“Endometriosis is a very tricky disease and is sometimes difficult to diagnose, as the possible variety of presentation symptoms is huge and often non specific,” explains Mr Denis Tsepov, MRCOG consultant gynaecologist, laparoscopic and robotic Surgeon, at The Harley Street Clinic BSGE Endometriosis Centre, Part of HCA Healthcare UK.
“The typical and most common symptoms of endometriosis include extremely painful and heavy periods, pelvic pain between periods, painful sex, constant fatigue, menstrual bloating.
“These symptoms are not necessarily 100 percent specific to endometriosis, but certainly are not normal and should trigger robust investigations if you present them to a doctor.
“We sometimes see less typical symptoms and signs of endometriosis, which can present either in combination with the above mentioned symptoms or in an isolated form.”
Pain during bowel motion (dyschezia)
“This could be a sign of deep infiltrating endometriosis of the bowel (where endometriotic deposits grow into the bowel muscular wall), which can present in combination with rectal bleeding and either bowel urgency or extremely slow bowel function and typically has strong link to the time of the cycle.
“This is a serious symptom and should be investigated in a specialist endometriosis referral centre. In severe cases endometriosis can gradually and “silently” obstruct the whole lumen of the bowel and this may present as an acute bowel obstruction situation requiring emergency surgery.”
Menstrual bladder pain, bleeding during passing urine and menstrual bladder dysfunction (frequency, urgency and incomplete bladder emptying)
“This could be signs of infiltrating urinary tract endometriosis and requires special investigations. Endometriosis compressing the ureters (tubes draining urine from kidneys to the bladder) can progress very slowly often without causing any pain symptoms and ultimately result in a kidney failure on the affected side.”
Menstrual shoulder pain
“This is a relatively rare symptom, which may indicate presence of deep infiltrating endometriosis on the diaphragm (a muscle separating chest and abdominal cavities).
“This is to do with irritation of a diaphragmatic nerve by infiltrating endometriosis deposit. This type of endometriosis is very rarely seen at MRI scan and is best diagnosed during laparoscopy and treated by excision if found.”
Menstrual chest pain
“This, plus coughing blood during periods can be caused by endometriosis affecting either the outer lining of the lungs (pleura) and the lung tissue but this is very rare indeed. Symptoms like this needs urgent investigation by the multidisciplinary endometriosis or cardio-thoracic team.”
Cyclical bleeding from the belly button (umbilicus) and belly button cyclical pain and swelling
“This is a symptom of umbilical endometriosis, which is a rare presentation of the disease outside pelvis. This requires detailed imaging, possibly a biopsy and typically requires surgical excision.”