Q. I recently saw some of the symptoms of endometriosis discussed on television. The list included pain during sex and pain during menstruation, and also I heard that this problem can affect reproduction. I am 23 and realize that this is more common later in life, but what are some other symptoms to keep an eye on? I have a doctor's appointment later this month, and even though I don't have any of these symptoms, I am wondering how extensive the test is for endometriosis. Should I ask for it to put my mind at ease?
A. Endometriosis is caused by the implantation of endometrial tissue on other surfaces in the pelvis or abdomen. It affects an average of 10 to 20 percent of women during their reproductive years. It often is associated with the symptoms you mention, such as pain during sex or painful periods. Interestingly, painful periods can develop after many years of painless periods. This suggests that the endometrial tissue implanted at the remote sites is growing. While this tissue can respond to the usual cyclic changes in hormones, it is never shed, and so keeps growing, creating more and more pain due to compression on nerves or other organs, such as the bladder or colon.
Other symptoms that often concide with the woman's periods include painful elimination (urine or bowels), abdominal or lower back pain, and irregular bleeding.
The only way to definitely make the diagnosis is with laparoscopy that can visualize other areas with endometrial implants. Unless you are having symptoms, or trouble conceiving, or have a family history of endometriosis or unexplained fertility problems, your doctor will probably not want to perform a laparoscopy (which is actually minor surgery) on you.
Once a diagnosis of endometriosis is made, initial treatment often includes use of birth control pills as well as other hormone modifiers so that the implants do not grow. Surgery may be indicated if the disease is very severe.