Signs and Symptoms of Endometriosis

Endometriosis is a chronic condition in which tissue similar to the endometrium or inside lining of the uterus grows outside of the uterus on organs such as ovaries, fallopian tubes, bowel, exterior uterine walls, kidneys, bladder, or even lungs.

• Painful menstrual periods
• Heavy menstrual periods
• Spotting or bleeding between menstrual periods
• Pain during or after sex
• Pain in the pelvis or lower abdomen
• Infertility
• Painful bowel movements or urination, especially during menstrual periods
• Fatigue, diarrhea, constipation, nausea, or bloating, especially during menstruation
• Neuropathy due to swelling and scar tissue

Pain associated with endometriosis can vary widely from person to person. Some women don’t experience painful symptoms at all, while others experience severe pelvic pain or pressure.

Tamer Seckin, MD, founder of the Endometriosis Foundation of America and author of The Doctor Will See You Now: Recognizing and Treating Endometriosis, describes the range of endometriosis pain in the following ways:

• You may experience cramping and intense pain with menstruation. Think throbbing contractions or sudden, sharp, stabbing pains that may leave you breathless. It may start before menstruation begins and not let up for several days afterward.
• You may feel a dull, throbbing pain around the time of ovulation.
• GI distress is also common, including bloating, gas, and cramps, sometimes accompanied by diarrhea and constipation. Symptoms are worse around menstruation.
• Pain during sexual activity can feel like sandpaper, along with sharp pains that radiate toward the abdomen.
• You may have painful bowel movements or urination due to irritated tissue.

Neuropathy may cause sciatica, a sharp, burning, radiating pain down your leg, inner thigh, or back, that can make walking or even crossing your legs uncomfortable.

The degree of pain doesn’t necessarily dictate the severity of endometriosis. You can have a very early case and feel pain much worse than another woman whose disease is much more advanced. The level of pain experienced with endometriosis depends more so on:

• Location If lesions are in an area rich in nerve endings, the pain will be more intense.

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• Swelling Lesions swell and bleed much like the uterine lining does during a menstrual cycle. Since the area has limited room and no way to expel the blood, this swelling and bleeding causes pain.

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• Scarring Scarring of surrounding tissue caused by lesions can also increase pain levels by causing organs to stick together.

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Endometriosis can cause pain, and sometimes very severe discomfort, during or after sexual penetration or orgasm. It can be difficult to seek treatment for this sensitive problem.

Painful sex, coupled with the anticipatory fear of that pain, can also be a big turnoff.

Unfortunately, many women are too embarrassed to talk with their physician about the pain associated with sexual intercourse. Some may think nothing can be done and try to ignore it or live with it. Others are told that their pain is psychological or somehow less than real.

However, women with endometriosis don’t have to live with pain that interferes with intimacy or sexual relationships. Treatments are available, and sex doesn’t have to hurt.

Since many people think of endometriosis as only a gynecological issue, bowel endometriosis can be tricky to detect.

Endometriosis can easily be confused with other conditions due to its varying signs and symptoms, so it’s important to see your gynecologist to obtain an accurate diagnosis. For instance, beyond endometriosis, pelvic pain could also be related to these conditions:

• Adenomyosis, in which endometrial tissue infiltrates the wall of the uterus instead of getting outside the uterus
• Appendicitis
• Celiac disease
• Diverticulitis
• Ectopic pregnancy
• History of sexual abuse or trauma
• Inflammatory bowel disease
• Interstitial cystitis
• Intrauterine device (IUD)
• Irritable bowel syndrome
• Miscarriage
• Pelvic cancer
• Pelvic inflammatory disease
• Severe kidney or urinary tract infections
• Uterine fibroids (benign tumors in the uterus wall)
• Uterine polyps

• The most common symptom of endometriosis is chronic pelvic pain, although some women don’t experience any symptoms at all.
• Additional signs and symptoms of endometriosis include painful and heavy menstrual periods, spotting or bleeding between menstrual periods, pain during sex, infertility, pain and gastrointestinal distress during menstrual periods, and neuropathy.
• Pain associated with endometriosis can vary widely from person to person, and pain levels aren’t necessarily an accurate reflection of the severity of the condition.
• Endometriosis can easily be confused with other conditions due to its varying signs and symptoms, so it’s important to see your gynecologist to obtain an accurate diagnosis.