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Endometriosis: Symptoms
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The historical evolution of endometriosis is not known, but the disease was first defined in 1920, and there were around 20 reports about it in the worldwide literature in 1921. Examination of the earlier medical literature has suggested to some that the disorder had been found, even though not specifically identified, during the 19th century. It has taken some time for endometriosis to gain recognition among the majority of medical practitioners. During the 1980s, women who had endometriosis symptoms in their teens experienced a delay of more than 8 years in receiving a diagnosis of endometriosis and often had to visit several doctors before gaining a diagnosis. The situation has improved during the past 20 years, though there is often still a delay of a year or more between reports of symptoms and confirming the diagnosis, perhaps in an effort to avoid unnecessary laparoscopic examinations at a time when surgical or hormonal treatments might be put off for a time anyway. Also, some women do not seek diagnosis and treatment for dysmenorrhea until they are older and it has been found to persist or worsen.
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Manipulation of the endogenous hormonal milieu is the basis for the medical management of endometriosis. The treatment of endometriosis with combination of estrogens and progestagens was originally used to induce "pseudopregnancy" with resultant amenorrhea due to decidualisation of endometrial tissue (Kistner, 1959). The modern equivalent is the continuous use of the combined oral contraceptive pill. Any low-dose combination oral contraceptive pill containing 30-35 mg of ethinyl oestradiol used continuously (to achieve amenorrhea) can be effective in the management of endometriosis (Moghissi, 1999). Symptomatic relief of dysmenorrhea and pelvic pain is reported in 60-95% of patients. Following a first-year recurrence rate of 17-18%, a 5-10% annual recurrence rate has been observed.
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Endometriosis is diagnosed by a person's symptoms and what a doctor finds on the physical exam. The confirmation of endometriosis is made during surgery, though, to actually see the deposits of the endometrium outside the uterus. This is often done laparoscopically - with a camera, not with a full open surgery.
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Symptoms of endometriosis, such as pain in the lower abdomen, crampy pelvic pain, and pain during intercourse, are unpredictable [Table 2]. Symptoms of endometriosis differ among women, and can ... change over the course of the disease. As many as 30% of women with endometriosis never have any symptoms. However, three types of pain have been described. The first is lower abdominal and deep pelvic pain that continues throughout menstruation. This crampy pain usually starts about two days before the menstrual flow and lasts for several days afterward.
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Endometriosis symptoms are often most severe just before and during the menstrual cycle and get better as the menstrual period is ending. But for some women, pain is ongoing and does not improve during the menstrual cycle.3 Ongoing pain is especially common in teens with endometriosis.
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Even if a girl's symptoms point to endometriosis, a doctor may not want to perform a laparoscopy right away. He or she may first order scanning tests that can create images of the pelvic region, such as ultrasound or magnetic resonance imaging (MRI). This helps to rule out other possible causes of the symptoms. Doctors may ... start by telling a girl to take acetaminophen or ibuprofen. Some doctors will prescribe birth control pills, not as a method of contraception but because they have been proven to reduce painful periods, especially those associated with endometriosis.
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