“I knew something wasn’t right when my periods became increasingly painful, but my doctor kept dismissing it as normal cramping,” shares Sarah, a 28-year-old (details changed) who received her endometriosis diagnosis through the non-invasive GIMA biomarker method in Canada. Her story reflects what many of you might be experiencing right now.

Pain pattern recognition plays a significant role in identifying endometriosis. You may experience these distinct patterns:

1. Cyclic Pain: Your pain becomes more intense before and during menstruation, effects your daily life and persists despite over-the-counter medications
2. Chronic Pain: The discomfort persists beyond 6 months
3. Radiating Pain: Your discomfort extends to your lower back and legs
4. Deep Pain: The pain becomes more intense during physical activity, bowel movements, urination or intercourse.

Your menstrual cycle provides important clues about endometriosis presence. Watch out for these warning signs:

• Spotting for 3 or more days before your first medium or heavy day of flow⁶
• Heavy menstrual bleeding (menorrhagia)
• Clots or flooding during menstruation
• Brown bleeding at the end of your period
• Unexpected bleeding between periods (spotting).
• Menstrual periods that continue beyond seven days

Endometriosis can affect your digestive and urinary systems. Changes in bowel movements and urinary habits might become noticeable during your menstrual cycle. These symptoms can include painful urination (dysuria), constipation, or diarrhea that gets worse during menstruation.

Your ability to spot endometriosis depends on recognizing these patterns and their connection to your menstrual cycle. A single symptom might not point to endometriosis, but multiple signs or ones that worsen over time call for a closer look through non-invasive diagnostic methods.

Tracking your symptoms can help your healthcare provider’s diagnostic approach substantially. A detailed symptom diary is a great way to get quantified insights about your condition. We recommend a standardized and objective system like NEO, Marquette or Sensiplan, that can be interpreted by a clinician because of their standardization. They also connect you to a knowledgeable fertility awareness instructor who can refer you to a clinician focused on restoring reproductive health.

At the minimum, any symptom diary you choose should include the timing of symptoms, their severity, their effect on your daily life and any medications you used to manage pain. This detailed information proves valuable during discussions about the need for faster diagnostic and treatment options when meeting with your healthcare provider.

When you recognize and record endometriosis warning signs, it helps you quantify what is happening and can help your doctor build a medical case to further investigate endometriosis presence.

• Recognize patterns and their connection to your menstrual cycle.
• Multiple signs that worsen over time call for a closer look.
• Record the timing of symptoms, their severity, their effect on your daily life and any medications you used to manage pain.

This detailed information proves valuable during discussions about the need for faster diagnostic and treatment options when meeting with your healthcare provider.

Choose a standardized and objective method of fertility tracking so you can access medical care that is restorative and focused. This is particularly important if you’re TTC or want to preserve your fertility for the future.

Consider a method that provides initial training with a fertility educator. This is not expensive and helps you understand your cycle more quickly

Trying to capture symptoms and avoiding pregnancy:

• Natural Cycles
• Sensiplan
• Phendo – specifically for endometriosis and supports research

If you’re TTC:

• Read Your Body
• MIRA hormone health clinic
• NEO Fertility. Offers medical care through restorative reproductive medicine clinician
• Offers medical car through restorative reproductive medicine clinician

In Canada, thefive year diagnostic gap from symptom onset to diagnosis1is set to close because of advancements in medical technology and women’s raised awareness and ability to track their reproductive health.

• Discuss your symptoms and the impact on your everyday life
• Bring a detailed symptom diary and medical/family history
• You’ll likely need a physical examination

Your diagnostic experience might include:

• Electroviscerography (EVG) records your gastrointestinal myoelectrical activity (GIMA), specific electrical patterns in your digestive system recording your cell’s direct response to prostaglandins produced by endometrial tissue. AI compares your GIMA pattern to the known unique GIMA biomarker present in endometriosis and adenomyosis patients.
• Can detect presence of any endometriosis at all stages and locations including stage 1 superficial and extra pelvic endometriosis.
• You receive accurate information providing diagnosis support to your clinician without the need for surgery
• GIMA biomarker testing, also known as the ENDOSURE test, provides remarkable accuracy, and robust model sensitivity & specificity making it a strong decision support tool for physicians assessing for endometriosis.

• Transvaginal ultrasound / Abdominal ultrasound
• Can detect endometriomas (chocolate cysts), larger deep infiltrating endometriosis in the pelvic area, and organ position changes from scarring or adhesions

• Offers high-resolution images of soft tissues and can detect deep infiltrating endometriosis.

Note: The updated 2022 guidelines of the European Society of Human Reproduction and Embryology (ESHRE) recommend using both ultrasound and MRI as first-line diagnostic tests for endometriosis.

• May include CA-125, C-Reactive Protein (CRP) and white blood cell count (WBC) tests: elevated levels, and other hormonal tests to rule out related conditions.

• Discuss results of diagnostic tools to support a diagnosis
• Develop a treatment plan tailored to your needs with symptom management in the near term
• Referral to a specialist for treatment
• Your diagnostic and treatment journey may vary and depends on your symptom severity and your health and fertility goals. Your healthcare provider will determine the most appropriate tests and treatments based on your symptoms and medical history and life goals.

References:

1. Singh, Sukhbir et al.; Prevalence, Symptomatic Burden, and Diagnosis of Endometriosis in Canada: Cross-Sectional Survey of 30 000 Women, JOBC, Volume 42, Issue 7, 829 – 838 – add date and DOI
2. Noar, M, et al.; Gastrointestinal Myoelectrical Activity (GIMA) Biomarker for Noninvasive Diagnosis of Endometriosis. J. Clin. Med. 2024, https://doi.org/3390/jcm13102866
3. Magnetic Resonance Roadmap in Detecting and Staging Endometriosis: Usual and Unusual Localizations. Piccolo CL, Cea L, Sbarra M, De Nicola AM, De Cicco Nardone C, Faiella E, Grasso RF, Beomonte Zobel B. Applied Sciences. 2023; 13(18):10509. https://doi.org/10.3390/app131810509
4. European Society of Human Reproduction and Embryology. Endometriosis Guideline. ESHRE. Published 2022. Accessed November 2, 2024. https://www.eshre.eu/Guideline/Endometriosis
5. Kassel G. Blood Tests for Endometriosis: 5 Things to Know. Healthline. Published February 10, 2023. Accessed November 2, 2024. https://www.healthline.com/health/endometriosis-blood-test
6. Heitmann RJ, Langan KL, Huang RR, Chow GE, Burney RO. Premenstrual spotting of ≥2 days is strongly associated with histologically confirmed endometriosis in women with infertility. Am J Obstet Gynecol. 2014 Oct;211(4):358.e1-6. doi: 10.1016/j.ajog.2014.04.041. Epub 2014 May 4. PMID: 24799313.
7. J Fourquet, et al.,Patients’ report on how endometriosis affects health, work, and daily life,Fertility and Sterility,2010,https://doi.org/10.1016/j.fertnstert.2009.09.017.
8. (https://www.sciencedirect.com/science/article/pii/S0015028209036966)
   Abstract: The objective of this study was to assess the burden of endometriosis by obtaining patient-reported outcome data describing the experience of living with this disease. Survey data from 107 women with self-reported, surgically diagnosed endometriosis showed that living with this disease may be characterized by physical limitations that disrupt health, work, and daily life.

Keywords: Endometriosis; patient-reported outcomes; pelvic pain; menstrual pain; infertility; work performancehttps://www.sciencedirect.com/science/article/pii/S0015028209036966