Endometriosis: Symptoms and Concerns for Women

Endometriosis?

Hello, Dr.
Lu~~~ I previously read an article about endometriosis.
Here's the situation: I have quite severe premenstrual syndrome, including menstrual cramps, irritability, fatigue, and significant pain during menstruation.
My menstrual blood is dark brown, and I experience diarrhea from the onset of menstruation until it ends, along with frequent flatulence.
There's also a peculiar phenomenon: a few days before my period, a small area near the anal sphincter close to the vaginal opening becomes swollen and painful to touch or wipe, and this lasts until my period ends, after which it disappears on its own.
Additionally, I haven't used contraception for the past two years, but I have never been pregnant.
I would like to ask the doctor if this indicates any medical condition.
Thank you so much~~~ Sincerely, the puzzled little fish.

Xiao Yu, 20~29 year old female. Ask Date: 2002/10/02

Dr. Lü Lizheng reply Obstetrics and Gynecology

Hello, Xiao Yu!
1.
Based on your description, it is highly likely that you have endometriosis.

2.
The cause of this condition is the growth of endometrial tissue in places within the body where it should not grow, leading to various symptoms.
For example, when it invades the uterine muscle layer, it can cause poor uterine contractions, resulting in difficult menstrual flow that appears dark brown and is very painful.
It can spread within the pelvic cavity, interfering with the ovaries and disrupting the peristalsis of the fallopian tubes, making it difficult to conceive.
When it attaches to the rectum, it can stimulate the rectum, leading to diarrhea; if it invades the anus, there may be a mass during menstruation that disappears after the period ends.

3.
Because the "ectopic" endometrial tissue behaves similarly to normal endometrial tissue, it is also influenced by hormonal stimulation, which means that symptoms are most severe around the time of menstruation.

4.
Fortunately, endometriosis is benign and does not pose a life-threatening risk.

5.
Unfortunately, current medical treatments are not very effective, and even after surgery, there is a possibility of recurrence many years later; however, surgery remains the preferred option.
I recommend that you first visit a major hospital to discuss your condition in detail with a physician and decide whether to pursue further treatment.
It is advisable to undergo a laparoscopy to confirm whether this is indeed the condition.
If you have any questions, feel free to reach out, and I will respond as best as I can.

Wishing you and your family peace and happiness.

Sincerely,
Dr.
Lu Lizheng, Department of Obstetrics and Gynecology, Taoyuan Hospital, Department of Health, Executive Yuan.

Reply Date: 2002/10/02

More Info

Endometriosis is a complex and often misunderstood condition that affects many women, and it can manifest in various ways. Based on your description, it seems you are experiencing several symptoms that could be indicative of endometriosis or other related gynecological issues. Let’s break down your symptoms and concerns.

Symptoms of Endometriosis
1. Severe Menstrual Pain (Dysmenorrhea): The intense pain you experience during menstruation is a common symptom of endometriosis. This pain can be debilitating and may not respond well to over-the-counter pain medications.

2. Premenstrual Symptoms: Severe premenstrual syndrome (PMS) symptoms, including irritability, fatigue, and gastrointestinal issues like diarrhea, can also be associated with endometriosis. The hormonal fluctuations that occur during your menstrual cycle can exacerbate these symptoms.

3. Dark Brown Menstrual Blood: The presence of dark brown blood can indicate older blood that has taken longer to exit the body, which is sometimes seen in women with endometriosis due to the presence of endometrial tissue outside the uterus.

4. Gastrointestinal Symptoms: The abdominal pain and increased frequency of gas and diarrhea during your menstrual cycle can be linked to endometriosis, particularly if the endometrial tissue is affecting the intestines.

5. Pain Near the Rectum: The swelling and pain near the anus, especially close to the vaginal opening, could suggest the presence of endometrial tissue in that area, which is known as rectovaginal endometriosis. This can cause localized pain and discomfort, particularly during menstruation.

6. Infertility: The fact that you have not conceived despite not using contraception for two years can be concerning. Endometriosis is a known factor that can contribute to infertility in women.

Next Steps and Recommendations
Given your symptoms, it is essential to consult with a healthcare provider who specializes in gynecology or reproductive health. Here are some steps you can take:
1. Medical Evaluation: Schedule an appointment with a gynecologist to discuss your symptoms in detail. They may perform a pelvic exam, ultrasound, or MRI to assess for endometriosis or other conditions.

2. Consider a Laparoscopy: If endometriosis is suspected, a laparoscopic procedure may be recommended. This minimally invasive surgery allows for direct visualization of the pelvic organs and can confirm the diagnosis. It also allows for the removal of endometrial tissue if found.

3. Pain Management: Discuss pain management options with your doctor. This may include hormonal therapies (like birth control pills, GnRH agonists, or progestins) that can help regulate your menstrual cycle and reduce pain.

4. Lifestyle Adjustments: Some women find relief through dietary changes, regular exercise, and stress management techniques. Keeping a symptom diary can also help identify triggers and patterns related to your menstrual cycle.

5. Support Groups: Consider joining a support group for women with endometriosis. Sharing experiences and coping strategies can be beneficial.

Conclusion
Your symptoms warrant further investigation, and it is crucial to address them with a qualified healthcare professional. Endometriosis can significantly impact quality of life, and early diagnosis and treatment can help manage symptoms and improve overall well-being. Don't hesitate to advocate for yourself and seek the care you need.

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