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What are the symptoms of endometriosis?

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3 fertility expert(s) answered this question

Answer from: Sibte Hassan, MBBS, FCPS, MRCOG, MSc

Gynaecologist, Fertility specialist and Gynaecologist at London Womens Clinic
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The most common symptoms are painful periods and the pain just starts just before the periods and once the periods start, it starts to ease out and when the periods finish, it completely goes away. The periods are sometimes heavy, sometimes very painful, heavy periods are the most significant and common symptom. The other symptom could be if there is endometriotic deposits deep within the pelvis, patient could have deep pain during the intercourse as well so, intercourse could be progressively painful and sometimes if it involves the peritoneum and the diseases it involves the bowel and there are scar tissue between the bowel and uterus patient could have some changes in the bowel habits as well leading to diarrhea sometimes or constipation. Sickness because of this involvement of peritoneum and bowel obviously bloated sometimes as well due to scar tissue and because of change in the bowel movements. Obviously because it causes scar tissue within the pelvis, it could potentially affect the ovarian function and tubal function which could lead to difficulty in conceiving if a female is trying to conceive. Because it’s a progressive disease, it can lead to scarring every month which can eventually lead to long-term chronic pain. We call it chronic pelvic pain and patients can have mental health problems because of the continuous burden of the disease which is progressively increasing, fatigue and lower tummy pain. So, depending on the number of deposits, the severity of the disease and the organ involved, the symptoms could be slightly variable but these are the common symptoms.

Answer from: Ahmed Elgheriany, MRCOG, MD, MSc

Gynaecologist, Fertility Specialist GENNET City Fertility
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This is a strange disease and they can come in different shapes. So, first of all if it affected the bowel and you may be confused for longer time in your life with irritable bowel syndrome (IBS) because if it’s spot in the bowel or on the rectum can cause diarrhea or can cause constipation and of course, we’ll have bloating. The very recent study was done in Manchester where they fulfilled the rectum of endometriosis patients with mild endometriosis, severe endometriosis, irritable bowel syndrome and normal ladies with just minimal gases and they found very interesting, that the threshold of pain of normal people here (high) and with endometriosis (mild, moderate, severe) and the IBS all were very low threshold for pain. So, it’s not related to the symptoms, not related to the severity of the stage or anything – once you have endometriosis you may have abnormal tolerance for the pain inside your colon and this will also reflect in the muscle of your pelvis. So, if you have constipation you will need to do a spasm in your pelvic muscle and this spasm can cause pain and with it may cause pain inside the intercourse also. If you have diarrhea, you are exerting more often to hold this diarrhea and this also strain on pelvic muscle and this strange kind of pain can cause you to have very strange pain and nobody can figure it out. If you went for examination by a gynecological doctor, you will not find anything -we don’t have any method to prove that it’s deep pelvic muscle pain – we do not know it, it’s not in common practice between obstetrician, between gynecologists or even between gastroenterologists as a common practice. Bloating can also happen due to this irritability of the colon all the time. You may not complain of dysmenorrhea, dyspareunia or pelvic pain but you may have this strange feeling that something is spastic and this pain can sometimes be very debilitating for your movement. So, this is a very strange syndrome – that’s why nobody listens to these words. When we treat it by giving hormone contraception, by giving any painkiller – still she is complaining of pain because the threshold, once if per say you touch the hot oven, every time this hot oven you see hot oven, you will just move quickly – same with endometriosis: if you feel this pain and you start to treat but you still have this memory, once anybody touches this muscle again or just any kind of spasm will exaggerate it. So, this is very strange, it needs to be tackled and be explored and be spoken up by a cognitive behaviorist. Cognitive behavioral therapy could help you. You can speak with yourself: “I know, if it’s not related to the period maybe I’m exaggerating my response now” – this can help and sometimes it could lead you to just sleep and don’t move and rest but this will not help. Unfortunately, this will not help. Try to just move your body a little bit – just doing the easy move step, easy move or easy steps, some exercise. I will not say belly dancing or any blanks so, this will not help at all but just try to keep your body moving a little bit to just decrease this response to pain. If you rest, it will increase more and more – just to try to move but not doing any core exercise definitely if you have such kind of pain.
This is one thing related to the abnormal symptoms of endometriosis which is not revealed until now. The second thing, it’s bladder endometriosis which is very common especially in advanced disease to have endometriotic glands or islands implanted inside the bladder or implanted inside the ureter. So you may have chronic UTI (urinary tract infection) and you are going to the hospital, we have some bloods in your urine, we are doing investigation, doing anything – we can’t find anything – we put you in antibiotic because it’s slowing pain and flank pain – typical pain of endometriosis. Sorry it’s not typical pain of endometriosis – you are treating something related to the urinary tract and if you are going to the generalists, they will not think of something abnormal with this, unless you are taking very detailed history about what I told before. So, it can come from bladder pain syndrome, an urge sensation all the time you want to go to the toilet and you have pain and nothing in there and you are doing a urine test – it’s fine, it’s completely fine. So, an inflammatory response inside your tummy could exaggerate this response of excessive unexplained urinary symptoms. Excessive unexplained – we just relax our mind, it’s IBS so, it’s IBS. What can cause problems worse when any clinician puts you in any pain relief and now very recently are using cannabis or opiates. Opiates and cannabis will make this problem worse and more because it will just cause constipation, sometimes cause more bloating in your tummy so, it will accelerate the symptoms. I exerting many efforts to put people away from cannabis rather than prescribe it because it’s sometimes not helping, it’s still very very new new study because many new research about cannabinoids can avoid on endometriosis but we will just discuss this later as an option of treatment so, this is very exaggerated symptoms, sometimes it could cause, if it’s just implanted in the lung maybe cough of bleeding, maybe bleeding epistaxis and the weird thing that it’s abnormal see they found endometriosis gland inside a male (!) was bleeding from his nose. So, this is very very strange. This can explain what’s happening, maybe these pre-genetic cells that are implanted in each place in your body. So, it’s a very strange disease.

Answer from: Andrew Horne, Professor

Gynaecologist, Co-Director EXPPECT Edinburgh, Chair of Academic Board RCOG, Professor of Gynaecology and Reproductive Sciences at The University of Edinburgh 
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The symptom of endometriosis is pelvic pain and that pain can come in different forms – most commonly it’s around menstruation, so period pain can be really very severe but it can come at other times in the menstrual cycle. It can even be present throughout the menstrual cycle all of the time. The other types of pain that individuals with endometriosis report are pain with with sex and we often talk about that as being a deep pain inside. Individuals with endometriosis can sometimes get pain after sex as well and they can also experience pain opening the bowels and also pain passing urine. Pain is the primary symptom of endometriosis but it’s also associated with other problems such as difficulty getting pregnant and it can be also associated with a symptom which is sometimes difficult to pinpoint which is fatigue which a lot of patients report and that’s often very difficult to treat as well.

About this question:

How do I know if I have endometriosis?

Endometriosis is associated with pain but is that the only symptom that one can have? What symptoms might suggest that we have endometriosis? How to quickly diagnose endometriosis?

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