The four most common symptoms associated with endometriosis include painful periods (dysmenorrhea), heavy periods (menorrhagia), painful sex (dyspareunia) and chronic pelvic pain.
Now that we have this framework of nerve injury that is caused by childbirth, constipation, surgery and worsened by stress, alcohol, caffeine, tobacco,drugs, etc. it may be more appropriate to adopt the view that many gynaecological symptoms arise from injuries to pelvic nerves and their subsequent re-growth in the lower uterus, cervix, uterosacral ligaments and vagina, rather than the possibility of “endometriosis”.
Injuries to pelvic nerves may have wide-ranging effects, and therefore, many different symptoms. It is important to recognise that these consequences may not yet be fully accepted in the specialty yet there are different levels of evidence to support each of them:
(1) Changes in visceral form e.g. myometrial hyperplasia (see “Association with Fibroids”), endometrial hyperplasia (see “Association with Adeno”) (viscus = organ)
(2) Changes in visceral function e.g. the uterus and Fallopian tubes no longer contract in a co-ordinated fashion, the bladder and bowel fail to empty completely
(3) Susceptibility to different forms of infection i.e. women become susceptible to recurrent thrush infections and opportunist organisms
(4) Susceptibility to different exogenous agents i.e. stress, alcohol, tobacco, caffeine, drugs, etc. worsens symptoms, often in an unpredictable fashion.
(5) Pain arising from re-growth of nerves (reinnervation) e.g. pelvic pain, painful periods, (uterus), painful sex (vagina), painful vulva, irritative bladder, irritable bowel, etc
(6) Pain following removal of all pelvic organs (“central sensitisation”) i.e. once you have injured your pelvic nerves this memory is held in your brain and spinal cord, that may be responsible for less severe, recurrent symptoms some years later
That would mean it is possible to obtain a clear history from many women as to what caused and worsens their symptoms by taking a detailed history and confirming it by physical examination and appropriate investigations e.g. ultrasound and magnetic resonance imaging.
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