Maria Sophocles, MD: Telling Signs of Endometriosis


Why any physician needs to have a strong sense of a patients' clinical history to distinguish endometriosis symptoms.

Yes, there’s clinical and genetic indications pointing a patient to being at risk for endometriosis. But the condition is not always an open-shut diagnosis.

In an interview with MD Magazine®, Maria Sophocles, MD, medical director of Women’s Healthcare of Princeton, explained how tracking a patients’ symptoms as much as they do their clinical history are critical for physicians to catch endometriosis sooner than later.

MD Mag: What signs or symptoms should physicians be looking for in possible endometriosis?

Sophocles: So, if you have a patient who comes to your office, and she's complaining of pain with menses, we call that dysmenorrhea and that could be endometriosis. But when a patient tells you that the week before her period, she begins to have pain—and the pain is severe—7 to 10 days before the period, and then once she begins to menstruate the pain improves, this is suspicious for endometriosis. This is those implants beginning to be fed by estrogen, beginning to grow, swell, and cause pain.

When a patient tells you she's had issues with infertility, she has had visits to pain clinics, and no one can find anything, that she's had ultrasounds and no one can find anything—these are also big red flags for endometriosis. Because endometriosis is really a two-dimensional disease. It's endometrial implants, with the endometrium being located outside the uterus, and it doesn't really show up on ultrasound unless it's developed in the ovary.

Women can have a particular type of cyst within the ovary filled with endometriosis, and that does have a particular appearance on ultrasound. But that's a fairly advanced case of endometriosis, and unless you see that, your pelvic ultrasound may look perfectly normal. So just because you have an unremarkable pelvic ultrasound, do not, as a clinician, believe that your patient might not have endometriosis.

It really takes a little bit better history-taking to understand what else is going on. We know the risks of endometriosis. There is a genetic predisposition. We know that women that have heavier, shorter cycles are at increased risk of endometriosis. There's even a link between endometriosis and asthma.

So it's important that if you suspect it, but you don't feel sure about how to make the diagnosis, to refer that patient to an OB/GYN. Or if you're an OB/GYN and you're not sure, refer that patient to someone with extra training. I mean, there are clinics and endometriosis clinics. Find someone in your community who has a particular expertise because it's too important to not miss. And many women with endometriosis end up not getting properly diagnosed until their fourth, fifth, or sixth physician.

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