The typical history is of pain which increases premenstrually, and severe dysmenorrhoea with the least pain in the follicular phase.
Clinical findings in endometriosis are markedly variable. In mild cases, routine gynaecological examination is likely to reveal no abnormality. A common feature of bimanual pelvic examination is that of discomfort, especially if performed during the premenstrual phase. It may be possible to palpate induration and tenderness in the uterosacral ligaments when these are involved (Figure 4.1). These features are demonstrated perhaps most clearly by a combined vaginal and rectal examination. If the pouch of Douglas is involved extensively, the uterus will become fixed in retroversion, and the adnexa will appear immobile.