Fact or Myth? The more severe the Endometriosis, the more severe the pain.

The answer is, “not always.”

It depends on where the Endometriosis is found and how each woman reacts to the pain. My friend had less Endometriosis than me but was bedridden and on disability for a year until her surgery, whereas I am high functioning at stage III until menses, then I’m bedridden for up to four days.

MainLineFertility.com writes:

“Not every woman who experiences painful periods has endometriosis. Moreover, some patients with endometriosis have no pain with their periods. It is a puzzling feature of endometriosis that the pain it causes is not always in proportion to the amount of endometriosis tissue present in the pelvis.”

MedScape.com writes:

“The relationship between pain and the stage and site of endometriosis is controversial. Subjects with advanced disease may have little discomfort, whereas women with minimal or mild endometriosis may present with incapacitating pain.

“Some reports show a correlation between the severity of dysmenorrhea and the stage of endometriosis.[48,49] Yet, observations to the contrary, revealing no association between the stage of endometriosis and the severity of dysmenorrhea as well as nonmenstrual pelvic pain, have also been published.[44,47,50]

“Perper et al[51] observed that the intensity of dysmenorrhea was related to the number of endometrial implants but not to the stage of the disease. However, this finding was contradicted by Muzii et al,[49] who reported a lack of correlation between pain severity and the number as well as the type (typical “black” and atypical “fresh/clear”) of endometriotic lesions.

“Evidence regarding the association between the intensity of pain and morphologic features of the endometriotic implants is inconclusive and contradictory.[44,49,52-54]

“Some data indicate that endometriosis-associated pain persists throughout the reproductive years and that endometriosis stage is directly related to the persistence of pain.[55] Furthermore, deeply infiltrating endometriosis is strongly correlated with pelvic pain and the degree of pain is related to the depth and the volume of infiltration.[47,56,57]

“In a multicenter cross-sectional observational study of 469 women with surgically diagnosed endometriosis and pain symptoms (>6 months), rectovaginal septum endometriosis was associated with more frequent dyspareunia; however, the statistical significance of this finding was borderline.[44] The same study found no significant correlation between stage and site of endometriosis and severity of dysmenorrhea, nonmenstrual pain, and dyspareunia.”