Can endometriosis cause sores in the mouth?

Endometriosis and Oral Lesions

Endometriosis does not cause sores in the mouth, as it is primarily a condition affecting the pelvic region with endometrial-like tissue growing outside the uterus. 1, 2

Understanding Endometriosis

Endometriosis is defined as an inflammatory disease characterized by endometrial-like tissue located outside the endometrial cavity, typically in the pelvic region. 1, 2

• Endometriosis affects approximately 10% of individuals assigned female at birth during their reproductive years 2
• The disorder is associated with inflammation and fibrosis, occurring on or extending below the peritoneal surface 1
• Deep endometriosis (DE) refers specifically to lesions extending deeper than 5 mm under the peritoneal surface 1

Common Locations of Endometriosis

Endometriosis typically presents in predictable locations within the pelvis, not in the oral cavity: 1, 2

• Pelvic organs (most common location) 3
• Ovaries and dependent areas covered with peritoneum 4
• Uterosacral ligaments 1
• Rectosigmoid wall 1
• Less commonly: appendix and diaphragm 1

Typical Symptoms of Endometriosis

The clinical presentation of endometriosis is variable but primarily involves pelvic symptoms: 1, 2

• Pelvic pain (reported by 90% of patients with endometriosis) 2
• Dysmenorrhea (painful menstruation) 1, 5
• Dyspareunia (painful intercourse) 1, 5
• Dyschezia (painful bowel movements) 1
• Dysuria (painful urination) 1
• Menorrhagia (heavy menstrual bleeding) 1
• Infertility (affects approximately 50% of patients with endometriosis) 1, 4

Diagnostic Approach for Endometriosis

The diagnosis of endometriosis is challenging and does not include evaluation of oral lesions: 1, 2

• Historically diagnosed by laparoscopy with histologic inspection 1
• Clinical diagnosis based on symptoms, physical examination, and imaging 2
• Imaging modalities include transvaginal ultrasound (TVUS) and pelvic MRI 1, 2
• Expanded protocol TVUS studies can identify and "map" deep endometriosis 1

Extrapelvic Endometriosis

While endometriosis can rarely extend beyond the pelvis, oral involvement is not documented in any of the clinical guidelines or research evidence: 3, 6

• Endometriosis is now considered a systemic disease with manifestations outside the female reproductive tract 6
• It can affect metabolism in liver and adipose tissue 6
• It can lead to systemic inflammation 6
• It can alter gene expression in the brain causing pain sensitization and mood disorders 6
• However, no evidence supports oral cavity involvement 1, 2

Management of Endometriosis

For patients with confirmed endometriosis, treatment options include: 5, 7, 2

• NSAIDs as first-line agents for pain management 5, 7
• Hormonal therapies including oral contraceptives and progestins 5, 7, 2
• GnRH agonists for at least three months for significant pain relief 5, 7
• Surgical removal of lesions when medical therapies are ineffective 5, 7, 2

Conclusion

If a patient presents with oral sores and suspected endometriosis, the oral lesions should be evaluated separately as they are not a manifestation of endometriosis. 1, 2, 3 The patient should be referred to an appropriate specialist (such as an oral pathologist or dermatologist) for evaluation of the oral lesions, while endometriosis management should follow established guidelines. 5, 7, 2