What are the symptoms of endometriosis?

Endometriosis is a chronic disease that is difficult to diagnose and to treat.

Without treatment, endometriosis gets progressively worse in 65% to 80% of patients.

Even with treatment, endometriosis continues to advance in 20% of patients.

Cysts and implants may grow and spread to other parts of the pelvis, and in very severe cases, to the urinary or intestinal tracts. Eventually adhesions may form. These are dense, web-like structures of scar tissue that can attach to nearby organs and cause pain, infertility, and intestinal obstruction.

Pelvic Pain

The most common problem for women with endometriosis is pain, which can significantly impair the quality of life.

The pain experienced around menstruation (dysmenorrhea) can be so debilitating that up to 25% of women with the condition can be incapacitated for two to six days of each month. In severe cases, regular activities may be curtailed for up to two weeks per month. Sleeping problems have been reported in three quarters of patients, mostly due to pain.

Studies suggest that endometriosis is the cause of about 15% of cases of pain in the pelvic region in women. (i.e. the lower trunk of the body.)

Timing of Pain

In addition to during menstruation, endometrial pain can occur at other times of the month.

A survey published by the Endometriosis Association reported the following findings on the timing of endometrial pain:

• 71% of women reported pain within two days after their periods started.
  
• 47% reported pain in the middle of a cycle. (A sharp pain during ovulation may be due to an endometrial cyst located in the fallopian tube that ruptures as the egg passes through.)
  
• 40% reported pain at other times of the month.
  
• 20% reported continual pain.
  
• 7% said there was no pattern.
  
• Many women with endometriosis experience pain during intercourse.(dyspaerunia)

Location of Pain

Nearly all women with endometrial pain experience it in the pelvic area (the lower part of the trunk of the body).

The pain is often a severe cramping that occurs on both sides of the pelvis, radiating to the lower back and rectal area and even down the legs.

Occasionally, however, pain may also occur in other regions if endometriosis effects other part of the pelvic area, such as the bladder or intestine.

Severity of Pain

The severity of the pain also varies widely and does not appear to be related to the extent of the endometriosis itself.

In other words, a woman can have very small or few implants and have severe pain, while those with extensive endometriosis may have very few signs of the disorder except for infertility. Large cysts can rupture and cause very severe pain at any time.

Infertility

The medical literature indicates that endometriosis may account for as many as 30% of infertility cases.

Some evidence suggests that between 30% and 50% of women with endometriosis are infertile.

Often, however, it is difficult to determine if endometriosis is the primary cause of infertility, particularly in women have mild endometriosis. In an attempt to determine the chances for infertility with endometriosis, researchers have come up with a staging system based on findings during diagnostic surgery. [See Staging of Endometriosis.]

It should be noted that endometriosis rarely causes an absolute inability to conceive, but, nevertheless, it can contribute to it both directly and indirectly.

ENDOMETRIAL CYSTS.



Endometrial cysts may directly cause infertility in a number of ways.

• If implants occur in the fallopian tubes, they may block the egg's passage.
  
• Implants that occur in the ovaries prevent the release of the egg.
  
• Severe endometriosis can eventually form rigid webs of scar tissue (adhesions) between the uterus, ovaries, and fallopian tubes, thereby preventing the transfer of the egg to the tube.

IMMUNE FACTORS AND THE INFLAMMATORY RESPONSE.

Even in early stage endometriosis, investigators have observed increased immune system activity.

It is possible that in such cases, the body perceived these endometrial implants as hostile/ foreign, and launched an attack.

In this process, the body produces excess amounts of specific immune factors that contribute to infertility,like the following:

• Cytokines.
  
  Cytokines are very potent immune factors that, when overproduced, cause damage and inflammation in the very regions that are directed to protect. Such damage could produce scarring and obstructions that interfere with implantation and development of a fertilized egg.
  
• Prostaglandins.
  
  Elevated levels of these factors not only produce inflammation but increase uterine contractions. (Women with endometriosis have a higher than average risk for miscarriage.)
  
• Other Immune Factors.
  
  Growth factors (which stimulate growth of new blood vessels) and toxins produced by the implants could impair fertility.

Effects on Other Parts of the Pelvic Region

Implants can also occur in the bladder (although rare) and cause pain and even bleeding during urination.

Also rarely, implants form in the intestine and cause painful bowel movements, constipation, or diarrhea.

Cancers

Endometriosis is not a malignant disease, however, but experts have been debating for years whether it represents any significant danger.

The possible risks for ovarian and endometrial cancers are of specific concern. Some researchers have identified certain genetic mutations that may transform endometrial cells into ovarian or endometrial cancers in rare cases. (Some evidence suggests that ovarian cancer associated with endometriosis may differ from most ovarian cancer cases, and, in fact, have a better outlook.)

Emotional Effects

The emotional effect of severe endometriosis can be almost as devastating as the pain. It can affect the quality of life. In one survey conducted by the Endometriosis Association, patients reported the following emotional effects from this disease:

• 84% of patients reported feeling depressed during periods of pain.
  
• 75% felt irritable.
  
• More than half reported feelings of anxiety and anger.
  
• About 20% said they felt hopeless.

Other Symptoms

Patients may experience additional symptoms, which include the following:

• Joint and muscle aches.
  
• Fatigue
  
• Bloating
  
• Nausea
  
• Dizziness
  
• Heavy menstrual bleeding
  
• Headaches
  
• Depression and malaise (feeling generally low)
  
• Sleep problems