Of all the symptoms associated with endometriosis, basically, pelvic pain is the one that predominates:
Painful menstruation (Dysmenorrhoea). This is the most important and common place symptom to appear during the period or even in the days before and/or after.
Pain during sexual intercourse (Dyspareunia).
Periovulatory pain. Pelvic pain related to ovulation.
Chronic pelvic pain. Pain predominantly in the lower abdomen but without any relation to the menstrual cycle.
Dyschezia. Pain when defecating, possibly accompanied by changes in bowel movement frequency, in the form of either diarrhoea or constipation.
Pain when urinating (Dysuria).
Menstrual haematuria or rectal bleeding. The appearance of blood in the faeces or urine in association with the menstrual period.
Chest pain, pain due to nerve root compromise (sciatica, etc.).
In cases where the patient presents adenomyosis, the pain may also be associated with the presence of heavy menstrual bleeding.
Reproductive problems, such as sterility (inability to conceive) or infertility (abortions), also tend to be commonplace.
Therefore, the individual set of symptoms presented by each patient with endometriosis can have a significant impact on their quality of life.
Signs of endometriosis
There is a poor correlation between the clinical forms of presentation and the typical signs and symptoms experienced by the patient. In other words, the intensity of pain felt by a given patient does not correspond with the extent and stage of their endometriosis. With the exception of asymptomatic patients, the most common patient profile is one who presents the different forms of pelvic pain (dysmenorrhoea, periovulatory pain, dyspareunia, chronic pain, etc.) from practically their first menstruation (menarche), often requiring treatment with additional painkillers.
Some patients present a history of vagal reactions with a loss of consciousness associated with pain, and a history of time off work and school during their menstrual period.
Even though the gynaecological examination may be normal, the most frequent physical signs are related to the observation and/or palpation of the endometrial lymph nodes behind the cervix, the uterosacral ligaments, the walls of the vagina and the rectum.