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Symptoms and Signs of Endometriosis

How do I know that I have endometriosis?

It can be very difficult for a woman, particularly a young woman, to recognize the symptoms of endometriosis. Often the disease goes undiagnosed for years, only to be discovered when a patient presents with infertility or symptoms that have become very severe. The most common symptom of endometriosis is pain in the lower abdomen, the pelvis, or the lower back, mainly during menstrual periods. However, the amount of pain a woman feels does not depend on how much endometriosis she has. Some women have no pain, even though their disease affects large areas. Other women with endometriosis have severe pain even though they have only a few small 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.

What are 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 more than two days, and can even persist after the period is over. Pain from endometriosis characteristically does not respond well to analgesics and birth control pills. More than 3 out of 4 women with endometriosis have a history of incredibly painful, crampy periods that can be traced back to their adolescence. The event of ovulation (on day 14 of the reproductive cycle) is often very painful in patients with endometriosis. As an individual gets older there may be non-menstrual pelvic pain in the picture. Since pain is considered a subjective vital sign, the nature of its description varies from one individual to the other. Association and overlapping with other symptoms, like bowel movements frequency, gas around and during periods, constipation, diarrhea, and painful bowel movements, are all part of the symptom chain of endometriosis. Therefore, the nature, duration, radiation of painful periods and its association with other symptoms are important in making clinical decisions in 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, which is more pronounced around menstruation.
  3. Painful sex (dyspareunia) and painful bowel movements
    Painful sex (dyspareunia) and painful bowel movements are 2 of the cardinal symptoms of endometriosis. In this image, there is a deep involvement of endometriosis to the posterior cul-de-sac (area between the back of the uterus and rectum). During sexual intercourse or when one passes a bowel movement, this area of tissue will be irritated and cause pain due to the build 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 something a woman will dread as opposed to enjoy. Thus, if your partner suffers from endometriosis and is experiencing dyspareunia it is important to be kind, supportive and always keep in mind the endometriosis pain they very well may be going through.
  4. Painful bowel movements: Like dyspareunia, this fifth cardinal symptom may point to a deeper involvement of endometriosis to the rectovaginal septum and pelvic lateral walls. However, painful bowel movements and painful sex have different series of symptomatology when the lateral pelvic walls are affected at the deeper levels, along with the ureters, arteries, and nerves.
  5. Neuropathy: The nerves may be directly involved or stimulated mostly by surrounding pathology due to swelling and scarring that changes the microcosm of the retroperitoneum (space in the abdomen behind the peritoneum) as well as direct involvement of the nerves. Symptoms naturally differ from one patient to another according to the varying location of the lesions. From changes of sensory feelings to radiating pain to the back, lumbosacral area, inner thigh and along the track of sciatica nerve. Some of these patients cannot cross their legs and even their walking and gait are affected.
    As it can be seen here, peripheral system nerves 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 leading to nerve pain that causes such symptoms as radiating pain to the leg, back, and inner thigh.
  6. Infertility: Last but not least, the most frequent yet most elusive symptom of endometriosis is infertility, defined as both the difficulty to conceive and difficulty in holding pregnancy. Due to its silent nature, we sometimes refer to this as “cardinal symptom 0” of Endometriosis. Complex immunobiological factors both at the cellular and antibody levels are involved. Inflammatory toxins that arise because of endometrioma scar tissue, do not allow the sperm and egg to naturally mate. Endometriosis visibly causes 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 treatments without their endometriosis ever being addressed.

What is the complete list of Symptoms for endometriosis?

Not all women will have all of the following symptoms, however, if you are exhibiting any of these symptoms and think you may have endometriosis, please consult your doctor.

  • Dysmenorrhea – painful menstrual cramps often classified as "killer cramps"; pain may get worse 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 periods

    • 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 your menstrual cycle.

  • Dyspareunia- pain during or after sex

    • Painful orgasm

  • Painful bowel movements or painful urination during menstrual periods

    • Rectal pain

    • Blood in urine

    • Urinary frequency, retention or urgency

    • Urinary tract difficulties

  • Neuropathy – nerves affected by advanced cases of the disease and 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 influenced.

    • 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 if you have strong signs of endometriosis?

As we may now all be familiar with the classic symptoms of endometriosis, the signs and the findings of endometriosis are dependent on a physician evaluation, in which a patient’s history will be discussed and a pelvic exam will be conducted. But only you know your body best. If you feel that you have the following symptoms and that endometriosis may be the probable cause, you do not need to suffer in your day to day life.

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