gynecology and obstetrics
Endometriosis
Symptoms and Signs of Endometriosis
The classic triad of symptoms is dysmenorrhea, dyspareunia, and infertility. Cyclic midline pelvic pain, specifically pain preceding or during menses ( Dysmenorrhea ) and during sexual intercourse ( Some women with extensive endometriosis are asymptomatic; some with minimal disease have incapacitating pain. Dysmenorrhea is an important diagnostic clue, particularly if it begins after several years of relatively pain-free menses. Symptoms often lessen or resolve during pregnancy. Endometriosis tends to become inactive after menopause becauseestrogenandprogesteronelevels decrease. Symptoms can vary depending on location of implants. Ovaries: Formation of an endometrioma (a 2- to 10-cm cystic mass localized to an ovary), which occasionally ruptures or leaks, causing acute abdominal pain and peritoneal signs Adnexal structures: Formation of adnexal adhesions, resulting in a pelvic mass or pain Bladder: Dysuria, hematuria, suprapubic or pelvic pain (particularly during urination), urinary frequency, urge incontinence, or a combination Large intestine: Pain during defecation, abdominal bloating, diarrhea or constipation, or rectal bleeding during menses Extrapelvic structures: Vague abdominal pain (sometimes) Pelvic examination may be normal, or findings may include a retroverted and fixed uterus, enlarged or tender ovaries, fixed ovarian masses, thickened rectovaginal septum, induration of the cul-de-sac, nodules on the uterosacral ligament, and/or adnexal masses. Rarely, lesions can be seen on the vulva or cervix or in the vagina, umbilicus, or surgical scars. 