tubal dismorfism, and ovarian pathology  inthe form micro endometrioma as well as adhesions as barries to succesful pregnancy. Not able to get pregnant is many patients are unnessarily treated with in vitro treatments without  endometriosis being addresed. 

OFFICE VISIT: The signs and findinds of endometriosis are revealed  during office visit.It takes an experienced doctor without any difficulty promptly recognize all associated aspect in this critical junture of office visit. The timing of this visit is ideally during the period or around the period tme. Abdominal, and pelvic pain is evaluated by palpation.  CVA tenderness is checked , together with leg tests of raising and leg crossings are performed. Then vagina and cervix is inpected  by speculum. Cervix is inspected  for presense of stricture or pin hole appearance. Then  a gentle single digital pevic bimanual examination is performed. The tenderness of cevix to touching  and mobilization is promptly noted.(Cervical Motion Tenderness) Subsequently anterior and posterior  cervix,  then upper vagina is evaluated with digital palpation.. Nodularity, thickening, shortening of uterosacral ligament  and recto vaginal, cul de sac, and lateral vaginal walls are  evaluated.  Tendernes  of these locations have significant value to the  extend of the disease.
 Following the bimanual examination  the next step becomes the transvaginal sonographic evaultion. The uterine walls, endometrial canal and endometrial cavity are carefully evaluated  for the presence of adenomyosis, fibroids and polyps. The culdesac and rectoginal septum are scanned.Some patients may be requested to have bowel prep prior to this exam of  sonographic evaluation (Transvaginal Recto-Vaginal sonogram). Sono hysterographic examination  further may enhance the presence of endometrial lesions of submucocal fibroids and polyps particularly in patients with history of infertility and and heavy periods irregardless of  their pain symptoms. Ovaries then becomes the most important organ  in transvaginal sonogram. Endometrioma needs to be ruled out recognizing its the very special unique appearance.  

updated by Tamer Seckin, MD 08-11-2012