Monthly Recurrence of Pelvic Pain, Nausea, Vomiting, and Diarrhea

Published:September 20, 2021DOI:


      • Recurring nausea, vomiting, and diarrhea associated with pelvic pain could be associated with endometriosis.
      • Endometriosis is often misdiagnosed, resulting in a delay of true diagnosis and treatment.
      • Diagnostic imaging may include transvaginal ultrasound.
      • Medical management often includes nonsteroidal anti-inflammatory drugs, hormonal contraceptives, and, if necessary, surgical removal of lesions.


      This is a case study describing a young woman with a chief complaint of intermittent nausea, vomiting, diarrhea, and fluctuating pelvic pain. She was initially evaluated in the emergency department and treated for a viral illness after a “negative” workup. Her symptoms worsened and were recurrent. Knowledge of the vast variable symptomatology in the presentation of endometriosis is essential to identify, diagnose, and treat patients who are often misdiagnosed.


      To read this article in full you will need to make a payment


      Subscribe to The Journal for Nurse Practitioners
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Agarwal S.K.
        • Chapron C.
        • Giudice L.C.
        • et al.
        Clinical diagnosis of endometriosis: a call to action.
        Am J Obstet Gynecol. 2019; 220: 354.e1-354.e12
        • Ghiasi M.
        • Kulkarni M.T.
        • Missmer S.A.
        Is endometriosis more common and more severe than it was 30 years ago?.
        J Minim Invasive Gynecol. 2020; 27: 452-461
        • Treloar S.A.
        • Bell T.A.
        • Nagle C.M.
        • Purdie D.M.
        • Green A.C.
        Early menstrual characteristics associated with subsequent diagnosis of endometriosis.
        Am J Obstet Gynecol. 2010; 202: 534.e1-534.e6
      1. National Institute for Health and Care Excellence. Overview | endometriosis: Diagnosis and management | guidance | nice. 2017. Accessed July 1, 2021.

        • Zondervan K.T.
        • Becker C.M.
        • Missmer S.A.
        N Engl J Med. 2020; 382: 1244-1256
        • Hall J.E.
        Menstrual disorders and pelvic pain.
        in: Jameson J.L. Fauci A.S. Kasper D.L. Hauser S.L. Longo D.L. Loscalzo J. Harrison’s principles of internal medicine. 20th ed. McGraw-Hill Education, New York, NY2018
        • Papadakis M.A.
        • McPhee S.J.
        • Bernstein J.
        • Endometriosis
        Quick Medical Diagnosis & Treatment 2020.
        McGraw-Hill Education, 2020
        • Nnoaham K.E.
        • Hummelshoj L.
        • Webster P.
        • et al.
        Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries.
        Fertil Steril. 2019; 112: E137-E152
        • Nisenblat V.
        • Bossuyt P.M.
        • Farquhar C.
        • Johnson N.
        • Hull M.L.
        Imaging modalities for the non-invasive diagnosis of endometriosis.
        Cochrane Database Syst Rev. 2016; 2: CD009591
        • Dunselman G.
        • Vermeulen N.
        • Becker C.
        • et al.
        ESHRE guideline: management of women with endometriosis.
        Hum Reprod. 2014; 29: 400-412
        • Falcone T.
        • Flyckt-Rebecca R.
        Clinical management of endometriosis.
        Obstet Gynecol. 2018; 131: 557-571
        • Jensen J.T.
        • Schlaff W.
        • Gordon K.
        Use of combined hormonal contraceptives for the treatment of endometriosis-related pain: a systematic review of the evidence.
        Fertil Steril. 2018; 110: 137-152.e1


      Catherine Nadeau, DNP, FNP-BC, CCRN, CNE, is an assistant professor at the University of South Florida in Tampa and can be contacted at [email protected] .


      Stephen McGhee, DNP, MSc, PGCE, RNT, VR, FAAN, is an assistant professor of clinical at Ohio State University in Columbus.


      Juan M. Gonzalez DNP, AGACNP-BC, ENP-C, FNP-BC, CEN, CNE, is an associate professor of clinical at the University of Miami in Coral Gables, FL.