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The symptoms
of endometriosis

Endometriosis causes pain during or around the menstrual period

Endometriosis lesions are responsible for a variety of painful symptoms, which initially appear during menstruation. Over the years, these symptoms can also be felt outside the menstrual period, but their intensity remains at its peak 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 during bowel movements or urination, pain in the chest or shoulders, pain along the path of the sciatic nerves.

Endometriosis can also lead to infertility. This infertility, combined with the above-mentioned painful symptoms, justifies the search for endometriosis.

Dysmenorrhea
Dyspareunias
Digestive symptoms
Urinary symptoms
Other catamenial symptoms
Intermenstrual pain
Infertility

Dysmenorrhea

Dysmenorrhea: or painful periods

In the majority of cases, dysmenorrhea is chronologically the first painful symptom, often appearing with the first menstrual period. They can lead to absenteeism from school or work, and are characterized by :

  • Dull pains in the hypogastrium, in the iliac fossae, but also in the flanks or lower back.
  • The frequent (partial or total) analgesic efficacy of anti-inflammatory drugs, suggestive of the inflammatory mechanism of pain.
  • Improvement (or even disappearance) with contraceptive pills
  • Frequent association with menorrhagia (heavy periods)

Dyspareunias

Deep dyspareunia or pain during intercourse

These are ballistic dyspareunias, triggered by deep penetration, generally in the posterior cul de sac. This symptom can have a negative impact on the couple's sexuality, and reduce the chances of spontaneous conception.

They may be due to deep retrocervical endometriosis, uterosacral ligaments or vaginal cul de sacs, but also to superficial endometriosis of the cul de sac of Douglas, as well as adenomyosis.

Digestive symptoms

Digestive symptoms associated with menstruation are varied and non-specific:

Pain during defecation and distension of the rectum, sometimes increased during menstruation. Catamenial diarrhoea, or conversely severe catamenial constipation, exacerbated abdominal meteorism - all these signs may suggest endometriosis, without being specific.

Their presence justifies the search for digestive localizations of endometriosis, notably in the rectum or sigmoid colon, which together account for 2/3 of digestive disorders.

Nevertheless, digestive symptoms may simply be due to an irritative effect of superficial or deep endometriosis lesions on the digestive tract or on the nerves responsible for its contractile activity.

More rarely, and in advanced forms, acute intestinal obstruction can be a sign of severe endometriosis, requiring emergency surgery.

digestive surgery

Urinary symptoms

Catamenial cystalgia, daytime and nocturnal pollakiuria, and the impression of regularly having a urinary infection (but without a proven infection on bacteriological examination of the urine) during menstruation justify the search for deep endometriosis of the bladder.
However, like digestive symptoms, these urinary symptoms may be linked to an irritative effect of the endometriosis lesions.
Deep endometriosis nodules may infiltrate or even envelop the ureters. This can result in episodes of back pain, but most often these lesions remain asymptomatic for a long time. They may lead to stenosis of the ureter, or even ureteral and pyelocalic dilatation upstream, complicated in extreme cases by low-noise renal atrophy and complete destruction of the kidney.

urological surgery

Other catamenial symptoms

Any painful or embarrassing symptom occurring cyclically at the same time as menstruation may suggest endometriosis:

  • Scapular or basi-thoracic pain (usually right-sided) may be the expression of endometriosis lesions of the diaphragm
  • Pain in the buttocks, perineum or sciatica may be due to compression of the sacral roots by deep endometriosis.
  • Catamenial dysuria (difficulty in urinating, sensation of incomplete micturition) may result from the impact of deep vaginal endometriosis lesions on the splanchnic motor nerves of the bladder.
  • Episodes of catamenial pneumothorax justify a search for diaphragmatic, pleural or lung parenchymal endometriosis

Intermenstrual pain

These pains occur between menstrual periods and can lead to a chronic, daily pain base, resistant to the usual analgesic drugs. They are often associated with advanced endometriosis and intra-abdominal adhesions, but also with associated neuropathic mechanisms that make management more complex, with treatments often less effective.

chronic pain care

Infertility

Endometriosis is a risk factor for infertilityEndometriosis is a risk factor for infertility, and is found in a third of women consulting for couple infertility lasting more than a year.

The mechanisms causing infertility in endometriosis, isolated or associated, are as follows:

  • Intra-peritoneal and intra-tubal inflammation may have a detrimental effect on egg-sperm interaction
  • Intratubal or tubo-ovarian obstruction preventing gametes from meeting
  • Dyspareunia and asthenia secondary to chronic pain can considerably reduce the number of sexual encounters, thereby limiting fertility.
  • Impaired ovarian reserve due to endometriomas, which destroy the ovarian parenchyma, and whose surgical removal can aggravate pre-existing ovarian insufficiency.
  • Adenomyosis, a factor in embryo implantation failure.
infertility care

In extreme cases, endometriosis lesions can lead to dreadful complications, such as complete destruction of the kidneys, intestinal obstructions, pneumothorax or loss of voluntary bladder control.

Bibliography: Roman H, et al. Hum Reprod. 2012 Dec;27(12):3440-9

The symptoms
of endometriosis
in figures

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

Endometriosis

What is endometriosis?

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Types of endometriosis

What types of endometriosis lesions are there?

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Diagnosis

How is endometriosis diagnosed? 

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Treatments

How is endometriosis treated? 

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Last updated on Feb 2, 2021 @ 17:25