3 Unusual Symptoms of Endometriosis: Part 2

Welcome back to the Doctor Rich channel! A few months back, we posted a popular video titled  “Unusual Symptoms of Endometriosis.” We’re going to do a follow-up with three MORE unusual symptoms of endometriosis — and stick around to the end to find out what our bonus unusual symptom is!

Don’t have time to read this post? Watch the video here instead!

Now it’s important to remember that endometriosis is a very common condition — one in ten women have this! It causes extremely painful periods that can be very disruptive — and even lead to hospitalization or require surgery! For a primer on endometriosis, check out this video here. 

Typically, endometriosis implants (or scarring) occur on the ovaries, the uterosacral ligaments and other pelvic ligaments, as well as bowel and bladder — but it can occur in other places (even outside the pelvis)! In fact, endometriosis has been found in every major organ system in the body — including the gut, the bladder, within nerves and brain, the skeletal system in the bone, in lungs, within the vascular system, lymphatics, and even muscle. 

Now it’s important to keep in mind that there are other conditions (for example in the gut) that are more likely to be responsible for the pain — like for example inflammatory bowel disease or irritable bowel syndrome. That’s more likely than endometriosis, but endometriosis is a great mimicker and can cause symptoms in all of these different organ systems. 

The key to identifying endometriosis is the cyclic presentation — the pain will come once a month, and it’s coordinated with the period (which these other primary diseases of the organ systems don’t occur that way). Inflammatory bowel disease doesn’t occur in a monthly, cyclic fashion with the period. So if that is the presentation — then endometriosis should be considered in a differential. 

Unusual Endometriosis Symptoms

  1. In a C-section scar

 So believe it or not, endometriosis implants (or ectopic endometriosis) can occur within a scar — typically a scar from a prior C-section. These masses (or these implants) typically present as a bulge or a mass that can actually be felt within the scar. Typically these masses are identified because patients have abdominal pain, and they can locate it to the C-section scar. There is really no other treatment other than surgical resection. And depending on the size of the mass and the involvement with the connective tissue (or the fascia) in the abdominal wall, sometimes a mesh has to be placed to prevent a hernia from forming as a result. The other thing to keep in mind is if these lesions aren’t completely resected — they can recur. And sometimes even when they are completely resected, they can recur as well. Either hormonal suppression or hysterectomy would need to be considered at the same time to avoid recurrence of these lesions. 

  1. In the chest

The second presentation is endometriosis of the thorax (or the chest) — within the chest wall or within the lung. Now the most common presentation for this is cyclic pneumothorax — or blood in the lung that occurs once a month. 

Talk about taking your breath away! 

But symptoms can also include shortness of breath once a month, a severe cough during the period, and even coughing up blood during the period. Interestingly (80% of the time), it occurs on the right side — and is usually diagnosed because the patient has shortness of breath and (through imaging studies) is found to have blood in the lung and gets a chest tube to drain that. The diagnosis can be made at that point — or otherwise has to be made with a lung biopsy (or even thoracic surgery) to actually remove the lesion. Management of this condition would be done by a thoracic surgeon. There are robotic specialists that can actually manage this (and other lung conditions) with minimally invasive surgery (small incisions) using the surgical robot.

So unfortunately, this is a very debilitating condition and because it’s so rare oftentimes goes unrecognized — as we can see in this video here:

“It was the most horrific experience in my life. And that was the beginning of a long, long journey. If one in ten women are battling this disease, then how many, HOW MANY families are suffering silently?”

  1. In the bowel or appendix

The third unusual symptom is bowel endometriosis — and specifically endometriosis of the appendix. This is not uncommon actually with Stage 3 and 4 advanced stage endometriosis — as the appendix is right at the pelvic brim. And it’s close to where the endometriosis implants normally occur. It’s actually fairly common in patients who have right lower quadrant pain or advanced stage endometriosis that it can involve the appendix. And during the treatment of endometriosis, oftentimes the pelvic surgeon/gynecologist will remove the appendix or in conjunction with a colorectal surgeon. It’s not at all uncommon for the pelvic surgeon/gynecologist to remove the appendix during the same surgery in those cases of advanced endometriosis (where they’re being treated for pelvic endometriosis).

*And the bonus symptom is… Endometriosis has been found (in some case reports) to occur in men!

Now, since this is an extremely rare diagnosis — the cause is poorly understood. We’ve talked in this video here about the different causes of endometriosis (or how endometriosis arises in women). One of those explanations is that the endometrial tissue goes back out through the tubes and implants in the pelvis. Clearly that cannot explain all causes of endometriosis — as it has been found in men as well. And this must be explained by a process of metaplasia where cells actually transform from peritoneal cells (or cells in the lining of the pelvis) and just spontaneously transform into endometriosis cells. So guys — not to worry, there’s only ever been a few case reports in history of this condition. 

Make sure to like and share this video — and enable your notifications to catch the next “Unusual Symptoms of Endometriosis!”