Symptoms of endometriosis, such as pain in the lower abdomen, crampy pelvic pain, and pain during intercourse, are unpredictable Table 02. Symptoms of endometriosis differ among women, and can also change over the course of the disease. As many as 30% of women with endometriosis never have any symptoms. However, three types of pain have been described. The first is lower abdominal and deep pelvic pain that continues throughout menstruation. This crampy pain usually starts about two days before the menstrual flow and lasts for several days afterward. The second type of pain is deep, crampy pelvic pain that lasts throughout the cycle; it usually occurs in women with severe endometriosis. Although most women experience some kind of cramping while they are menstruating, crampy pain associated with endometriosis is usually more severe. The third type of pain, pain during intercourse, worsens on deep penetration, and can be triggered by specific sexual positions; it can also worsen during menstruation.
Endometriosis sometimes causes symptoms that seem to be unrelated to the disease, such as difficult bowel movements, painful urination, and shortness of breath. If the colon or stomach is involved, bowel movements may be difficult and painful. There may also be blood in the stool. Likewise, endometrial tissue in the urinary tract can cause blood in the urine or pain while urinating. In the lungs, endometriosis can cause coughing, shortness of breath, and chest pain. Tissue can grow on abdominal scars and cause tenderness and swelling. Sometimes misplaced tissue even grows within the nerves that connect the brain and spinal cord to other organs; this may cause sciatica (pain that begins in the lower back and travels down the back of the thighs) and headaches during menstruation.
The most worrisome symptom of endometriosis is infertility, although the two conditions may not be linked. While there is no evidence that endometriosis directly causes infertility, some 20% to 50% of infertile women have endometriosis. There is no clear explanation for this, although scarring and damage to the reproductive organs may play an important role.
The severity of endometriosis pain depends on where lesions and scar tissue are located, and how far they extend. Pain tends to increase the longer endometriosis goes unrecognized and untreated. Keep in mind that pelvic pain and abdominal pain can have other causes, especially if they do not occur around the menstrual cycle. These causes include tubal pregnancy, urinary tract infection, irritable bowel syndrome, colitis, Crohn's disease, an inflamed fallopian tube, a ruptured ovarian cyst, and scarring behind the uterus and on the walls of pelvis (pelvic adhesions).
Table 2. Symptoms of Endometriosis
Low abdominal or deep pelvic pain that starts two days before menstrual flow and lasts several days afterward. Described as aching, dull, and crampy, spreading to back and thighs. May also cause nausea, diarrhea, and pressure in the rectum. Same as above but lasting throughout the entire cycle Pelvic pain that occurs during vaginal intercourse, especially during deep penetration or during specific positions. Usually worst just before the menstrual flow but may last throughout the cycle Infertility Difficult, painful bowel movements Blood in stool Pain during urination Blood in urine Coughing Shortness of breath Chest pain Sciatic pain Headaches around the menstrual period Pain, tenderness, or swelling in or around abdominal scars, usually associated with menstruation
Endometriosis mainly affects women in their reproductive years (between the ages of 15 and 44) Table 03. Although the exact numbers are unknown, about 10% of women between the ages of 15 and 44 (approximately 5 million women) are affected by endometriosis. Certain factors appear to increase risk. For example, endometriosis is more common in women with shorter menstrual cycles (<27 days), longer menstrual flow (>7 days), and spotting before their periods begin. It is less common among women who have had at least one pregnancy, although this protection seems to decrease as the time between pregnancies increases.
Endometriosis also appears to be related to estrogen levels. Estrogen is responsible for the thickening of the uterine lining during the menstrual cycle. Some lifestyle factors seem to reduce the risk for endometriosis by reducing estrogen levels. For example, exercising regularly and maintaining a lower percentage of body fat ratio seem to reduce risk because they lower the amount of estrogen circulating in the body at any given time.
A family history of endometriosis increases risk. Endometriosis is inherited through the mother. Also, studies show that a woman who has an identical twin with endometriosis is four times more likely than a woman in the general population to have endometriosis herself. For nonidentical twins, the risk is twice as high.
Table 3. Factors Affecting Risk for Endometriosis
Increases risk Menstrual periods >7days Menstrual cycle <27 days Spotting before the menstrual period begins Increased estrogen levels in the blood Having a mother with endometriosis Having an identical twin with endometriosis (quadruples the risk) Having a nonidentical twin with endometriosis (doubles the risk) Decreases risk A previous pregnancy Exercise A low body fat ratio
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