From the Guidelines
The classical symptoms of endometriosis and adenomyosis include chronic pelvic pain, painful menstruation (dysmenorrhea), painful intercourse (dyspareunia), and abnormal uterine bleeding, as supported by the most recent evidence from 2024 1.
Symptoms of Endometriosis and Adenomyosis
The symptoms of these conditions can be summarized as follows:
- Chronic pelvic pain
- Painful menstruation (dysmenorrhea)
- Painful intercourse (dyspareunia)
- Abnormal uterine bleeding
- Heavy menstrual bleeding and prolonged periods in adenomyosis
- Tender, enlarged uterus in adenomyosis
- Fatigue and gastrointestinal symptoms like bloating, nausea, constipation, or diarrhea during menstruation
Characteristics of Symptoms
The symptoms of endometriosis and adenomyosis can vary in severity and may not necessarily correlate with the extent of the disease. Even minimal endometriosis can cause severe pain, while extensive disease may be asymptomatic. The pain associated with endometriosis can be sharp, cramping, or a constant dull ache in the lower abdomen, lower back, and pelvic regions.
Diagnosis and Classification
The diagnosis of endometriosis is challenging due to variable presenting symptoms and nonspecific physical examination findings. Imaging studies, such as expanded protocol transvaginal ultrasound (TVUS) and MRI, can help diagnose endometriosis and inform treatment planning. Classification systems for endometriosis have been developed, but they have limitations and do not always predict symptoms, response to treatment, or quality of life outcomes.
Recent Evidence
The most recent evidence from 2024 1 supports the use of imaging studies, such as TVUS and MRI, to diagnose and classify endometriosis. The American College of Radiology Appropriateness Criteria recommend the use of these imaging studies to inform treatment planning and improve patient outcomes.
From the Research
Classical Symptoms of Endometriosis
- Chronic pelvic pain 2, 3, 4
- Infertility 2, 3, 4
- Dyspareunia (painful intercourse) 4
- Dysmenorrhoea (painful menstruation) 4
- Pelvic tenderness 4
- Heavy menstrual bleeding is not typically a symptom of endometriosis, but rather of adenomyosis 5
Classical Symptoms of Adenomyosis
- Heavy menstrual bleeding 5
- Pelvic pain 5
- Infertility 5
- One in three patients with adenomyosis may be asymptomatic 5