Symptoms of Endometriosis

October 3, 2011
C.Y. Liu, MD
C.Y. Liu, MD

Patients with endometriosis can have symptoms varying from constant excruciating pelvic pain to no symptoms whatsoever. Paradoxically, the extent of endometriosis has no correlation to the amount of pain a women will experience. Some women with severe endometriosis do not have any symptoms and may not know they have endometriosis until a pelvic mass is detected on a routine pelvic examination or a problem with infertility is discovered.

Symptoms of Endometriosis

Patients with endometriosis can have symptoms varying from constant excruciating pelvic pain to no symptoms whatsoever. Paradoxically, the extent of endometriosis has no correlation to the amount of pain a women will experience. Some women with severe endometriosis do not have any symptoms and may not know they have endometriosis until a pelvic mass is detected on a routine pelvic examination or a problem with infertility is discovered. The following are the common symptoms of endometriosis, but remember that women with endometriosis may have all, some, or none of these symptoms.

Pain and Discomfort in the Pelvic area
Women with endometriosis most commonly experience increasing pain and discomfort right before and during their monthly cycles. Painful sexual intercourse, pressure and bloating in the lower abdomen, and severe, sometimes incapacitating, cramps during this period are not uncommon. Some women with endometriosis, however, have constant pelvic pain, cramps, and painful intercourse which may not be associated with monthly cycles.

Abnormal Uterine Bleeding
A women with endometriosis may have some vaginal spotting a few days before and/or after her period, or she may have abnormally heavy and long periods.

Gastrointestinal symptoms
Gastrointestinal dysfunction ranges from abdominal bloating or nausea to intestinal cramps, cycles of diarrhea and/or constipation. Rectal bleeding and painful bowel movements may occur when the rectum and sigmoid colon are invaded by the endometriosis.

Infertility
The most common cause of unexplained female infertility is endometriosis.

Urinary symptoms
Frequency, urgency, bladder pain, and occasionally bloody urine may occur when endometriosis has involved the bladder. Endometriosis can invade the ureter (tube between the kidney and the bladder), may cause obstruction of the ureter, and damage the kidney.

Lower back pain which may radiate down the legs

Diagnosis of Endometriosis

Laboratory and imaging tests (ultrasound and x-rays) are not as helpful as the history and physical examination in diagnosing endometriosis. Indeed, in our own experience, the high suspicion and persistence in seeking the diagnosis of the patient are the two most important factors in leading to the majority of the diagnoses of endometriosis. Visualization of endometriosis on the lower genital tract (vagina and cervix) and tender nodules palpable above the vagina during routine pelvic examination is considered by many physicians to be diagnostic of endometriosis. However, laparoscopy (laparo = abdomen, scopy = inspection, thus, laparoscopy = inspection of abdominal cavity) to directly inspect the abdominal and pelvic cavity is the only definitive diagnosis of endometriosis.