Symptoms of Endometriosis

The commonest symptoms are pain and abnormal bleeding:-

Pain symptoms

  • Painful periods – dysmenorrhoea
  • Deep pain on intercourse that may last for a few hours, sometimes days after sex – dyspareunia
  • Cyclical or perimenstrual symptoms, such as bowel incontinence or bladder urgency/frequency, with or without bleeding or pain
  • Constant or intermittent pain occurring in the pelvis at times other than during a period – chronic pelvic pain
  • Pain in the back passage on opening the bowels –dyschezia
  • Pain on passing urine – dysuria
  • Ovulation pain

Abnormal bleeding symptoms

  • Heavy and prolonged periods
  • Some loss/staining before a period –pre-menstrual spotting
  • Passing blood on opening the bowels – rectal bleeding during a period commonly dark red and mixed with mucous
  • Blood in the urine – haematuria
  • Difficulty in becoming pregnant – infertility as result of the endometriosis blocking the fallopian tubes

Chronic fatigue

Staging

There are varying degrees of endometriosis and staging is based on severity. The endometrial implants within the pelvis respond to oestrogen and thicken, grow and rupture each month. The spilled contents cannot escape from the pelvis and so causes irritation, inflammation, scarring and adhesions. Each time larger implants or cysts rupture, more endometrial cells are spread and thus replication of the disease occurs.

Disease severity is assessed by simply describing the findings at surgery or quantitatively, using a classification system such as the one developed by the American Society for Reproductive Medicine. (ASRM). There is, however, no correlation between such systems and the type or severity of pain symptoms.

Stage 1 endometriosis is said to exist when there are relatively few implants where as Stage 4 endometriosis is said to exist when there are extensive implants and severe adhesive disease. Adjacent organs are usually involved such as the bladder and bowel. In some cases the normal anatomy of the pelvis can be grossly distorted.

It is important to remember that the staging of the disease does not necessarily correlate with the severity of symptoms. Some women with mild disease may experience debilitating symptoms, while women with more severe disease may suffer little effect.

Appearance

Endometriosis typically appears as superficial "powder-burn" or "gunshot" lesions on the ovaries and surfaces of the lining of the abdomen or black, dark-brown, or bluish puckered lesions, nodules or small cysts containing old blood. It can also present as more subtle lesions, including red blisters. Other appearances include white plaques or scarring and yellow-brown discoloration on the lining of the abdomen(peritoneum). In addition it may cause inflammation of the surrounding tissues leading to structures sticking together (adhesions). Some have severe disease hidden between the vagina and the rectum which cannot be seen with the laparoscope.

Endometriotic cysts in the ovaries can be very large usually contain thick fluid like tar and may be called chocolate cysts

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