Endometriosis typically presents with pain that begins when relative to the menstrual cycle?

• A. 1-2 weeks before menses and resolves with onset of menses
• B. During ovulation
• C. After menopause
• D. Unrelated to menses

Answer: (A)

Endometriosis causes pelvic pain that is tied to the menstrual cycle because ectopic endometrial tissue responds to the same hormonal signals as the uterus. In the luteal phase, about 1–2 weeks before menses, hormonal fluctuations stimulate this ectopic tissue, leading to inflammation and pain. When menses begins, the hormonal stimulus drops and the activity of the implants decreases, often causing the pain to resolve with the onset of menses. This premenstrual pattern is a classic clue for endometriosis.