A woman may have no idea that she has this condition, but it may be seen when looking at something else, perhaps at an operation for appendicitis, or at laparoscopy for investigation of infertility.

However, there may be hints that something is amiss in the pelvis. The severity of symptoms will vary according to the site and degree of endometriosis, but it is not always the women with the most endometriotic tissue that end up with the most symptoms. Sometimes women with quite extensive disease will have few symptoms, and vice-versa.

The classic symptom of endometriosis is pain. This is usually in the lower abdomen and is generally related to the menstrual cycle. Severe period pain (dysmenorrhoea), particularly in someone who has not had this problem when younger, may give a clue that endometriosis may have developed. Pain during sex (dyspareunia) is another typical symptom. Doctors classify dyspareunia as being ‘superficial’ or ‘deep’. Deep, meaning felt in the pelvis rather than at the vagina, is the type of dyspareunia typical of endometriosis. It may be intermittent, or only in some positions.

The pain probably relates to the tethering of the uterus and ovaries by endometriotic tissue and scarring, and the swelling and activity of the tissue in response to the normal circulating hormones.

If the endometriosis is on or near other organs in the pelvis it may produce other changes. Needing to wee more often around the time of the period every cycle, and sometimes pain on passing wee may happen if the bladder is involved. These are also symptoms of bladder infection. If endometriosis is the cause the symptoms will tend to recur each period. If it is due to infection a urine test can diagnose this.

The bowel also lives in the pelvis, and can be affected. It may be that a woman notices looser, more frequent bowel actions around the time of her period, or possibly gets constipated. Just to confuse the issue (more), many women do get bowel changes cyclically from a cause other than endometriosis.

It is thought that the increase in some of the hormonal messengers (prostaglandins in this instance) in the pelvis around the time of the period may be responsible. If a woman has endometriosis affecting her bowel (which is rare), she may have pain on passing poo, or notice blood in the bowel action.

Less often, actually incredibly rarely, endometriosis can give rise to very unusual symptoms. If the endometriotic tissue is in distant places, like the nose, brain, lung or liver, the woman may have weird cyclical symptoms. It is thought that the endometriotic cells can travel in the blood or lymph systems to get to more uncharacteristic locations, but this is very uncommon.


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