Seeing your GP is the first step towards obtaining a diagnosis of endometriosis. If your GP thinks you could have endometriosis he or she will refer you to a gynaecologist. If he or she will not give you a referral and you feel your symptoms warrant further investigation insist on a referral to a gynaecologist or find another GP.

The gynaecologist will take a history of your menstrual cycle and your symptoms. Things that should be discussed include when your periods began, when your symptoms began, the regularity of your cycle, and whether any other family members have had endometriosis.

Symptoms

The number, type and severity of symptoms experienced varies widely from woman to woman. Some women will have only one or two symptoms, some will have several, and a few will have many.

The most striking feature of endometriosis is the cyclical nature of the symptoms. In other words, the symptoms usually come and go or vary in intensity with the menstrual cycle. Thus, symptoms are usually felt or are worse during ovulation and/or around the time of the period, usually 2–3 days before the period and the first 2–3 days of the period.

Dysmenorrhea (period pain)

Dysmenorrhea is the most common symptom. It may manifest as an ‘aching’, ‘cramping’ or ‘throbbing’ sensation that can be felt anywhere in the pelvic area. The pain may radiate into the lower back, buttocks and thighs.

Dyspareunia (painful sexual intercourse)

Dyspareunia is a common but often unacknowledged symptom. It may be felt during intercourse and/or for up to 48 hours afterwards. It is often associated with endometriosis in the pouch of Douglas.

Pelvic Pain

Pelvic pain may be experienced constantly or intermittently and may or may not be related to the menstrual period. It may be provoked by certain activities such as sitting in a certain position or it may occur unpredictably.

Lower Back Pain

Lower back pain is another common but poorly recognised symptom that often accompanies period pain. It is commonly associated with endometriosis in the pouch of Douglas, uterosacral ligaments and rectovaginal septum.

Ovulation Pain

Ovulation pain is generally felt in only one ovary at a time. It usually begins 12–24 hours before ovulation and may last for up to five days. It results from the normal enlargement of the ovary during ovulation which causes stretching of endometrial implants and adhesions lying on the surface of the ovary. The pain is often described as ‘stabbing’ and it may radiate throughout the pelvic area and into the buttocks and thighs.

Bladder Symptoms

The most common bladder symptoms are pain in the bladder region, pain when urinating, frequent urination and blood in the urine. The symptoms are usually the result of endometriosis lying on the outside of the bladder or irritation from endometrial implants lying on the front of the uterus

Effects on Individuals

• Pain and tiredness caused by their endometriosis, especially around period time
• Effects of hormonal treatments that often cause depression, mood swings and irritability
• Unsuccessful treatments and ongoing pain
• Lack of support from partners, family, friends and work colleagues
• Grieving for the life they planned and the life they once led
• Their inability to have a child

Restricted Lifestyle

Pain and/or fatigue often limit what women with endometriosis can do, including -

• Restricting their leisure activities
• Limiting the time they can work or study
• Reducing the time they can spend with family and friends
• Stopping or restricting sexual activity
• Reducing their independence

Financial Difficulties

Endometriosis can lead to financial problems for many reasons, including -

• Having to take time off work
• Having to limit the hours worked and/or career choices
• Cost of treatment, especially surgery