Symptoms of Endometriosis
What are the signs to look out for?
Endometriosis symptoms can sometimes improve by themselves, but they can also progress over time. The symptoms are variable and range from mild to severe and can be constant or intermittent in nature. Pain symptoms tend to be worse prior to and during menstruation, and they can also appear around ovulation and sexual intercourse.
The pain often starts in the lead up to menstruation, (around 2-5 days before). Although some people, especially those with severe Endometriosis, can experience pain and symptoms outside of menstruation or even continuously (on-going pain).
People with Endometriosis may also experience pain, discomfort, and sometimes bleeding during pelvic exams or any other type of physical exam involving a doctor manually investigating their pelvis.
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These exams can be uncomfortable, even without Endometriosis, but it is important to remember that you are in charge. Any exam should be discussed with you beforehand and explained how it is helpful and if you experience pain during the examination and would like for it to stop, then just say so and it will be stopped right away.
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What can I do to help?
Keeping a symptom diary can not only help you think about your symptoms and how often they occur, but it can also help towards getting the care and support you need and help make a diagnosis.
It can also be useful when having conversations with health care professionals about your treatment choices and what treatments help you, as well as supporting you through your treatment plans.
Occasionally a symptom diary will help you understand other symptoms that you had not previously considered could be related to possible Endometriosis or other changes throughout your menstrual cycle.
It can be useful to record not only the symptoms you experience, but also the impact they have on your day to day life and how they made you feel at the time. It is often these knock-on effects that are harder to recall after they have happened but are incredibly helpful in understanding the impact of the condition and assessing changes after treatments are started.
Some people may experience one or two symptoms, whereas others may experience a combination of them.
Endometriosis pain is variable and different people will experience very different symptoms, which do not always correlate with the degree of anatomical changes the Endometriosis has caused or the stage of disease.
It is not simply the case that more ‘severe’ Endometriosis causes more severe pain.
The following symptoms are often associated with Endometriosis (the list is not exhaustive) and includes:
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Pain in your lower tummy (pelvic pain)
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This pain is usually felt in the lower abdomen and lower back, but it can also radiate to the rectum, hips and legs. The intensity of this discomfort can reach such levels that even small tasks like sitting and walking can become challenging, particularly during your period.
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Period pain that stops you doing your normal activities
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This pain can vary in its intensity, some individuals may find themselves bedridden, unable to attend school or work, impacting their daily lives, whilst others may find it improves or becomes manageable after taking pain relief and they are able to continue with normal activities. Even if this is the case, pain is not a ‘normal’ symptom, and it should not be suffered in silence.
Additionally, there is a chance of experiencing abdominal pain, which can manifest as cramping, a burning sensation, or a varying intensity of a dull ache.
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Painful bloating
Water retention and bloating are typical of sensitivity to changes in hormones during the menstrual cycle.
However, for individuals with Endometriosis, and those experiencing bowel Endometriosis, this sensitivity to hormone changes can result in more pronounced abdominal distention beyond the typical ‘bloat’ experienced by others.
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This type of swelling can be triggered by various factors, including menstruation, physical activities like carrying out exercise, sexual intercourse, or even dietary choices.
This abdominal swelling can lead to discomfort and pain, lasting anywhere from a few hours to several days. In some cases, it may also be caused by the presence of a large cyst.
This bloating can also be due to fluid build-up in the second half of the menstrual cycle, but it is also largely contributed to by swelling of the bowel and gas.
Identifying dietary changes that either help or trigger this can be difficult, but through trial and error and with the help of a dietitian it can be made easier.
Pain during or after sex
This pain may vary in intensity, ranging from sharp to dull and may even be accompanied by bleeding in some cases. For some people this pain can also be triggered by orgasm, causing deep pain for several hours afterwards. The intensity of the pain can also be affected by the position you may be in during sexual activity.
It is usually a deep internal pain, although other unpleasant sensations such as involuntary muscle spasms in the vagina (vaginismus) can also be triggered by Endometriosis, leading to pain in the lower vagina or vulva even, during light touch and inserting a finger or tampon, for example.
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Fatigue (extreme tiredness)
Lethargy, lack of energy, exhaustion, and the general feeling of being ‘run-down’.
Pain when passing urine or stools
Painful bladder and bowel movements may suggest signs of Endometriosis. In some cases, individuals may feel a heightened urgency or increased frequency to pass urine, along with experiencing pain in the lower back and kidney area, which can often resemble UTI-like symptoms. Changes in bowel habits may also include difficulties in passing stools. In rarer instances, the presence of blood in urine or stools may suggest signs of Endometriosis.
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Fertility problems
Endometriosis can lead to difficulties conceiving.
Other common symptoms may include gastrointestinal symptoms such as nausea and vomiting, constipation or diarrhoea, acid reflux, dizziness, headaches and migraines.
Feelings of isolation, heightened anxiety and depression are often felt by people with Endometriosis.
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You may also experience heavy or pro-longed menstrual bleeding. This may be due to a condition called Adenomyosis.
Similarly to Endometriosis, although common, Adenomyosis is also under-diagnosed and often misunderstood.
Adenomyosis happens when endometrial-like tissue grows inside the muscle wall of the uterus (myometrium), causing the uterus to thicken and increase in size.
Over time as the condition progresses, it can cause the uterus to grow larger than a healthy uterus, causing severe menstrual pain, fatigue, heavy menstrual bleeding, fertility problems, and pain associated with menstruation, sex, and bladder and bowel movements.
It is not uncommon for people to have both Adenomyosis and Endometriosis.
Endometriosis is a long-term condition which can have a big impact on your life, affecting both your mental and physical health.
If you are experiencing pain that is stopping you from carrying out your usual day-to-day activities, if you have noticed changes around your menstrual cycle or if you’re feeling low in mood or anxious, it is important to tell your doctor as early as possible.
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