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Endo-what?! to understanding Endometriosis and its symptoms

What is Endometriosis?

En-Doh-Mee-tree-oh-sis. Repeat after me, as it deserves to be known. It is a largely unknown female disease that affects about 176 million women worldwide. Endometriosis occurs when endometrial-like tissue is found outside of the uterus. This tissue, which normally lines the uterus, is associated with monthly menstruation and is often characterized by abnormal painful and heavy periods, as well as pelvic pain, severe cramps, and pain with sex (dyspareunia).

The backstory …

Even though Endometriosis has been shrugged off as period pain for many years, it has a serious economic impact in addition to health impacts. Endometriosis costs the UK economy alone £8.2bn a year in treatment, loss of work and healthcare costs.

An even lesser known fact is that Endometriosis affects just as many women as diabetes does. The awareness and funding story for Diabetes however takes an entirely different trajectory! To put things into perspective, that’s about $10 in funding per person with endometriosis and $200 per person with diabetes, a disease considered to have a similar quality of life impact and to affect about the same number of women. It’s not all doom and gloom. Things are changing with increasing awareness of Endometriosis.

What are the 6 Cardinal Symptoms of Endometriosis?


Dysmenorrhea aka painful periods

Cramping usually points to a uterine source while pain and aches point to the peritoneum and ligaments. Endometriosis pain does not disappear in one day. The duration of pain associated with endometriosis usually continues more than two days and can even persist after the period is over.

Pain from endometriosis characteristically does not respond well to analgesics and birth control pills. More than three out of four women with endometriosis have a history of incredibly painful, crampy periods that can be traced back to their adolescence.

The event of ovulation (on or around day 14 of the reproductive cycle) is often very painful in patients with endometriosis. Association and overlapping with other symptoms, like bowel movements frequency, gas around and during periods, constipation, diarrhoea, and painful bowel movements, are all part of the symptom chain of endometriosis.

Therefore, the nature, duration, radiation of painful periods and its association with other symptoms are important in making clinical decisions in ruling out other pelvic disorders.

Gastro-intestinal abnormalities aka gassiness, bloating

The second cardinal symptom of endometriosis is the gastrointestinal triad of bloatedness, gassiness, and cramps associated with or without diarrhoea, and constipation, which is more pronounced around menstruation.

Painful sex (dyspareunia)

is another sign of endometriosis. During sexual intercourse, an area of tissue will be irritated and cause pain due to the build-up of endometriosis scar tissue. Painful sex is at times positional and usually involves deep involvement of endometriosis in the rectovaginal septum and pelvic walls. This symptom often leads to intimacy issues, as intercourse starts to become unpleasurable for a woman. If your partner suffers from endometriosis and is experiencing dyspareunia, it is important to find alternative positions and listen to her needs.

Painful bowel movements

The fourth symptom may point to the rectovaginal septum and pelvic lateral walls. Endometriosis patients are often misdiagnosed as having IBS when their symptoms are being caused by endometriosis as IBS tends to be accompanied by constipation and abdominal pain.

Neuropathy aka Nerve related stuff

The nerves may be directly involved or stimulated mostly by surrounding pathology due to swelling and scarring that changes the retroperitoneum (space in the abdomen behind the peritoneum) as well as direct involvement of the nerves. Symptoms naturally differ —from changes of sensory feelings to pain that radiates to the back, lumbosacral area, inner thigh or along the track of sciatica nerve — according to the varying location of the lesions. Some of these patients find that they cannot comfortably cross their legs and even their walking and gait are affected. In cases of endometriosis, these nerve signals can be damaged leading to nerve pain that causes such symptoms as radiating pain to the leg, back, and inner thigh.


The most frequent yet most elusive symptom of endometriosis is infertility, defined as both the difficulty to conceive and difficulty in carrying a pregnancy to term. About a third of infertility is caused due to endometriosis. Complex immunobiological factors both at the cellular and antibody levels are involved. Inflammatory toxins that arise because of endometrioma scar tissue do not allow the sperm and egg to mate naturally. Endometriosis visibly causes tubal dysmorphism and ovarian pathology that serve as barriers to a successful pregnancy. Unable to get pregnant, many patients are unnecessarily treated with in-vitro fertilization treatments without their endometriosis ever being addressed.

Please do remember that:

  • Endometriosis is not an infection

  • Endometriosis is not contagious

  • Endometriosis is not cancer

If you have any questions, let us know!