What are the signs and symptoms of endometriosis?

From the Guidelines

Endometriosis typically presents with pelvic pain, particularly during menstruation (dysmenorrhea), which often worsens over time, and is associated with a range of symptoms including painful intercourse (dyspareunia), pain during bowel movements or urination, excessive bleeding, infertility, and chronic fatigue, as noted in the most recent study 1. The clinical presentation of endometriosis is variable, ranging from asymptomatic to severe symptoms that interfere with daily activity, with pelvic pain being the most common symptom, which can manifest as dysmenorrhea, dyspareunia, dyschezia, dysuria, or menorrhagia, according to the study published in the Journal of the American College of Radiology 1. Some key points to consider include:

• The severity of symptoms doesn't necessarily correlate with the extent of the disease, as some women with extensive endometriosis may have minimal symptoms while others with mild disease may experience severe pain, as discussed in the study 1.
• Symptoms often worsen during menstruation because endometrial tissue, regardless of location, responds to hormonal changes of the menstrual cycle, causing inflammation and pain, as explained in the study 1.
• It's essential to note that these symptoms can overlap with other conditions like irritable bowel syndrome, pelvic inflammatory disease, or ovarian cysts, making diagnosis challenging, and consulting a gynecologist is recommended for proper evaluation, which may include physical examination, imaging studies, and possibly laparoscopy for definitive diagnosis, as suggested in the study 1. The diagnosis of endometriosis is challenging because of variable presenting symptoms and nonspecific physical examination findings, and imaging before surgery is now supported by the literature, as it helps inform patient decision making, is important for surgical planning, and impacts management, as stated in the study 1. Some women may also experience bloating, nausea, constipation, or diarrhea, particularly during menstrual periods, and approximately one-half of patients with endometriosis experience infertility, as reported in the study 1. The most recent and highest quality study 1 prioritizes the importance of proper evaluation and diagnosis, and recommends consulting a gynecologist for persistent pelvic pain, which may include physical examination, imaging studies, and possibly laparoscopy for definitive diagnosis.

From the Research

Signs and Symptoms of Endometriosis

The signs and symptoms of endometriosis can vary, but common symptoms include:

• Pelvic pain, including dysmenorrhea, nonmenstrual pelvic pain, and dyspareunia 2
• Infertility, with 26% of people with endometriosis reporting infertility 2
• Heavy menstrual bleeding 3
• Other menstrual problems, such as irregular periods or spotting 4

Risk Factors for Endometriosis

Risk factors for endometriosis include:

• Younger age at menarche 2
• Shorter menstrual cycle length 2
• Lower body mass index 2
• Nulliparity (never having given birth) 2
• Congenital obstructive müllerian anomalies, such as obstructed hemivagina 2

Diagnosis of Endometriosis

Diagnosis of endometriosis can be challenging, but a suspected clinical diagnosis can be made based on symptoms, supported by:

• Physical examination findings 2
• Imaging with transvaginal ultrasound and/or pelvic magnetic resonance imaging 2
• Surgical visualization of lesions, which is the definitive method of diagnosis 2

Treatment of Endometriosis

Treatment of endometriosis depends on the severity of symptoms, extent of disease, and desire for pregnancy. Options include:

• Hormonal medications, such as combined oral contraceptives and progestin-only options, which are first-line treatment 2, 5
• Surgical removal of lesions, usually with laparoscopy, which may be considered if first-line hormonal therapies are ineffective or contraindicated 2
• Nonsteroidal anti-inflammatory drugs (NSAIDs), which may be used for pain management, although evidence for their effectiveness is limited 6
• Anti-angiogenic therapy, which is a potential non-hormonal therapy for the treatment of endometriosis 3