Some women with severe endometriosis have no symptoms, whereas some with minimal disease have incapacitating pain. Often, a woman doesn't have menstrual pain from endometriosis until she's had the disease for several years. Some women experience pain during sexual intercourse (dyspareunia) before or during menstruation.
Endometrial tissue attached to the large intestine or bladder may cause abdominal swelling, pain during bowel movements, rectal bleeding during menstruation, or lower abdominal pain during urination. Endometrial tissue attached to an ovary or a nearby structure can form a blood-filled mass (endometrioma). Occasionally, an endometrioma ruptures or leaks, causing sudden, sharp abdominal pain.
Common symptoms of endometriosis include cyclical pain, dysmenorrhea, and infertility. Sharp stabbing pain comes and goes. Pelvic aching or burning sensations may not be limited to the time of menstruation. There may be pain at ovulation. There may be frequent or constant pain over the site of an endometrial lesion, yet there may be referred pain in distant sites, especially between the neck and shoulders. Pain that is relieved by ordinary treatment is a significant symptom of endometriosis. If you experience frequent back pain, nausea before every period, or pain with deep intercourse, a bowel movement, or urination, it is wise to get a diagnosis.
The pain associated with endometriosis may also interfere with sleep or cause depression or fatigue. Digestive symptoms include a swollen abdomen or intestinal gas. In more advanced cases, inflammation may lead to pinched nerve pain.
A pelvic examination may reveal tender nodules, or the ovaries may feel tender and enlarged. Diagnosis is usually confirmed by ultrasound or laparoscopy.
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