Endometriosis - Signs and Symptoms
Written by Dr.M.D.Mazumdar, MD
Endometriosis can produce a variety of symptoms in different degrees of severity.
While in one woman, mild endometriosis can be present with a multitude of signs and symptoms, a second woman may have quite severe endometriosis with no symptoms at all - the endometriosis may only be discovered while investigating for other conditions like infertility.
Symptoms also depend on the sites of endometriosis.
Common Symptoms of Endometriosis
- Menorrhagia: Excessive bleeding during menstruation is called menorrhagia. This symptom is present in about 75% of all women with endometriosis. The severity of menorrhagia increases with the increasing duration of endometriosis. This is more so if the ovaries are affected with endometriotic tissue and there is consequent hormonal disturbance.
- Pain during Periods: The main symptom of endometriosis is pain during menstrual periods starting at any time from puberty to menopause and gradually increasing in intensity. The pain usually starts just before the periods and gets worse during it when there is bleeding into a closed space. It then subsides slowly after the period is over. But a deep, dull ache can remain throughout the month.
- Pain in the Abdomen: Some women have a constant discomfort in the lower abdomen, which occasionally radiate to the groins and upper legs. A sudden and acute pain can occur if an endometriotic cyst bursts as can happen during a menstrual period.
- Pain during Sex/Coitus: If endometriosis is present deep in the pouch of Douglas (the space between the uterus and the rectum) or in the upper part of the vagina, there can be pain during coitus.
- Backache: Some women may present with backache if the endometriotic nodules are present in the uterosacral ligaments and the rectal wall.
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Physical Signs of Endometriosis
Physical findings depend on the severity and location of the disease.
- Abdominal Examination: Examination of the abdomen by palpation may produce no symptoms. But some women may have pain in the lower abdomen on deep palpation.
- Bimanual Pelvic Examination: Examination may reveal tender, fixed nodules deep in the pelvis and / or large cystic ovaries. The nodules are usually felt behind the uterus in the Pouch of Douglas. The uterus may be fixed and retroverted.
- No signs or symptoms: Endometriosis in many patients are only diagnosed when the patient is examined for some other complaint, usually for infertility. It can remain for many years with no definite signs and symptoms.
Tests for Endometriosis
The following tests help in the diagnosis of endometriosis:
- Ultrasonography: In early cases of endometriosis, ultrasonography (USG) will show no positive results. But when the endometriosis has been present for a long duration, an USG may reveal large cysts filled with blood in the pelvic cavity. These cysts, called 'chocolate cysts' are usually diagnostic of endometriosis.
- Blood Test: Blood tests for a substance called CA-125 may suggest the presence of endometriosis. But CA-125 is also present in other conditions like ovarian tumor, breast cancer, uterine cancer etc, and is thus not diagnostic of endometriosis.
- Diagnostic Laparoscopy: Laparoscopy or 'pin-hole' surgery is the only procedure which can accurately diagnose endometriosis. The advantage of this procedure is that treatment of endometriosis by releasing some of the adhesions between the pelvic organs can be done at the same sitting.
Pre-disposing Factors or Risks of Endometriosis
Pre-disposing factors or risk factors are factors that make a woman more prone to suffer from endometriosis.
- Age: Endometriosis is common between the ages of 30 - 40 years. But it can occur at any time between the puberty and menopause.
- Socio-economic condition: Endometriosis is common in the richer classes of society. It is suspected that this is probably due to the late marriage and late childbearing age of these women.
- Family: Endometriosis has race and genetic causative factors as is seen from the fact that endometriosis often affects more than one woman in a particular family.
- Infertility:Endometriosis is commonly linked with infertility. In many women, endometriosis is diagnosed only while testing for the cause of infertility. Almost 50 - 60 % of patients with endometriosis are childless, or have only one child. Whether endometriosis causes infertility or infertility causes endometriosis is debatable but the fact remains that the two conditions often go together.
Treatment of Endometriosis is mainly by medicines, although surgery may also be required to remove adhesions caused by the condition.
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