7 Subtle Signs Of Endometriosis Doctors Want You To Know About

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By Natalia Lusinski | Originally Published Oct 25, 2018 on Bustle | Featuring Dr. Sherry Ross

Endometriosis is a painful disorder that you may hear about, but not know much about. It occurs when tissue that lines the uterus grows outside of the uterus. Though certain symptoms, such as extremely painful menstrual cramps, can be common signs of endometriosis, there are also more subtle signs of endometriosis that a woman may experience. Sometimes, you may think a symptom you’re having, such as painful periods, may be no big deal, but it’s important to get it checked out and see what’s behind the symptom.

Lena Dunham had a a total hysterectomy earlier this year to end the chronic pain she had as a result of endometriosis. And Dunham’s not alone — more than 11 percent of American women between the ages of 15 and 44 are affected by endometriosis, although it is most common among women in their 30s and 40s. Among women with it, it can also impact their fertility, so it is important to see a doctor if you experience any symptoms of endometriosis.

“‘Endometrial implants,’ as they are referred to, can be found on the ovaries, fallopian tubes, bowels, bladder, and anywhere else in the pelvis,” Dr. Sherry A. Ross, women’s health expert and author of she-ology. The Definitive Guide to Women’s Intimate Health. Period., tells Bustle. “The onset of symptoms related to endometriosis varies person to person, and symptoms happen as a result of your menstrual cycles.” She says that, with each period, the endometrial implants will bleed — no matter where they are located in your body — and the most common symptom is severe menstrual cramps.

Dr. Ross says that the most common symptoms of endometriosis are related to pain, which can be chronic and disruptive. However, she says that it’s important to pay attention to lesser-known symptoms of endometriosis, too. Below, she and other experts weigh in.

1. You Have Pain During Sex

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Although pain during sex may have various causes, it is also a symptom of endometriosis. “Some women with endometriosis may experience pain with sex, depending on where the endometrial implants are located in the pelvis,” Dr. Ross says. “If the implants are on nerves, ligaments, and tissue stretched during sex, pain can be significant and often unbearable; it can last hours and days afterwards.” She adds that, sometimes, women will not be able to have sexual penetration at all because the pain is so bad.

Dr. Michael Krychman, MD, OB/GYN, sexual medicine gynecologist and the executive director of the Southern California Center for Sexual Health and Survivorship Medicine and co-author of The Sexual Spark: 20 Essential Exercises to Reignite the Passion, agrees.

“If you’re having pain with sex — especially with deep penetration — and you shy away from doggie style, rear entry, or missionary because they are always uncomfortable, take note,” he tells Bustle. “It may not be that you dislike the positions or are not stimulated by them, but deep penetration may cause pain that can, in reality, be endometriosis.”

2. You Have Pelvic Pain

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Pelvic pain is generally one of the first signs of endometriosis, Dr. Kecia Gaither, MD, a double board-certified physician in OB/GYN and Maternal Fetal Medicine, tells Bustle. “These pains are generally exacerbated with menstruation, and may be secondary to endometrial implants on the ovary,” she says. She adds that if you have an endometrioma — a “chocolate cyst” on your ovary — it’s called this because the blood within the cyst is dark brown. “As a result, you may think it’s just ovulatory pain,” Dr. Gaither says. However, the pain could actually be a sign of endometriosis.

Dr. Ross agrees. “As a result of the bleeding implant(s), scar tissue — or ‘spider webs,’ as I like to refer to them — develops in your pelvis, causing pain and all the other symptoms related to endometriosis,” she says. “So, ongoing pelvic pain can be a result of endometrial implants spread throughout the pelvis.”

3. You Have Pain From Ovarian Cysts

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An ovarian cyst caused by endometriosis, an endometrioma, is an estrogen-dependent, blood-filled cyst, Dr. Ross says. “When they rupture, the pain from blood spilled into the pelvis is typically more painful than the clear cystic fluid leaked from a ruptured ovarian cyst,” she says. “Endometrioma can rupture and cause infertility.”

4. You Have Pain With Urination And/Or Bowel Movements

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“Because endometrial implants can develop on certain areas of the bladder or bowel, they can produce scarring and inflammation throughout the pelvis, bladder, and bowels on nerves and ligaments,” Dr. Ross says. “As a result, you may experience pain with urination or during a bowel movement.”

Similarly, Dr. Krychman says that people sometimes mistake pain with defecation for other conditions, but that it’s a subtle symptom on endometriosis. “It’s often thought of as constipation or upset stomach pains, but can actually mean endometrial implants on the colon,” he says. “If the pain is constant or cyclical, it is best to get evaluated.”

5. You Have Pain In The Legs And/Or Butt

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If you’re having pain in your legs and butt and don’t know the cause, it could be a subtle sign of endometriosis. “Endometriosis-associated pain in the legs and/or buttocks is due to endometriosis implanting along the pelvic nerves,” Dr. Gaither says. “You may think it’s just leg cramps, but this may not be the case.”

6. You Have Pain In The Lower Back And/Or Chest Pain

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Lower back pain can also be a sign of endometriosis, Dr. Ross says, as can chest pains. “Less commonly, endometrial implants can appear in the chest cavity,” she says. “These implants can appear on ligaments and nerves, which can lead to chest pain — especially around your period.” She adds that coughing up blood is another symptom — yet a very rare one — caused by endometrial implants in the chest area.

7. You’re Having Trouble Becoming Pregnant

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If you’re having trouble becoming pregnant, it may be due to endometriosis. However, your doctor must evaluate you to determine what the cause is. “Endometrial implants can cause scarring along the ovaries/fallopian tubes, causing issues with ovulation interference,” Dr. Gaither says.

Dr. Ross agrees. “Endometriosis can cause scar tissue on the fallopian tubes,” she says. “This scar tissue can cause infertility by blocking the ability of the egg and sperm to fertilize naturally.”

As you can see, it’s imperative to be aware of any subtle — or not-so-subtle — signs of endometriosis you may be experiencing. “Endometriosis is important to be aware of since it is a progressive disease,” Dr. Ross says. “Forty percent of women with infertility have endometriosis, and it’s impossible to know the extent of endometriosis unless a laparoscopy is preformed to visualize scar tissue or endometrial implants.”

That said, make sure you speak to your doctor about any unusual symptoms you’re experiencing — so they can determine if it’s endometriosis.

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