Fast Five Quiz: Key Aspects of Endometriosis

Michel E. Rivlin, MD


October 23, 2017

Secondary dysmenorrhea occurs twice as often in women with endometriosis as in controls. Pain frequently commences before menses. Endometriosis should be considered in a patient presenting with significant dysmenorrhea, and the patient should be started on empiric therapy.

Cyclic pain is pain that accompanies bleeding at the time of menstruation. This could involve the bladder (hematuria), bowel (hematochezia and painful defecation), or, rarely, bleeding at uncommon sites such as the umbilicus, abdominal wall, or perineum.

Patients who are sexually active may report deep dyspareunia that is worst in the premenstrual phase of the cycle. Deep dyspareunia may be due to scarring of the uterosacral ligaments, nodularity of the rectovaginal septum, cul-de-sac obliteration, and/or uterine retroversion, all of which may also lead to chronic backache.

The hallmark finding on examination is the presence of tender nodular masses along thickened uterosacral ligaments, the posterior uterus, or the posterior cul-de-sac. Obliteration of the cul-de-sac in conjunction with fixed uterine retroversion implies extensive disease. Occasionally, a bluish nodule may be seen in the vagina due to infiltration from the posterior vaginal wall.

For more on the symptoms and physical examination of patients with endometriosis, read here.


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