Editing Endometriosis (section)

===Pelvic pain===
A major symptom of endometriosis is recurring pelvic pain. The pain can range from mild to severe cramping or stabbing pain that occurs on both sides of the [[pelvis]], in the lower back and rectal area, and even down the legs. The amount of pain a person feels correlates weakly with the extent or stage (1 through 4) of endometriosis, with some individuals having little or no pain despite having extensive endometriosis or endometriosis with scarring, while others may have severe pain even though they have only a few small areas of endometriosis.<ref name="Stratton2011">{{cite journal | vauthors = Stratton P, Berkley KJ | title = Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications | journal = Human Reproduction Update | volume = 17 | issue = 3 | pages = 327–46 | year = 2011 | pmid = 21106492 | pmc = 3072022 | doi = 10.1093/humupd/dmq050 }}</ref> The most severe pain is typically associated with menstruation. Pain can also start a week before a menstrual period, during, and even a week after a menstrual period, or it can be constant. The pain can be debilitating and result in emotional stress.<ref>{{cite journal|vauthors=Colette S, Donnez J|date=July 2011|title=Are aromatase inhibitors effective in endometriosis treatment?|journal=Expert Opinion on Investigational Drugs|volume=20|issue=7|pages=917–31|doi=10.1517/13543784.2011.581226|pmid=21529311|s2cid=19463907}}</ref> Symptoms of endometriosis-related pain may include:
* [[Dysmenorrhea]] (64%)<ref name="ovarianendo">{{cite journal | vauthors = Gałczyński K, Jóźwik M, Lewkowicz D, Semczuk-Sikora A, Semczuk A | title = Ovarian endometrioma - a possible finding in adolescent girls and young women: a mini-review | journal = Journal of Ovarian Research | volume = 12 | issue = 1 | page = 104 | date = November 2019 | pmid = 31699129 | pmc = 6839067 | doi = 10.1186/s13048-019-0582-5 | doi-access = free | title-link = doi }}[[File:CC-BY icon.svg|50px]] Text was copied from this source, which is available under a [https://creativecommons.org/licenses/by/4.0/ Creative Commons Attribution 4.0 International License] {{Webarchive|url=https://web.archive.org/web/20171016050101/https://creativecommons.org/licenses/by/4.0/ |date=16 October 2017 }}.</ref> – painful, sometimes disabling cramps during the menstrual period; pain may get worse over time (progressive pain), also lower back pains linked to the pelvis
* Chronic pelvic pain – typically accompanied by lower back pain or abdominal pain
* Dyspareunia – painful [[sexual intercourse]]
* [[Dysuria]] – urinary urgency, frequency, and sometimes painful voiding<ref name="NIH">{{cite web|url=https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/symptoms|title=What are the symptoms of endometriosis?|author=<!--Not stated-->|website=National Institutes of Health|access-date=4 October 2018|archive-date=27 January 2021|archive-url=https://web.archive.org/web/20210127204323/https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/symptoms|url-status=live}}</ref>{{Failed verification|date=December 2024|reason=The reference mentions neither urgency nor frequency, only painful voiding}}
* [[Mittelschmerz]] – pain associated with ovulation<ref>{{cite journal | vauthors = Brown J, Farquhar C | title = Endometriosis: an overview of Cochrane Reviews | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD009590 | date = March 2014 | volume = 2014 | pmid = 24610050 | doi = 10.1002/14651858.cd009590.pub2 | pmc = 6984415 }}</ref>
* Bodily movement pain – present during exercise, standing, or walking<ref name="NIH" />

Compared with patients with superficial endometriosis, those with deep disease appear to be more likely to report shooting rectal pain and a sense of their insides being pulled down.<ref name="Ballard">{{cite journal | vauthors = Ballard K, Lane H, Hudelist G, Banerjee S, Wright J | title = Can specific pain symptoms help in the diagnosis of endometriosis? A cohort study of women with chronic pelvic pain | journal = Fertility and Sterility | volume = 94 | issue = 1 | pages = 20–7 | date = June 2010 | pmid = 19342028 | doi = 10.1016/j.fertnstert.2009.01.164 | doi-access = free | title-link = doi }}</ref> Individual pain areas and intensity appear to be unrelated to the surgical diagnosis, and the area of pain is unrelated to the area of endometriosis.<ref name=Ballard/>

There are multiple causes of pain. Endometriosis lesions react to hormonal stimulation and may "bleed" during menstruation. The blood accumulates locally if not cleared shortly by the immune, circulatory, and lymphatic systems. This accumulation can lead to swelling, which triggers inflammation via [[cytokines]], resulting in pain. Another source of pain is organ dislocation that arises from [[Adhesion (medicine)|adhesion]] binding internal organs together. The ovaries, the uterus, the oviducts, the peritoneum, and the bladder can all be bound together. Pain triggered in this way can last throughout the menstrual cycle, not just during menstrual periods.<ref>{{page needed|date=April 2015}}{{cite book|vauthors=Murray MT, Pizzorno J |title=The Encyclopedia of Natural Medicine|date=2012|publisher=Simon and Schuster|location=New York, NY|edition=3rd}}</ref>

Additionally, endometriotic lesions can develop an independent nerve supply, creating a direct and two-way interaction between lesions and the [[central nervous system]]. This interaction can produce a variety of individual differences in pain that, in some cases, become independent of the disease itself.<ref name=Stratton2011/> Nerve fibers and blood vessels are thought to grow into endometriosis lesions by a process known as [[neuroangiogenesis]].<ref>{{cite journal | vauthors = Asante A, Taylor RN | title = Endometriosis: the role of neuroangiogenesis | journal = Annual Review of Physiology | volume = 73 | pages = 163–82 | date = 2011 | pmid = 21054165 | doi = 10.1146/annurev-physiol-012110-142158 }}</ref>