Endometriosis is often associated with pelvic pain, but some of its symptoms extend beyond the reproductive system. These symptoms overlap with other conditions and may be dismissed due to their nonspecific nature. In some cases, the condition goes unrecognized for years, preventing patients from receiving appropriate evaluation and care. Specialized testing enables patients to make more informed decisions. Here are several uncommon symptoms of endometriosis to be aware of:
Bladder Pain
Bladder symptoms are not always associated with endometriosis, especially when pelvic pain is not prominent. Some individuals experience discomfort when urinating or recurrent bladder pain; others experience frequent urination during their menstrual cycle. This pain or discomfort can occur when endometrial-like tissue affects or irritates the bladder and surrounding tissues.
Patients should keep a detailed log of when they experience bladder symptoms. Healthcare providers use the information to determine whether further evaluation is appropriate, particularly when discomfort occurs around menstruation. Early detection of endometriosis may help reduce the risk of additional tissue damage and worsening symptoms. Laparoscopy is one treatment option; this is a surgical procedure used to identify and remove or destroy endometrial-like and scar tissue. Healthcare providers may also recommend:
- Hormonal treatment to help reduce inflammation and manage symptoms
- Lifestyle changes, such as quitting smoking, to potentially reduce endometriosis symptoms
- Heat therapy to ease symptoms and muscle tension
Bowel Issues
Bowel-related discomfort is another uncommon symptom of endometriosis, and it sometimes goes unrecognized. Endometriosis may cause digestive symptoms such as bloating and painful bowel movements. These symptoms are more difficult to interpret because they have numerous possible causes, including irritable bowel syndrome.
Some patients experience severe gastrointestinal (GI) distress. Unlike typical bloating, this type of swelling is extreme, painful, and pronounced enough to make the abdomen appear distended. This symptom may be associated with deep-infiltrating bowel endometriosis or superficial endometriosis. Deep infiltrating endometriosis occurs when endometrial-like tissue embeds deeply into tissues, including the bowel and rectal wall. Superficial endometriosis occurs when lesions develop on the surface of pelvic tissues and organs. Both types can cause inflammation and irritation, which sometimes lead to painful bowel movements or intestinal cramping.
Pain During Sex
Another uncommon symptom of endometriosis that deserves attention is pain during or after sex, known as dyspareunia. Several potential causes can lead to this issue, and endometriosis is one of them. Patients should document when they feel the pain and whether it changes during the menstrual cycle. Healthcare providers use the nature and timing of the discomfort, along with other symptoms, to determine whether the patient needs further evaluation. These include changes in menstrual flow, recurrent pregnancy loss or unexplained infertility, and subtle abdominal pain without a clear origin. While these symptoms are unable to establish an endometriosis diagnosis on their own, they can prompt further evaluation when they present themselves together.
Progesterone Resistance and Infertility
With endometriosis, the abnormal tissue growth sometimes spreads to the ovaries and ovarian tubes. This can result in unexplained infertility as the growth causes inflammation and damages the reproductive organs. In some cases, it leads to scar tissue and adhesions on the fallopian tubes; this has the potential to block the eggs from reaching the uterus.
This condition has also been associated with progesterone resistance, a reduced response of endometrial tissue to the effects of progesterone. Progesterone normally helps prepare and maintain the uterine lining for potential embryo implantation. In endometriosis, inflammation and altered hormone signaling may interfere with progesterone activity and affect endometrial receptivity, potentially contributing to infertility and implantation problems.
These factors also affect assisted reproductive technologies, including in vitro fertilization (IVF). Patients who experience unexplained infertility or repeated IVF or embryo-transfer failures should discuss further evaluation with a fertility specialist, particularly when endometriosis is suspected. Some providers may use an endometrial biopsy to assess BCL6, a biomarker associated with inflammation and endometriosis. This test helps patients and healthcare professionals make more informed treatment decisions. If a patient receives a positive result, there is a high chance that endometriosis-related inflammation is present, and they can discuss more targeted next steps with their provider.
Explore Uncommon Symptoms of Endometriosis
Endometriosis does not present the same way in everyone, and some of its uncommon symptoms are easily mistaken for different conditions. Bladder and bowel discomfort, painful intercourse, and unexplained infertility can become more meaningful when they occur together or repeatedly. Tracking your symptoms helps healthcare providers determine whether you need further evaluation, which assists with detecting endometriosis early. Talk with your healthcare provider about endometriosis symptoms and BCL6 testing to learn more.