Endometriosis history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Joseph Nasr, M.D.[2] Aravind Kuchkuntla, M.B.B.S[3], Mohammed Abdelwahed M.D[4]
Overview
Endometriosis is a condition affecting women in the reproductive age group. Patients with endometriosis may have a positive family history, presence of congenital cervical stenosis, or obstructive lesions in the uterovaginal tract. The presenting features include cyclical abdominal pain, dysmenorrhea, pain with passing stools, and pain with intercourse. Pain severity does not reliably correlate with lesion number, location, or subtype (except deep posterior cul-de-sac disease, which correlates with dyspareunia). Some individuals may remain asymptomatic, and endometriosis may be incidentally identified during surgical procedures performed for other indications.
History and Symptoms
History
Patients with endometriosis may have a positive family history, presence of congenital cervical stenosis, or obstructive lesions in the uterovaginal tract.[1][2]
Endometriosis should also be considered in adolescents with severe dysmenorrhea or chronic pelvic pain unresponsive to first-line therapy.[3]
Symptoms
The most common symptom of endometriosis is a cyclical, severe lower abdominal pain with menorrhagia. Pain may also occur outside of menstruation, and chronic nonmenstrual pelvic pain is common.[4][5] Pain mechanisms may include nociceptive, neuropathic, and nociplastic components.[4][5] The following is a list of common presenting symptoms in a patient with endometriosis:[6][7][8]
Common Symptoms
- Chronic pelvic pain - this is controversial[9] Deeply Infiltrative Endometriosis may be more important
- Dysmenorrhea
- Dull or cramping pelvic pain that begins two days before menstruation and persists through and after menses
- Dyspareunia
- Dyschezia
- Cyclic rectal pain
- Dysuria and hematuria
- Urinary frequency
- Hydroureter in advanced disease[10][11]
- Premenstrual or intermenstrual spotting (bleeding between periods)
- The onset of pain is prior to the first day of menstrual cycle and continues for two to three days after the last day of the cycle[12]
- Prolonged menstrual bleeding and (Menorrhagia)
- Widespread body pain
- Fatigue
- Sleep disturbance
- Memory or cognitive difficulties[4][5]
Less common symptoms
- Cyclical rectal bleeding in colorectal endometriosis
- Infertility
- Nausea and vomiting
- Patients with endometriotic cyst or mass in the ovary may present with an acute abdomen
- Endometrial cysts in the thoracic cavity may cause thoracic endometriosis syndrome (catamenial pneumothorax)
- Presents as recurrent, self-resolving chest pain and breathlessness primarily seen before menstruation[13]
- Catamenial hemoptysis[14]
- Cyclic shoulder pain[14]
- Abdominal wall nodules
- Umbilical bleeding during menses[14]
- In less than 1% of patients, deep endometriosis may present with bowel obstruction, hematochezia, hematuria, or hydroureter.[10][11]
Associated Overlapping Pain Conditions
Patients with endometriosis frequently have chronic overlapping pain conditions, including irritable bowel syndrome, bladder pain syndrome, and pelvic floor myalgia.[4][5]
References
- ↑ Thomsen LH, Schnack TH, Buchardi K, Hummelshoj L, Missmer SA, Forman A; et al. (2017). "Risk factors of epithelial ovarian carcinomas among women with endometriosis: a systematic review". Acta Obstet Gynecol Scand. 96 (6): 761–778. doi:10.1111/aogs.13010. PMID 27565819.
- ↑ Lassus H, Pasanen A, Bützow R (2015). "[Is endometriosis a premalignant condition to ovarian carcinoma?]". Duodecim. 131 (19): 1777–84. PMID 26638662.
- ↑ Vercellini P, Salmeri N, Somigliana E, et al. Müllerian anomalies and endometriosis as potential explanatory models for the retrograde menstruation/implantation and the embryonic remnants/celomic metaplasia pathogenic theories:a systematic review and meta-analysis. Hum Reprod.2024;39(7):1460-1470. doi:10.1093/humrep/deae086
- ↑ 4.0 4.1 4.2 4.3 Coxon L, Demetriou L, Vincent K. Current developments in endometriosis-associated pain. Cell Rep Med. 2024;5(10):101769. doi:10.1016/j.xcrm.2024.101769
- ↑ 5.0 5.1 5.2 5.3 Kaplan CM, Kelleher E, Irani A, Schrepf A, Clauw DJ, Harte SE. Deciphering nociplastic pain: clinical features, risk factors and potential mechanisms. Nat Rev Neurol. 2024;20(6):347-363. doi:10.1038/s41582-024-00966-8
- ↑ Murphy AA (2002). "Clinical aspects of endometriosis". Ann N Y Acad Sci. 955: 1–10, discussion 34-6, 396–406. PMID 11949938.
- ↑ McDonald JS (2001). "Diagnosis and treatment issues of chronic pelvic pain". World J Urol. 19 (3): 200–7. PMID 11469608.
- ↑ Cranney R, Condous G, Reid S (2017). "An update on the diagnosis, surgical management, and fertility outcomes for women with endometrioma". Acta Obstet Gynecol Scand. 96 (6): 633–643. doi:10.1111/aogs.13114. PMID 28186620.
- ↑ Stout AL, Steege JF, Dodson WC, Hughes CL (1991). "Relationship of laparoscopic findings to self-report of pelvic pain". Am J Obstet Gynecol. 164 (1 Pt 1): 73–9. PMID 1824741.
- ↑ 10.0 10.1 Mușat F, Păduraru DN, Bolocan A, Constantinescu A, Ion D, Andronic O. Endometriosis as an uncommon cause of intestinal obstruction—a comprehensive literature review. J Clin Med.2023;12(19):6376. doi:10.3390/jcm12196376
- ↑ 11.0 11.1 Leone Roberti Maggiore U, Ferrero S, Candiani M, Somigliana E, Viganò P, Vercellini P. Bladder endometriosis: a systematic review of pathogenesis, diagnosis, treatment, impact on fertility, and risk of malignant transformation. EurUrol. 2017;71(5):790-807. doi:10.1016/j.eururo.2016.12.015
- ↑ Morotti M, Vincent K, Becker CM (2017). "Mechanisms of pain in endometriosis". Eur J Obstet Gynecol Reprod Biol. 209: 8–13. doi:10.1016/j.ejogrb.2016.07.497. PMID 27522645.
- ↑ Marjański T, Sowa K, Czapla A, Rzyman W (2016). "Catamenial pneumothorax - a review of the literature". Kardiochir Torakochirurgia Pol. 13 (2): 117–21. doi:10.5114/kitp.2016.61044. PMC 4971265. PMID 27516783.
- ↑ 14.0 14.1 14.2 AndresMP, Arcoverde FVL, Souza CCC, Fernandes LFC, Abrão MS, Kho RM. Extrapelvic endometriosis: a systematic review. J Minim Invasive Gynecol. 2020;27(2):373-389. doi:10.1016/j.jmig.2019.10.004