Endometriosis lesions are responsible for a variety of painful symptoms, which initially occur during menstruation. Over the years, these symptoms can also be felt when not having a period, but nevertheless their intensity remains at its highest during or around the period. The classic symptoms are pain in the lower abdomen (pelvic pain), pain during sexual intercourse felt deep in the pelvis, pain when having a bowel movement or urinating, pain in the chest or shoulders, pain on the path of the sciatic nerves.
Endometriosis can also cause infertility. Infertility associated with the above-mentioned painful symptoms is a good reason to look for endometriosis.
Dysmenorrhea: or painful periods
In the majority of cases, dysmenorrhea is chronologically the first painful symptom, often appearing at the time of the first periods. They can lead to school or work absenteeism, and are characterized by :
Deep dyspareunia or pain during sexual intercourse
These are ballistic dyspareunia, triggered by deep penetration, generally in the posterior pouch. This symptom can have a negative impact on a couple’s sexual life and reduce the chances of spontaneous conception.
They may be due to deep retrocervical endometriosis, uterosacral ligaments or vaginal pouches, but also to superficial endometriosis of the pouch of Douglas, as well as to adenomyosis.
Digestive symptoms associated with menstruation are varied and non-specific:
Pain with defecation or distension of the rectum, sometimes increased during menstruation. Catamenial diarrhea, or conversely severe catamenial constipation and exacerbated abdominal bloating, all these are signs that may suggest endometriosis, without being specific.
Their presence justifies investigation of digestive locations of endometriosis, particularly in the rectum or sigmoid colon, which together represent 2/3 of digestive disorders.
Nevertheless, the digestive symptoms may simply be due to an irritation effect of the superficial or deep endometriosis lesions on the digestive tract or on the nerves which are responsible for its contractile activity.
More rarely and in advanced forms, acute intestinal occlusion may disclose severe endometriosis, requiring emergency surgical treatment.
Catamenial cystalgia, daytime and nocturnal frequent urination, as well as the impression of regularly having a urinary infection (but without proven infection from bacteriological examination of the urine) during menstruation are grounds for looking for deep endometriosis of the bladder.
However, like the digestive symptoms, these urinary symptoms may be linked to an irritation effect of endometriosis lesions.
The nodules of deep endometriosis can infiltrate or even envelop the ureters. This can result in episodes of back pain, but most often these lesions are asymptomatic for a long time. They may lead to stenosis of the ureter, or even to ureteral and pyelocaliceal dilation upstream, complicated in extreme cases by low-level renal atrophy and complete destruction of the kidney.
Any painful or embarrassing symptom that occurs cyclically and is concomitant with menstruation may suggest endometriosis:
These are pains that occur between periods and can lead to chronic, daily pain that is resistant to the usual analgesic drugs. They are often associated with advanced endometriosis, intra-abdominal adhesions, but also with associated neuropathic mechanisms which make management more complex, with often a lessened efficacy of proposed treatments.
Endometriosis is a risk factor for infertility; it is found in one third of women seeking treatment for infertility lasting more than one year.
The mechanisms causing infertility in endometriosis which can be isolated or associated are the following:
In extreme cases, endometriosis lesions can lead to dramatic complications, such as complete destruction of the kidneys, intestinal obstruction, pneumothorax or loss of voluntary bladder control.
Bibliography : Roman H, et al. Hum Reprod. 2012 Dec;27(12):3440-9
40%
of women suffering from infertility and chronic pain have endometriosis
48%
have their sex life affected by the disease
45%
consider that their professional career has been affected by the disease
Source :
1. The Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility. Fertil Steril 2004; 92(Suppl1),40 45.
2. IPSOS GEDEON RICHETR Endofrance
3. IPSOS GEDEON RICHETR Endofrance
For multidisciplinary management of endometriosis, IFEM Endo accompanies you throughout your care journey of medical and surgical treatment, medical follow-up and pain management.
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