James Liu, MD, professor and chair of the department of reproductive biology at Case Western Reserve University School of Medicine, recently outlined these potential signs of endometriosis in an editorial. Announced in a press release, the commentary was published in the consumer version of a recent issue of Merck Manual, a publication that provides medical information to a cross-section of users, including medical professionals and students.
The editorial was timed to coincide with Endometriosis Awareness Month, which takes every March. While the exact cause is unknown, the disorder affects roughly 200 million women globally, according to the Endometriosis Foundation of America.
The disease occurs when womb cells develop elsewhere in the body, often causing inflammation, bleeding, severe cramping, and sometimes scar tissue. It can also cause infertility, and is more common in women who have fertility issues, Liu said.
Pelvic pain associated with endometriosis is typically indistinguishable from other causes, including menstruation, urinary tract infections, pelvic inflammatory disease, and irritable bowel syndrome. And the disease is difficult to diagnose. Because of these factors, Liu wrote, the disease can go undiagnosed for years.
However, there are some telltale signs that point to endometriosis, according to Liu.
1. If pain is worse right before, during, and after menstruation
“Especially for women who develop endometriosis at a young age, it’s often assumed the pain is a result of their normal menstrual cycle,” Liu wrote. “In fact, endometriosis pain often overlaps with menstrual pain. Bleeding inside and outside the uterus occurs at the same time.”
However, pain often occurs before or after menstrual bleeding. While frequently caused by disorders unrelated to endometriosis, the disease can also result in pain during sexual intercourse, bowel movements, or urination, according to the editorial.
2. If antibiotics don’t help
At first, physicians often attribute symptoms to urinary tract infection or pelvic inflammatory disease. “They’ll prescribe antibiotics to clear up the infection, and may order a culture of the urine or culture,” Liu wrote. “If the test results come back negative and antibiotics do not help, women — and their physicians — should consider endometriosis as a potential cause of their pain.”
3. If a relative has endometriosis
Although there are no genetic tests for endometriosis, women who have family members with the disease are more likely to have it themselves. If a woman has a relative with endometriosis, she should reveal that to her physician during her first visit about symptoms, Liu said.
He also said a delayed diagnosis can pose significant consequences, including interferences with work or school due to repeated hospital visits. In addition, it can complicate family planning, and cause relationship problems for women erroneously told they have a sexually transmitted disease.
A discussion with a primary physician about pelvic pain, family history, and results of antibiotic treatment could lead to a referral to an obstetrician-gynecologist for a diagnostic laparoscopy.
Liu’s research interests include in vitro fertilization, menopause management, reproductive endocrinology and fertility, and gynecology.
Merck, a leading biopharmaceutical company, published its first manual in 1899 as a small reference book for physicians and pharmacists.