by Endometriosis can cause severe, disabling pain and lead to infertility. Understand what the main signs are.
Presenting very intense menstrual colic, having an abundant flow of menstruation and feeling pain in sexual intercourse with penetration are some of the main symptoms of endometriosis. Although they seem common, these signs are indicators that something is not right with menstruation and sexual and reproductive health.
Endometriosis is a disease characterized by the presence of endometrial tissue, which lines the inner cavity of the uterus, in the region of the pelvis and abdomen. A disease affects one in 10 women in Brazilaccording to the Ministry of Health, and about 180 million women worldwide, according to the World Health Organization (WHO).
But, after all, how to identify the first signs of endometriosis and when to seek a doctor to investigate and treat the problem? “The presence of one or more of these symptoms justifies going to the doctor to identify whether endometriosis exists or not”, says Alexandre Pupo, gynecologist and obstetrician, physician on the clinical staff of Hospital Sírio-Libanês. See below, what are the symptoms of endometriosis:
Menstrual cramps are one of the main symptoms of an endometriosis crisis. Although pain in the lower abdomen is common during menstruation, intense, long-lasting and sometimes disabling pain is not normal and can be an indicator of endometriosis.
Read more: 5 problems that can be confused with endometriosis
“It’s a cramp that starts before menstruation, one or two days before, and lasts throughout the menstrual flow”, explains Alexandre. With the evolution of the disease, menstrual cramps can intensify more and more and also cause back pain, especially in the lumbar region.
In addition to menstrual cramps, one of the most common symptoms of endometriosis is pain during penetrative sexual intercourse, also called deep dyspareunia. “It is a pain as if the penis were hitting the bottom of the vagina, in a place that causes pain and often requires the woman to change position or interrupt the sexual act because of the pain”, details the gynecologist.
In addition to pain, in some women it is possible to experience bleeding during intercourse due to the chronic inflammation caused by endometriosis. Pain is most common around the menstrual period, but it can happen at other times of the cycle.
Endometriosis can also cause infertility. “If a couple is trying to get pregnant, maintains a sexual frequency of at least three times a week, over a year, and is unable to get pregnant, this condition is called infertility and the cause may be endometriosis”, says Alexandre.
This can happen because endometriosis can cause anatomical changes that prevent the fallopian tubes from functioning properly. In addition, the presence of inflammatory endometrial cells in other regions outside the uterine cavity can affect egg quality and sperm function, making fertilization difficult. According to the Brazilian Society of Endometriosis, more than 30% of cases of the disease lead to infertility.
Know more: Can people with endometriosis get pregnant?
Intestinal changes, such as increased frequency of defecation, diarrhea and pain to defecate, are some of the bowel endometriosis symptoms. “These are cyclic changes, which happen during menstruation”, clarifies the gynecologist. “During the menstrual period, the patient has a looser bowel and, sometimes, diarrhea”, he adds.
In addition, the presence of bleeding and changes in the texture and size of the stools may also occur. “If the endometriosis is compressing the intestine and reducing the lumen, the stools can become thinner”, adds Alexandre.
Endometriosis can also reach the bladder and, with that, cause some physiological changes, such as the frequent urge to urinate and the presence of blood in the urine. “These unique symptoms in the menstrual period are also indicative of endometriosis”, says the gynecologist.
In addition, symptoms of bladder endometriosis may include discomfort when urinating, the presence of pus in the urine, urgent urination, pain in the kidneys and pelvic area that worsen during menstruation, fatigue and tiredness; there may or may not be a fever.
A The belly of those with endometriosis can also become more swollen, with a feeling of “fullness”, especially during menstruation. “Associated with the other previous symptoms, the patient may have what we call dysquesia, which is swelling, malaise, swelling and abdominal pain. If this happens cyclically, that is, always during the menstrual period, it may be associated with endometriosis”, explains Alexandra.
This is also a common symptom in those who have intestinal endometriosis and may be related to the other gastrointestinal symptoms mentioned above, such as the frequent desire to have a bowel movement and diarrhea.
The presence of bleeding in the stool and urine during the menstrual period can also be symptom of deep endometriosis. In this type of disease, endometrial tissue that has grown outside the uterine cavity is infiltrated deeper into the affected organ – at least five centimeters deep.
“Deep endometriosis can affect the bowel, bladder, ovary itself and the posterior portion of the uterus, in addition to the uterine ligaments”, explains Alexandre. “Usually, this is noticed by a change in the functioning of the intestine and the functioning of the bladder”, he adds.
In deep endometriosis, the typical pain of the disease, which begins during the menstrual period, can become chronic pain over time. “It is a continuous pain in the pelvic region that, during menstruation, gets much worse. It becomes more worrying when it is associated with bleeding in the stool or urine and when this pain is so great that it disables the woman from carrying out her daily activities, “she says.
Treatment for endometriosis varies according to the degree of the disease. In milder cases, it can be done with anti-inflammatory medications to relieve pain, or with combined oral contraceptives (estrogen and progesterone), which block menstruation and help reduce disease outbreaks.
In more significant cases, with more intense symptoms, treatment should be surgical. According to gynecologist Alexandre Pupo, the best options are laparoscopy and robotic surgery. “These are minimally invasive surgeries, in which it is possible to identify where the outbreaks of the disease are”, says the professional.
Read more: When is endometriosis surgery necessary?
As he explains, endometriosis appears as “little islands” of endometrial tissue in places close to the uterus. “If you remove 100% of all the disease found in the peritoneal cavity, that is, inside the abdomen, you have cured this endometriosis event,” he says.
However, it is important to emphasize that endometriosis still does not have a fully known cause in medicine and, therefore, it is not yet known what makes the patient more susceptible to having the disease. “Even after treatment for that endometriosis event, a woman is still subject to an increased risk of having endometriosis again. But that event, once removed in its entirety, is healed, ”she concludes.
