What are some early warning signs for endometriosis?

Endometriosis can give symptoms at a very young age. Teenagers can have pelvic pain, painful periods, painful ovulation and then as they get older, will start experiencing painful intercourse. It is a very interesting question as sometimes teenagers experience painful periods and painful ovulation and they may need to take time off school and they’re just giving the pill as a way to control their symptoms and there’s no full investigation to determine whether they have got endometriosis or not. Some studies in the literature suggest that a great proportion of these young women that have had early onset pelvic pain symptoms may have underlying endometriosis.

Obviously it can start from any age – usually in the late 20s 30s reproductive age group but it can start a bit earlier as well. Again, if there is a strong family history you could suspect on the basis of symptoms that yes the patient has got slightly unusually painful heavy periods and that is an early sign obviously and if there is a high index of suspicion obviously painful intercourse, change in bowel habits – all these symptoms. If there is a monthly component and they are related to your periods, you could suspect endometriosis but in a significant number of cases the diagnosis could be missed and patients suffer from the pathology and disease for many many months and years before the actual diagnosis and management plan is offered. It is important in that sense that symptoms are slightly non-specific and there could be other differential diagnoses as well until the final diagnosis is confirmed. There’s a chance that there could be delay in the exact diagnosis.

Oral contraceptive pill, the estradiol that we give and progesterone is responsible. To be honest, we assume that whoever gets the oral contraceptive pill gets it mainly for protection – do not get pregnant – it is not. From the history speaking with women, I realised that those women that probably developed all those problems later on, they used to have problems even at young age. So many women have taken a contraceptive pill not only not to get pregnant but some of them they did not have regular cycle, pain and it was not just “I took a pill and I resulted in this” but “I took a pill because I wanted not to get pregnant but also in the same time I did not had a regular cycles”, at the same time I did not have some other things that are pointless to the women to discuss it, the doctors usually do not pay attention to that and then you have a group of women that they have evidence from very young age that they may develop some problems in the future. The oral contraceptive pill masks it – masks those problems and when you stop it everything appears.

The early symptoms of endometriosis, I can say it’s just 3D: Dysmenorrhea which is pain and painful period throughout your life could accelerate, could flair, could decrease and this pain typically can start before the period, go on with you inside your bleed and after you bleed will carry on for like a couple or three days. This is a very typical pain of endometriosis. This pain can disabilitate many school girls from going to school or many women to carry on their job and go to their job and just take many days off leave. So, this is the first and from Dysmenorrhea and the second sentence is Dyspareunia – it’s to be more precise, it’s a deep pain happening with deep penetration during intercourse and especially in same spot because endometriosis, most commonly, be in a uterine circular ligament. This ligament just supports the cervix, the neck of the womb to the sacrum and the common to have nerves inside this ligament. So, it’s easily touched with deep penetration during intercourse and if you are complaining often from the same problem, it could be a very early sign to diagnose yourself – even without a doctor – if you have this common pain with penetration. The third issue is Deep Pelvic Pain – all the time: deep pelvic pain, chronic pelvic pain. Chronic pelvic pain may be due to the endometriosis itself from what it causes on the rectum or what is causing into your bowel or it may be from the inflammatory marker inside your pelvis. So, this is the common early symptoms to have: chronic pelvic pain, all the month you have pain, you will have a problem with deep penetration during intercourse and the first thing is Dysmenorrhea.

That’s a very good question because early information is the solution to many problems. The first important point is the family history, if the mother or the sister, especially the first degree relatives if they have endometriosis because like I already mentioned that there is probably a genetic perspective to that based on Dr David Redwine’s recent theory. So, we do see that family history is very significant and if the sister is having severe endometriosis, we definitely should keep higher in the index of suspicion for this patient. Symptomatology wise, the first thing is the pain during periods which is not controlled, slowly it is getting worse and there is typically this pain is different because this pain gets worse with the period so, other pains will leave once the periods have progressed to day three or four but this endometriosis related pain gets worsened as the periods progress to day three and day four but this is not present very commonly to be making solid pointer in many large group of patients, it’s just the general dysmenorrhea, pain during periods is the first thing and then, these patients would not benefit from the normal painkillers and they would need the contraceptive pills and the role of contraceptive pills here is to basically quieten the reproductive system, it calms the reproductive system by stopping the ovulation and then this treats the pain as a temporary suppressing agent. Sometimes OC pills are used or sometimes progesterone is used for that. If the young girl is sexually active, she would say that the pain during sex is very very extreme so, these patients generally need OC pills but these days though she can definitely catch the first symptomatology and really prevent long years of pain for younger women and then if at all the pain is not being relieved and early laproscopy, we should not be hesitating towards doing that because that actually might improve the quality of life for the girl a lot much better.

I always say to to people who are worried about endometriosis if they have very severe period pain or pain within the pelvis at other times which is interfering with their quality of life, their ability to socialize, to have relationships, to work etc, now that’s a warning sign that they should go and see their GP and consider whether or not endometriosis is the causes the symptoms.

Yes, actually young girls and young ladies report that their periods from the start when they start their first period are painful so, those with painful periods or pelvic pain, pain during intercourse – these are some symptoms that can let us think that maybe they have endometriosis. Some of them will report even worse symptoms from early menstruation, that they have even pain when they open their bowels during periods so, this and with chronic pelvic pain and pain with periods are the earliest signs and symptoms that ladies usually and young girls report to might may indicate that they have endometriosis.