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    Updated on Jul 19, 2020. Posted on Feb 20, 2019

    6 Endometriosis Symptoms That Make it Hard to Diagnose

    “I would liken it to carrying a heavy backpack around constantly – you can forget it’s there for awhile, and then someone comes by and adds a brick to it and tells you to run uphill.”

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    Doctors diagnosed the intense abdominal cramping that hit Sharon Rosenblatt every month — and sometimes sent her to the emergency room — as kidney stones, a muscle pull, or the result of too much exercise.

    “Because I’m so active, people assumed I just tweaked something or pulled something,” Rosenblatt, 30, an avid runner, told BuzzFeed Health. But the pain every month was debilitating. “I remember just having trouble getting out of bed. Everything in that region felt achy, from my ribs down to my waist.”

    Rosenblatt’s heavy periods and cramping wouldn’t be diagnosed correctly, as endometriosis, for another three years. And she was lucky — on average, women wait a decade to be diagnosed after first having symptoms.

    Endometriosis occurs when cells like those lining the uterus grow where they shouldn’t — typically on the ovaries, fallopian tubes, and abdominal lining. These misplaced cell clusters, or implants, swell, break down and bleed every month. Inflammation results, and extensive endometrial disease and scarring can impair fertility.

    “We spend a lot of time teaching OBGYNs how to diagnose and manage endometriosis. Half the battle is recognition,” Dr. Arnold Advincula, vice-chair of women’s health and chief of gynecology at NewYork-Presbyterian/Columbia University Irving Medical Center in New York City, told BuzzFeed Health.

    Part of the reason it’s difficult to diagnose, he said, is that its symptoms overlap with a lot of other conditions, such as irritable bowel syndrome, polycystic ovary syndrome, and a bladder condition called interstitial cystitis.

    Women with endometriosis are also at increased risk of depression and anxiety, he added. “That can often cloud the picture, and if somebody’s not thinking about the diagnosis of endometriosis, they might miss it or go down the wrong road.”

    Here are six symptoms that make diagnosing endometriosis difficult.

    1. Pain

    “Killer cramps” are the key symptom of endometriosis, but the condition can cause pain at any point in a woman’s menstrual cycle. “It was just random times throughout the month I would start having pain,” Shelby Eichman, 26, a public relations manager in Los Angeles, told BuzzFeed Health. “I would be out for dinner, for example, and all of a sudden I would be doubled over and have to leave. It was getting to the point where it was interfering with my ability to live my life.”

    The amount of pain does not necessarily correlate with the extent of endometriosis, Dr. Kameela Phillips, an OBGYN in Manhattan, told BuzzFeed Health. For example, a woman may not experience much pain — what’s known as “silent endometriosis” — and still have disease throughout her pelvis.

    And the pain of endometriosis doesn’t always feel like menstrual cramps, Dr. Felice Gersh, founder and director of the Integrative Medical Group of Irvine, in California, told BuzzFeed Health. “She can have really any sort of abdominal pain. It can be diffuse, it can be vague, it can be a feeling of fullness or an achy pain, and it can vary throughout the abdomen in terms of location.”

    Pain with intercourse is another key symptom of endometriosis, Gersh noted. “It can be aching, stabbing, sharp,” she said. “It’s typically a deep pain, as opposed to a vaginal pain, but it can also be vaginal pain.”

    2. Extended periods and heavy menstrual flow

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    Some women with endometriosis will have very heavy periods, and some will experience bleeding between periods. Bleeding can also occur due to hormonal imbalances, adenomyosis, fibroids, and cysts, Phillips noted.

    3. Gastrointestinal symptoms

    Pain with bowel movements is a characteristic symptom of endometriosis, but women with the condition can have a host of other gastrointestinal disturbances, including diarrhea, constipation, bloating, and nausea. These can be especially bad during menstruation.

    Implants can also grow on the rectum, causing pain when pooping and rectal bleeding, according to Phillips.

    These symptoms mean that endometriosis may be misdiagnosed as irritable bowel syndrome, inflammatory bowel disease, or even hemorrhoids.

    4. Urinary symptoms

    Women with endometriosis can also have symptoms involving the bladder, Gersh noted. Such symptoms can feel like a bladder infection, and may include urgency and a sense of fullness in the bladder.

    “Endometriosis can also present with blood in the urine,” Phillips said. “Visible or microscopic blood in the urine can also be endometriosis if implants are on or invade the bladder lining.”

    5. Infertility

    Nazdravie / Getty Images

    Some women don’t know they have endometriosis until they seek treatment for infertility. On the other hand, fertility specialists can miss the diagnosis.

    While woman with minimal or mild endometriosis may be able to get pregnant on their own, women with moderate to severe disease are more likely to conceive if they undergo surgery to remove scar tissue and cysts.

    Women with endometriosis may also have difficulty carrying a pregnancy to term if they do conceive.

    6. Fatigue

    The constant inflammatory state brought on by endometriosis can lead to severe fatigue. Much more than ordinary tiredness, fatigue is a state of constant physical exhaustion. Fatigue is also a symptom of depression, chronic fatigue syndrome, and many types of chronic illness, so doctors may not immediately think of endometriosis in women who report fatigue.

    Coping with endometriosis pain left Shelby Eichman far more exhausted than she’d realized, until she underwent surgery to remove the abnormal tissue.

    “I would liken it to carrying a heavy backpack around constantly – you can forget it’s there for awhile, and then someone comes by and adds a brick to it and tells you to run uphill,” she said. “That’s what a flare or a bad pain day would feel like for me from an energy perspective.”

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