Case history
Case history #1
A 32-year-old nulliparous white female presents with a history of progressively worsening menstrual pain that is now causing her distress for most of the month. She misses 2 to 3 days of work each month. She finds no relief from ibuprofen and can no longer tolerate the headaches associated with her birth control pills. She is currently sexually active with her long-term partner. Her relationship is being affected by associated stress and pain during intercourse. On vaginal examination, her pelvic musculature is moderately tender. Her uterus is of normal size and minimally tender. Rectovaginal exam reveals uterosacral nodularity and exquisite tenderness. Stool is soft, brown and heme-negative.
Case history #2
A 41-year-old white female presents to her gynecologist for a routine healthcare visit. She has no complaints except for some mild lower abdominal bloating. Her past medical and surgical history is unremarkable. Her sister has recently been diagnosed with endometriosis. She and her husband have been trying to conceive for the past 2 years and have been unsuccessful. She is requesting a referral to an infertility specialist. On exam, she is thin and in no distress. Pelvic exam reveals 10 cm bilateral adnexal masses indistinguishable from the uterus. Transvaginal ultrasound performed in the office is significant for ovarian masses with homogeneous, low-level internal echoes.
Other presentations
Endometriosis should be considered in adolescent girls and young women who have had primary dysmenorrhea since menarche and who do not experience clinical improvement after 3 to 6 months of empiric therapy, as well as those with secondary dysmenorrhea.[1] Endometriosis can present in menopausal women.[2]
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