Classic Symptoms of Endometriosis


Endometriosis: Out and About, Even if You Don’t Know You Have It

Before discussing the chocolate cyst as part of endometriosis, it is important to be familiar with endometriosis itself. Although scientific studies do not yet reveal exactly what causes endometriosis, environmental factors and chemicals are cited as causes that pave the way for this disease.

“Endometriosis,” according to Dr. Bozdogan, “is one of the most frequently diagnosed diseases of women in the USA and worldwide.”

He should know, because he specializes his entire practice around the particular condition. He reports that the signs and symptoms of endometriosis range from none at all to debilitating pain and severe infertility.

“For those who have no symptoms,” he adds, “the progression of endometriosis from silent pathology can be insidious, such that by the time it produces actual symptoms, your pelvis may already have been ravaged from its devastating effects.”

You Don’t Need Smoke to Have a Fire

Dr. Bozdogan cautions women, especially those who include pregnancies in their future, that warning signals can be deceptive.

“For example,” he explains, “many women assume that severe menstrual pain is part and parcel of a normal monthly cycle, a notion supported by an older generation of women in their lives—mothers, grandmothers, aunts, well-meaning friends, etc. Women with symptoms are told simply to ‘deal with it.’ Also, it is not lost on me that insecurity in the most intimate part of a relationship can misdirect attention toward guilt or ‘failure as a woman’ when painful intercourse limits your ability to share intimacy physically with your partner. Both of these physical and psychological effects can delay your seeking care as well.”

He feels it is regrettable that this complacency or acceptance of such troubling symptoms allows the insidious progression to continue, negatively impacting quality of life while setting up a woman for failure in fertility.

The Chocolate Cyst

Dr. Bozdogan explains that endometriosis can collect in what is called a “chocolate cyst,” that is, an encapsulated collection of old blood and menstrual-like debris whose endometriosis cells have deteriorated and formed an inflammatory, brown, thick accumulation. Being walled off can cause a “silence” in the disease that can mislead a woman into thinking that all is well.

“The diagnosis of this type of cyst is becoming increasingly common, but a physician must know to look for it, even in a woman without symptoms during her routine GYN visit.”

He certainly is positioned to know, because his practice focuses on this condition, and he has seen this type of cyst many times—in the ovary, attached to the intestines, or as multiple nodular lesions trapped in scarred tissue between—and adhering to—the back of the uterus and the rectum. Sometimes endometriosis can involve the outside layers of the intestines, presenting first with gastrointestinal symptoms.

Closing: A Window of Opportunity.

Sadly, much time is wasted when women forego expert medical care and seek information on the Internet or—worse—seek treatment from healthcare providers who address endometriosis only from a general perspective.

“The clock is ticking when it comes to endometriosis,” Dr. Bozdogan emphasizes. “Once endometriosis has produced chocolate cysts or spills into the abdomen to create adhesions that adhere organs to each other, a window of approachability has closed, making the condition addressable only via specialized surgery that requires an expertise in state-of-the-art technology, such as robotic surgery. Most GYN surgeons do not have this expertise,” he admits, “which makes my approach all the more necessary by the time women seek care.”

This means that any subsequent surgery was really necessary long before it is finally performed, made worse by the fact by the risk that endometriosis poses to other organs.

“For example,” Dr. Bozdogan says,” if there is involvement over a ureter—one of a pair of tubes that drain urine from the kidneys—that respective side can be blocked and backed up, putting that kidney at risk for preventable kidney failure, even while there are no symptoms!”

This stresses the fact that endometriosis is not just its own self-contained pathology causing period pain or infertility, but can ravage any of the organs of the pelvis, stealthily in the background, until damage is far advanced:

  • uterus, tubes, and ovaries,
  • bladder,
  • ureter(s),
  • rectum and large intestines,
  • small intestines

Chocolate Cyst: The Classic Abnormality in Endometriosis.

Nothing is more classic or representative of endometriosis as a disease as the chocolate cyst. Besides occupying space which can cause symptoms, it also does not co-exist well with any other structures, either in one isolated corner or in entire regions of the pelvis.

Although Dr. Bozdogan points out that chocolate cysts need not be present—that other manifestations of the illness can be present—once endometriosis has progressed to the point of creating chocolate cysts, there are a group of   symptoms that should be considered a “canary in the mine,” when present, to warn of progression.

Dr. Bozdogan’s Classic Symptoms of Endometriosis 

  1. Chronic fatigue: “One of the most unexpected symptoms is chronic fatigue syndrome. Continuous fatigue, stress, and lack of focus on work are more common in women with endometriosis. Even seasonal fatigue may actually be a case of endometriosis.”
  2. Back and/or groin pain: “Although the most common complaint, it is unbelievable to me when a         gynecologist doesn’t ask about these types of pain. Indeed, endometriosis  may cause these exact symptoms.”
  3. Reluctance to go to the bathroom: “If the chocolate cyst constricts the intestines and narrows it, the simple act of going to the toilet can become incredibly painful, creating a hesitancy that not only causes constipation and frequent pain, but can even progress to limiting one’s eating—a psychological overreaction!”
  4. Infertility: “The relationship between endometriosis and infertility has been well established, especially with involvement of your tubes, blocking fertilization when sperm cannot meet egg. Sometimes no symptoms other than failure to get pregnant will prompt me to suspect endometriosis, which is often the case!”
  5. Painful sexual intercourse:“Since many women do not know that endometriosis can cause painful sexual intercourse, they do not consult with the gynecologist about their private sexual problems. This situation can cause serious problems between the partners, even to the point of separation, which is the final blow rendered by infertility. I find it useful to think of a possible chocolate cyst when sex is painful.”
  6. Painful menstruation: “One of the most frequent problems caused by a chocolate cyst is the pain that accompanies menstruation. However, many women have been led to believe that pain with a period is ‘very normal.’ They are falsely reassured by friends or family who claim as much.
  7. Gas and bloating in the abdomen: “The disease causes bloating in the intestines. Many women will complain of ‘swelling in my belly.’ When this is cyclic, endometriosis should always be considered.” 
  8. Depression: “Severe depression/anxiety disorder is often present, because this chronic disease limits a woman’s entire life. She cannot participate in sports or the usual activities of daily living, enjoy meals, is constantly tired, and generally is miserable. This is no way to enjoy life.”

Different Treatment Methods

Asserting that chocolate cyst is a treatable disease, Dr. Bozdogan offers this advice:

“There is no uniform treatment. We determine the treatment method according to your age, condition, particular chocolate cyst structure, and involvement of adjacent tissues. Some of our patients are treated with medication for this disease, but after a successful surgery, it is comforting to know that recurrence of the disease is minimal. The patient can heal quickly and return to work within a few days when advanced surgical techniques, such as robotic excision of endometriosis are used.”

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