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Endometriosis may cause pain. Classically, the pain of endometriosis
is most intense during the menstrual flow (dysmenorrhea) and it
may involve a wide range of pelvic and abdominal regions. The
pain may also be associated with intercourse (dyspareunia) that
lasts for several hours after the conclusion of relations (since
vaginal penetration commonly results in the movement of pelvic
structures most often affected by endometriosis). The cyclic nature
of the pain is based on the extraordinary responsiveness of endometrial
tissue (wherever located) to the sex steroids, estrogen and progesterone.
During the menstrual cycle, the ovary produces a tremendous amount
of estrogen and progesterone in a sequence that promotes an orderly
growth of endometrium. If a pregnancy does not occur, then the
uterine lining sheds predominantly through the uterine cervix
and out the vagina as menstrual flow. If the patient has endometriosis,
the endometrial cells that are "shed" in the pelvis
have no escape from the body and often cause a dramatic local
inflammatory reaction. This inflammation is the most widely accepted
cause for the pelvic pain associated with endometriosis.
The pain of endometriosis can range widely from a dull ache to
a severe piercing sharp pain. Typically the pain lasts for days
starting 1-2 days prior to the onset of the menstrual flow. The
pain may be greater in certain locations, but often involves the
- * midline pelvis (around and behind the uterus)
- * adnexal region (around the ovaries and tubes immediately
lateral to the uterus)
- * lower back deep in the pelvis (around the rectosigmoid
colon or uterosacral ligaments behind the uterus) where it is
often thought to be gastrointestinal
- * pelvis with radiation down one or both legs or into
the groin
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