clinical manifestations of end

Clinical Manifestations of Endometriosis

In Endometriosis by Jandra MuellerLeave a Comment

By Jandra Mueller, DPT, MS, PHRC Encinitas


Endometriosis is well known for its significant menstrual pain (dysmenorrhea), and often silent infertility. It has long been thought that this disease is a ‘women’s’ disease or menstrual disease allowing for a long history of hysterectomies and hormone suppression aimed at suppressing menstruation. 


Sampson’s theory of retrograde menstruation has been perpetuated since the 1920’s when he named the disease. However, we’ve only really taken a part of his theory and forget that even in the 1920’s he appreciated the complexity of endometriosis and there were likely additional factors that mediated this disease. We have come a long way since Sampson, though he paved the path forward for endometriosis. However, this theory has created significant harm in the endometriosis community.   In recent years, we have had numerous advances and a more in depth understanding of this disease, but there is still a long road ahead.


The delay of diagnosis is on average 7-10 years, in part because of this incomplete understanding, which can result in ongoing symptoms or additional symptoms due to side effects of medication. The disease itself is known to be the cause of several symptoms, which we call the clinical manifestations of endo.


Since the discovery of this tissue in the body resembling the endometrium, and the role of estrogen, we have also learned that early presentation (in pre-pubescent individuals) may present in the form of GI symptoms, often leading to the diagnosis of IBS. While the extent of endo doesn’t correlate with symptom presentation, we have learned that endo located in the cul-de-sac region or posterior aspect of the pelvis is related to pain associated with bowel movements known as dyschezia.


Endometriosis, especially deep infiltrating endo on the bladder, has been associated with urinary symptoms such as urgency, frequency, and pain with voiding (dysuria) resulting in the diagnosis (or misdiagnosis) of interstitial cystitis/painful bladder syndrome (IC/PBS). You may have heard endometriosis and IC/PBS called “the evil twins.” However, there are several, more likely, causes of these symptoms including side-effects from birth control pills, the “first-line therapies” for endometriosis.  


It’s estimated that 90% of those with endo have pelvic floor dysfunction or tight pelvic floor muscles which can often be the source, or contributing factor, of many of the same symptoms, such as dyspareunia. Endometriosis directly causes deep dyspareunia because of the structural changes, and the innervated lesions around the cervix, while pelvic floor dysfunction can also be a cause of deep dyspareunia, but also superficial dyspareunia, or both. It is important to remember that the first-line therapies such as birth control pills, often called “treatments” by physicians, are one of the leading causes of superficial dyspareunia along with painful pelvic exams and tampon use and urinary symptoms which we previously mentioned. 


Basic Explanations of the Clinical Manifestations:

  1. Dysmenorrhea: This is the medical term for painful menstrual periods, which are often the most noticeable symptom of endometriosis. The pain can range from mild to severe, and it may occur in the lower abdomen, lower back, or pelvis. For some, it is only around or during the menstrual cycle, for others it may be at other points of the cycle, and for others, intermittent or sporadic. 
  2. Dyspareunia: This refers to pain during or after sexual intercourse. Women with endometriosis may experience this pain due to the innervated endometriosis lesions surrounding the cervix.  The pain may vary depending on the menstrual cycle and the location of the lesions. 
  3. Dysuria: This is the medical term for painful urination. In cases of endometriosis, it can occur for several reasons including endo on the bladder, side-effects of medications, sensitivities or histamine and mast cell issues, dietary factors, and nervous system changes.  
  4. Dyschezia: This refers to pain associated with bowel movements. If endo has grown on or near the intestines and rectum, it can cause discomfort or pain during bowel movements, especially during the menstrual period.
  5. Infertility: Endometriosis can lead to fertility problems, and for some it is the only symptom.. There are several proposed theories as to why this happens, including the inflammatory nature of the disease, structural changes to the anatomy and obstruct the fallopian tubes or disrupt the normal movement of eggs and sperm. This is why many women discover they have endometriosis only when they seek treatment for infertility.


While these are the more common clinical manifestations of endo, there are several other symptoms that aren’t often correlated to endo such as chronic fatigue, difficulty breathing, rectal bleeding, and association of certain autoimmune diseases. 



iCareBetter: Endometriosis Unplugged hosted by Jandra Mueller, DPT, MS

Listen on Apple Podcasts or Spotify

Need to find a specialist? Check out iCarebetter’s ‘Find a Specialist’

Pelvic Pain Explained: Endometriosis + Resource List

Pelvic Pain Explained: Endometriosis

Myths about Endo

The Truth about the Birth Control Pill

New Perspectives on Endo: Gut-Immune Link & IG Live w/ Dr. Orbuch

Lj Powerhouse and Jandra Mueller of PHRC: IG Live Endometriosis Q&A



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