Which symptom is consistent with a diagnosis of endometriosis?

Dysmenorrhea, or painful menstruation, is a hallmark symptom of endometriosis. In this condition, the endometrial-like tissue grows outside the uterus, causing inflammation and scarring. This tissue responds to hormonal fluctuations of the menstrual cycle, leading to significant pain. The pain in endometriosis may begin before menstruation and can last several days, often becoming more intense during menstruation itself.

Patients with endometriosis frequently report that their dysmenorrhea is severe and does not respond well to nonsteroidal anti-inflammatory drugs (NSAIDs), which are commonly used to relieve menstrual pain. This unresponsiveness to NSAIDs is particularly telling in differentiating endometriosis-related dysmenorrhea from typical menstrual cramps, which often respond adequately to these medications.

In contrast, the other choices—having a history of pelvic inflammatory disease, experiencing abdominal bloating before menses, or an atypical Pap smear—are either nonspecific symptoms or associated with different conditions and do not directly indicate the presence of endometriosis. While pelvic inflammatory disease can contribute to chronic pelvic pain, it is not a defining symptom of endometriosis. Similarly, abdominal bloating can result from various factors unrelated to this condition, and atyp