Endometriosis is a gynecological condition that affects as many as 1 in 10 women in the United States. It can cause significant disturbances in the menstrual cycle and is known for severe pelvic pain. However, endometriosis is a far more complex condition that period pain. It also affects fertility and some studies suggest that endometriosis may increase the risk of ovarian cancer, although to a very slight degree.
Read more on what is endometriosis?
What happens in endometriosis?
The inner lining of the uterus is known as the endometrium. This is the tissue that is shed during menstruation and regrows in preparation for pregnancy following ovulation. It is an ongoing cycle that should happen almost every month during the reproductive years of a woman’s cycle. Normally endometrial tissue is only found in the inner lining of the uterus.
However, this endometrial tissue is found outside of the uterus in endometriosis. The exact reason why this occurs is not always clear. It appears to happen when the menstrual blood flows backward up into the fallopian tubes and empties into the pelvis. It may also occur when the endometrial cells gain entry into the bloodstream and are carried to some distant site.
Another possible cause of endometriosis is a result of surgery to the uterus. Some of the endometrial cells may be implanted outside of the uterus, usually in scar tissue. However, it has been noted that endometriosis is more likely to occur in women with a family history, in certain ethnicities and is also associated with a low BMI (body mass index).
Wherever this endometrial tissue is located, it responds to the female hormones in the same way as the endometrium lining the inside of the uterus. However, this can give rise to inflammation with swelling of tissue and bleeding outside of the uterus. The inflammation and blood can therefore trigger symptoms in and around the organs where it is located outside of the uterus.
How to Spot Endometriosis
The signs and symptoms of endometriosis are not significantly different from other common gynecological conditions like polycystic ovarian syndrome (PCOS). A combination of period pain, heavy periods and infertility do not conclusively point to endometriosis. Therefore it is imperative to consult with a medical professional who can conduct the relevant investigations such as an ultrasound, laparoscopy, laparotomy and/or biopsy.
While other conditions like polycystic ovarian syndrome (PCOS) and uterine fibroids are separate conditions, it is helpful to know the similarities and differences to endometriosis. Contrary to popular belief, menstruation (periods) should not be very painful and the duration and flow should not fluctuate from period to period. These abnormalities are symptoms of a gynecological condition and requires professional medical assessment.
Read more on the differences between endometriosis and PCOS.
Pelvic pain is one of the common signs of endometriosis. It is a chronic pain that may vary in intensity during the course of the menstrual cycle. Typically the pain is described as very severe and worsens just before menstruation (menstrual periods). The chronic pelvic pain may then subside once menstruation starts.
However, it can continue through menstruation and the onset of period pain may be difficult to differentiate from menstrual pain. Another pain-related symptom is dyspareunia, which is pain experienced during sexual intercourse. The pain in endometriosis may also intensify during defecation and even with passing urine.
Apart from the chronic pelvic pain, many endometriosis suffers report severe cramping pain (dysmenorrhea) that starts a few days before the menstrual periods. It intensifies and may then subside once the period starts or at least 1 to 2 days into the period. However, the pain may continue through menstruation. It is not uncommon for there to be lower abdominal pain and back pain which may also intensify during menstrual periods.
Difficulty Falling Pregnant
Infertility is considered one of the hallmark symptoms of endometriosis. However, this is not a problem for all women with the condition. It is estimated that only about 1 in 3 women with endometriosis will have a difficulty falling pregnant. Often women find that endometriosis symptoms subside with pregnancy but may recur after childbirth.
Irregular or Heavy Periods
Heavy periods is another common symptom of endometriosis. These periods are typically irregular and women with endometriosis often have a problem predicting when a period will occur. It is further complicated by intermenstrual bleeding, which is spotting or bleeding between the periods. This intermenstrual bleed should not be confused with menstrual bleeding (periods).
Pain in endometriosis is not limited to the uterus or other female reproductive organs. The bladder and large intestine which lie in close proximity to the uterus are often affected in endometriosis. While the endometrial tissue can lodge anywhere in the pelvis, the area around the rectum, colon or bladder are commonly affected. Therefore symptoms related to these organs are common.
These symptoms include:
- Cycles of diarrhea and constipation.
- Pain when defecating (dyschezia).
- Frequent urination.
- Pain when urinating.
- Flank pain if the ureters are affected.
- Pelvic pain when exercising.
It is important to note that complications beyond the female reproductive organs can also give rise to symptoms. Bowel obstruction may occur with adhesions. The symptoms of bowel obstruction may therefore be present. In cases of pelvic surgery with endometrial cells in the operative wound, there may be pain in the scar.
Read more on bowel obstruction symptoms.
There are several other non-gynecological symptoms that occurs with endometriosis. This includes nausea, vomiting, bloating and fatigue. These symptoms are non-specific means that it can occur with various diseases, not only endometriosis or gynecological disorders. As a consequence, these symptoms may give rise to changes in appetite, sleep patterns and with daily tasks.
In addition, the constant and severe pain as well as the difficulty falling pregnant can give rise to a host of psychological symptoms. This may vary from irritability and difficulty concentrating to depression. It is not uncommon for all of these symptoms to be mistaken for other conditions like polycystic ovarian syndrome (PCOS) or incorrectly attribute to premenstrual tension (PMT).