Title : From dysmenorrhea to infertility: The symptom spectrum of endometriosis - A case series
Abstract:
Background: Endometriosis is a complex, estrogen-dependent condition with a wide spectrum of clinical Emanifestations. While classically associated with pelvic pain and dysmenorrhea, it can also present with gastrointestinal, genitourinary, and reproductive complaints, often mimicking other conditions and delaying diagnosis.
Objective: To describe the clinical heterogeneity of endometriosis through a series of 14 cases, emphasizing the multisystem involvement and the diagnostic value of recognizing symptom patterns.
Methods: This retrospective case series includes 14 cases of women diagnosed with endometriosis based on clinical evaluation, imaging, and/or surgical confirmation. The data were collected from a gynaecology clinic in the Dutch Caribbean island of Curaçao. Cases were grouped thematically according to age, menopausal status, fertility status and dominant presenting symptoms: gastrointestinal, genitourinary, menstrual-related, and reproductive. Patient histories, diagnostic processes, and outcomes were reviewed to identify patterns and diagnostic challenges.
Results: Patients ranged from 16 to 66 years old at the time of diagnosis. 11 cases presented with premenopausal endometriosis, while 3 presented with postmenopausal endometriosis. Presenting symptoms included cyclic dyschezia, urinary frequency and urgency, dyspareunia, chronic pelvic pain, abnormal uterine bleeding, and infertility. Many patients had overlapping symptoms involving multiple systems. Surgical confirmation revealed deep infiltrating endometriosis in a subset of patients with severe bowel and bladder symptoms.
Conclusion: Endometriosis is a multifaceted disease that may present with symptoms beyond the reproductive tract. Recognition of the cyclical nature and multi-organ involvement is critical to improving early diagnosis. This case series highlights the importance of considering endometriosis in patients presenting with unexplained pelvic, bowel, bladder, or reproductive complaints.
