Endometriosis is the most common cause of chronic pelvic pain in women. It occurs when endometrial tissue grows in sites other than the uterine lining. Common sites include the ovary and peritoneum behind the uterus. Women presenting with symptoms of pelvic pain that is cyclic in nature, worsening pain with periods, infertility and pain with intercourse should be evaluated for this condition.
Initially, a woman may experience painful cramps with her period. Gradually this becomes severe and then starts to occur 1-2 days before the period. Eventually this time frame may extend to 1-2 weeks before the period. Many women report only being pain free the week after their period. The pain can range from mild to severe. For some this pain can be quite debilitating.
The daily pain is usually worse with the onset of the period. It is typically described as a lower abdominal cramping. Some women complain of back pain as well. The pain can radiate into the thighs. The pain outside of the period can be intermittent and sharp or constant. Other symptoms may include pain with intercourse during deep thrusting as well as urinary and bowel complaints. Some women may experience the pain for years before a diagnosis is made.
There are other causes of pelvic pain that may present in a similar fashion. Chronic interstitial cystitis may present with pain that is worse with the period. Some women even suffer from both conditions. Women can also experience pain with intercourse that maybe due to pelvic adhesions or a pelvic mass. Irritable bowel syndrome is another cause of pelvic pain that maybe confused with endometriosis.
There are some women who have endometriosis but do not experience pain. They may present with infertility and endometriosis is found during the evaluation process. It may also be an incidental finding at the time of surgery for some other issue such as a tubal ligation. Sometimes a pelvic mass is noted on routine examination that is later found to be an endometrioma.
Treatment can be initiated based on symptoms. It is important however to evaluate for other potential causes of pain. A pelvic examination, cultures and ultrasound can detect other causes of pain. A definitive diagnosis of endometriosis can only be made from looking in the pelvis. A laparoscopy is the most common route. Endometriosis has a typical appearance but sometimes the appearance may not be classic. A biopsy is often recommended which is taken for histopathological evaluation to confirm the diagnosis. Once a diagnosis is made then appropriate treatment can be initiated.
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