Endometriosis can cause an array of symptoms that differ from individual to individual and may worsen over time.
What are the common symptoms of endometriosis?
- Severe pelvic pain: The pain may be cyclical (worsening around the menstrual flow and ovulation) and/or non-cyclical in nature (constant throughout the cycle). Women describe a burning, throbbing, stabbing pain in different parts of their pelvis. This pain can be even more severe than labor pains and post-operative pain.
- Pain with sex: Endometriosis can cause pain with deep penetration. This is because the area of tissue just beyond the end of the vagina is commonly affected by the disease, making it exquisitely tender and sore.
- Pain with urination and bladder pain: If disease is present involving or near the bladder this may result in bladder pain/sensitivity and pain on emptying the bladder. Another common cause of bladder symptoms is interstitial cystitis, a condition that frequently co-occurs with endometriosis.
- Pain with bowel movements: Endometriosis involving the lowest part of the colon (the rectum) may result in pain with bowel movements during menses (or during the whole month long).
- Pain prior to bowel movements: Endometriosis involving the colon may result in pain just prior to bowel movements.
- Cyclical rectal bleeding: If bowel disease has invaded into the bowel wall, the patient may experience cyclical rectal bleeding.
- Bloating: Bloating may result from the inflammatory response to endometriosis involving the pelvis and bowels.
- Nausea and vomiting: This may be a symptom of severe pain, of the effect of inflammation on the gastrointestinal tract or more specifically could be a symptom of invasive small bowel disease. Acute vomiting can be a symptom of small bowel obstruction, a rare but serious complication of endometriosis demanding emergency medical intervention.
- Constipation and diarrhea: Endometriosis near or involving the bowel may result in IBS-like symptoms.
- Fatigue: Severe fatigue is a non-specific symptom of endometriosis. It is a common symptom experienced by sufferers of chronic illness and pain.
- Infertility: It has been estimated that 40% of women with endometriosis struggle with fertility problems. Around 20% of women in a healthy population will experience infertility, meaning that in those with endometriosis the risk of fertility problems is doubled. Infertility may be due to adhesions that result from the disease process or from the effect of the disease on the intrauterine environment; endometriotic tissue releases chemicals that may hinder conception and implantation.
- Shoulder tip pain: Less commonly, if a patient has diaphragmatic endometriosis, she may present with cyclical right shoulder tip pain. Diaphragmatic endometriosis is relatively rare.
Importantly, while endometriosis is associated with a range of symptoms the most common symptom is chronic pelvic pain. You do not have to experience all of these symptoms to have endometriosis. If you are experiencing debilitating pelvic pain this is not normal. It is your body’s way of communicating that something is wrong and you should seek the help of a doctor who is familiar with treating endometriosis and pelvic pain.
How do symptoms differ between patients?
While some patients are relatively symptom-free except for certain times of their cycles (menstruation and ovulation), others are debilitated by pain each and every day of the month. Many women experience a gradual worsening of symptoms over time, both in severity and in the duration of symptoms i.e., the number of days per month they are affected. A common myth is that endometriosis only affects a woman during her period – while this may be the case for some women, for most patients the pain affects them both during and outside their period.
Is endometriosis “just” monster cramps?
Endometriosis is not “just” monster cramps. Severe cramping during the menstrual flow is, in fact, more commonly associated with another gynecological condition called adenomyosis. Adenomyosis is where endometriotic tissue is found inside the muscular walls of the uterus and can cause severe cramping and heavy menstrual bleeding. Adenomyosis often co-occurs with endometriosis and for this reason the symptoms of the two conditions are frequently confused with one another.
Endometriosis does not, however, cause uterine cramps nor abnormal bleeding; these symptoms point to a problem with the uterus whereas endometriosis affects tissue outside the uterus.
What is the impact of these symptoms on a woman’s life?
The symptoms of endometriosis can be truly devastating. They can impact upon all areas of a woman’s life rendering her unable to function.
Teenagers with endometriosis may find that they are forced to miss one or more days of school each month while those in employment may find they are struggling to hold down a job due to the need to take leave on a regular basis for severe pelvic pain. Non-prescription pain medications may fail to alleviate the pain and prescription pain medications may only offer partial relief. Maintaining a sexual relationship may be difficult if not impossible due to severe pain during sex. Pelvic pain may interfere with social events and plans and may prevent a woman from partaking in physical exercise. Understandably, over time the symptoms of endometriosis can lead to social isolation, financial difficulties, relationship breakdown and severe emotional distress. Clearly, it is a disease that needs to be taken very seriously and treated effectively as soon as possible to restore a woman’s quality of life.
If you think you may be suffering from endometriosis, don’t suffer in silence. Take your symptoms seriously by talking to your doctor.