Patient's question:
Lately, when I have my period, my stomach has been very painful. Before, I didn't have menstrual cramps at all. My period is also irregular, and I've been married and want to have children, but I can't get pregnant easily. Intercourse wasn't very comfortable at first, either. Is this endometriosis infertility?Doctor's answer:
Endometriosis is typically characterized by symptoms such as lower abdominal pain, menstrual irregularities, dysmenorrhea, discomfort during sexual intercourse, infertility, and others.1. Bladder symptoms: Common in cases where endometriosis has spread to the bladder, it may cause cyclic urinary frequency and dysuria. When the bladder mucosa is affected, periodic hematuria may occur.
2. Menorrhagia: In intrinsic endometriosis, menstrual flow often increases, and the menstrual period may extend. This may be due to an increase in endometrial tissue, but it is often accompanied by ovarian dysfunction.
3. Pain during sexual intercourse: Occurs in cases of endometriosis in the uterosacral cul-de-sac or vaginal rectal septum, where surrounding tissue swelling affects sexual activity. Sensitivity discomfort before menstruation may worsen.
4. Infertility: Primary infertility due to endometriosis accounts for 41.5–43.3%, while secondary infertility accounts for 46.6–47.3%.
5. Rectal fullness: A typical symptom of endometriosis in the uterosacral cul-de-sac and around the rectum is: during the premenstrual period or after menstruation, patients experience severe pain when feces pass through the rectum, but no such sensation occurs at other times. Additionally, if the ectopic endometrium reaches the rectal mucosa, rectal bleeding may occur during menstruation. When the endometriotic lesion encircles the rectum in a narrow manner, it may cause tenesmus and obstruction symptoms, similar to a tumor.
6. Dysmenorrhea: A common and prominent symptom, usually secondary, meaning that patients report no pain during previous menstrual cycles but begin to experience dysmenorrhea from a certain period onward. It may occur before, during, or after menstruation. Some cases involve severe pain that requires bed rest or medication for relief. The pain often intensifies with the menstrual cycle. Due to continuously rising estrogen levels, the ectopic endometrium proliferates and swells. If further influenced by progesterone, it may bleed, stimulating local tissues and causing pain.