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What are the symptoms of endometriosis?

by Tamer Seckin, MD | Posted on June 10, 2020

How would I know if I have endometriosis?

It can be very difficult for any woman, regardless of her age, to recognize the symptoms of endometriosis. The disease often goes undiagnosed for years, only to be discovered when a patient experiences infertility or symptoms that have become very severe. The most common symptom of endometriosis is a pain in the lower abdomen, the pelvis, or the lower back, predominantly during menstrual cycles. However, the amount of pain a woman feels does not depend on how much endometriosis she may have. Some women experience no pain, even though their disease affects large areas. Other women experience severe pain, despite having only a few small endometriosis growths.

Stage 4 Endometriosis, Bowel, Endometrioma, Ahesions
This image depicts a patient with endometriosis in the form of a chocolate cyst and endometriosis scar tissue.

The 6 Cardinal Symptoms of Endometriosis:

  1. Dysmenorrhea (painful periods): Cramping usually points to a uterine source while pain and aches point to the peritoneum and ligaments. Endometriosis pain does not disappear in one day. The duration of pain associated with endometriosis usually continues for over two days, and can even persist after your period is over. Pain from endometriosis characteristically does not respond well to analgesics and birth control pills. Over three out of four women with endometriosis have a history of incredibly painful, crampy periods that can be traced back to their adolescence. Ovulation (on or around day 14 of the reproductive cycle) is often very painful in patients with endometriosis. Once a patient goes through menopause, they still may experience non-menstrual pelvic pain. Since pain is a subjective experience, the nature of its description varies from one individual to the other. Association with other symptoms, like frequent or painful bowel movements, gas around and during periods, constipation, and diarrhea, are common with cases of endometriosis. Therefore, the nature and duration of painful periods and their association with other symptoms are important in making clinical decisions and ruling out other pelvic disorders.
  2. GI abnormalities: The second cardinal symptom of endometriosis is the gastrointestinal triad of bloatedness, gassiness, and cramps associated with or without diarrhea and constipation. Generally these are more pronounced around menstruation.
  3. Painful sex (dyspareunia) and painful bowel movements
    Painful sex (dyspareunia) and painful bowel movements are two of the cardinal symptoms of endometriosis. In this image, there is deep involvement of endometriosis in the posterior cul-de-sac (the area between the back of the uterus and rectum). During sexual intercourse or a bowel movement, this area of tissue becomes irritated and causes pain due to the build-up of endometriosis scar tissue.
    Dyspareunia (painful sex) and painful orgasm: Painful sex, the fourth cardinal symptom, is at times positional and usually involves deep involvement of endometriosis in the rectovaginal septum and pelvic walls. This symptom often leads to intimacy issues, as intercourse starts to become unpleasurable for a woman. If your partner suffers from endometriosis and is experiencing dyspareunia, it is important to be kind, supportive, and mindful of the endometriosis pain they very well may be experiencing.
  4. Painful bowel movements: This fifth cardinal symptom may point to endometriosis in the rectovaginal septum and pelvic lateral walls. Endometriosis patients are often misdiagnosed as having IBS when their symptoms are really being caused by endometriosis.
  5. Neuropathy: The nerves may be directly involved or stimulated by surrounding pathology due to the swelling and scarring that changes the retroperitoneum (the space in the abdomen behind the peritoneum) as well as the direct involvement of the nerves. Symptoms naturally differ—from changes of sensory feelings to pain that radiates to the back, lumbosacral area, inner thigh or along the track of sciatica nerve — according to the varying location of the endometriosis lesions. Some of these patients find that they cannot comfortably cross their legs, and in some cases, their walking and gait are affected.
    The peripheral nervous system in the uterus and ovaries directly feed into the central nervous system: the body’s brain and spinal cord. In cases of endometriosis, these nerve signals can be damaged, resulting in nerve pain that causes radiating pain to the leg, back, and inner thigh.
  6. Infertility: The most frequent yet most elusive symptom of endometriosis is infertility, defined as both the difficulty to conceive and difficulty in carrying a pregnancy to term. Due to its silent nature, we sometimes call infertility the “cardinal symptom 0” of endometriosis. Complex immunobiological factors at both the cellular and antibody levels are involved. Inflammatory toxins that arise because of endometrioma scar tissue do not allow the sperm and egg to join naturally. Endometriosis causes visible tubal dysmorphism and ovarian pathology in the form of micro endometriomas and adhesions that serve as barriers to a successful pregnancy. Unable to get pregnant, many patients are unnecessarily treated with in-vitro fertilization treatments without their endometriosis ever being addressed.

Complete List of Endometriosis Symptoms

Not every woman experiences all of the following symptoms, however, if you are exhibiting any of these symptoms and think you may have endometriosis, please speak to your doctor.

  • Dysmenorrhea: painful menstrual cramps often classified as "killer cramps" with pain that increases over time.

    • Chronic or intermittent pelvic pain

    • endometriosis symptoms: back pain
      Due to dysmenorrhea or neuropathy, endometriosis can often cause back pain.

      Chronic pain in the lower back

    • Spotting or bleeding between menstrual cycle

    • Menorrhagia (heavy bleeding during menstrual cycle)

    • Painful menstruation

  • Gastrointestinal pain and discomfort during menstrual cycle.

    • Bloating

    • Gassiness

    • Cramps

    • Diarrhea or constipation

    • Constipation or nausea during menstrual cycle

  • Dyspareunia: pain during or after sex.

    • Painful orgasm

  • Painful bowel movements or painful urination during menstrual cycle.

    • Rectal pain

    • Blood in urine

    • Urinary frequency, retention, or urgency

    • Urinary tract difficulties

  • Neuropathy: when nerves are affected by advanced cases of the disease. Symptoms can include radiating pain to the back, lumbosacral area, inner thigh, legs, and along the track of sciatic nerve. Some patients find it difficult to cross their legs, and in some cases, their walking and gait are affected.

    • endometriosis symptoms: leg pain
      Due to neuropathy, endometriosis
      can often cause leg pain.

      Back pain

    • Leg pain

    • Thigh pain

  • Infertility: the inability to conceive or properly carry a child. This can also include miscarriage or ectopic pregnancy.

    • Miscarriage

    • Ectopic pregnancy

  • Fatigue

  • Aching

  • Constant discomfort

What do you do if you have strong signs of endometriosis?

An endometriosis diagnosis is dependent on a physician evaluation, in which a patient’s history will be discussed and a pelvic exam will be conducted. The presence of the disease can only be confirmed by subsequent laparoscopy and pathology. But only you know your body best. If you feel that you have the aforementioned symptoms and that endometriosis may be the probable cause, you do not need to suffer. Consult with Seckin Endometriosis Center today.

Ready for a Consultation?

Our endometriosis specialists are dedicated to providing patients with expert care. Whether you have been diagnosed or are looking to find a doctor, they are ready to help.

Our office is located on 872 Fifth Avenue New York, NY 10065.
You may call us at (646) 960-3080 or have your case reviewed by clicking here.

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