Endometriosis – signs and symptoms

Endometriosis is a slow, insidious condition that can be overlooked. The symptoms are general, progress gradually and are “normalised”. Women often think that excruciating or debilitating period pain is ‘normal’, and consequently, delay seeking help. There are also no specific sign and symptoms, nor diagnostic test that allow for an early diagnosis of the condition. On average, it takes 7.5 years from symptom onset to endometriosis diagnosis.

Taking a thorough case history will enable a clinician to differentiate from other gynaecological disorders and decide which further diagnostic investigation may be required.

Endometriosis typically affects women between 25-35 years old; however, it can occur in younger women with generalised pelvic pain. It is believed to increase in incidence with age due to increase in tissue metaplasia.

As retrograde menstruation is linked to endometriosis, regular menstrual cycles in these women are seen as a risk factor. Other risk factors include, early menarche short menstrual cycle, prolonged/ heavy menstrual flow, delay of first birth, reduced number of pregnancies and positive family history/presence of genetic markers.

The most common symptoms of endometriosis are pain related. This can manifest either as dysmenorrhoea, dyspareunia or generalised pelvic pain. Patients can also experience lower back pain or migraine. A patient may experience pain anywhere where endometrial lesions are located. This could be in the pelvic region, surrounding the uterus, bladder, bowel or ovaries. It can also occur in thoracic or abdominal tissue. Pain occurs when the lesions tear.

Bowel and bladder symptoms can also present due to adhesions or ectopic endometrial lesions in the corresponding areas. This can cause pain on urination or passing stool. Up to 20% of women with endometriosis were found to have concurrent interstitial cystitis. Irritable bowel syndrome is also experienced by some women. It has also been noted that many women with endometriosis suffer concurrently from autoimmune disease supporting the theory that an ineffective immune response plays a role in the pathogenesis of the condition.

The first line of investigation is usually transvaginal ultrasound. This can detect presence of cysts within the endometrium. It also may be used to differentiate types of cysts depending on the appearance. MRI may also be used as an adjunct to ultrasound. Serum CA125 may be raised in severe disease and genetic markers may be present. However, blood tests are only somewhat indicative and are insufficient for clinical diagnosis. Laparoscopy is the only test available for diagnosis.

It is important to remember, all the discussed symptoms can affect mood, energy and quality of life. Infertility is often a problem for women with endometriosis, something which may leave them feeling vulnerable, depressed or “less than” whole.  Always seek assessment from qualified health practitioners.

Source:  Juliana Ribereo BHSc Nat

 

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