What Is Endometriosis?When Period Pain Is More Than Cramps

You’ve called in sick on day two of your period more times than you can count. You’ve taken ibuprofen, used a heating pad, lain on the bathroom floor. You’ve been told it’s cramps, that it’s normal, that some women have it bad. You’ve started to believe that you’re the problem.

What it can feel like

OWH¹ lists severe menstrual cramps that may worsen over time, chronic lower back and pelvic pain, and deep pain during sex. The NHS² describes severe period pain that stops you doing normal activities, and heavy periods where you need to change pads or tampons every 1 to 2 hours. Beyond your period, the NHS lists pelvic discomfort, pain when you poo or pee, pain during sex and significant fatigue, plus fertility and mental health effects.

Cleveland Clinic³ says the most common symptom is pelvic pain that can range from mild to intense, and adds heavy bleeding or spotting between periods, and bowel and bladder issues. It also says you can have no symptoms at all.

The NHS² notes that in rare cases, endometriosis causes pain or bleeding in other places, such as the chest, which may cause shortness of breath and coughing up blood.

If your cramps are the main issue, see period cramps. For bleeding, see heavy periods and spotting. If sex hurts, dryness is one cause to look at, and bladder pain has its own article, interstitial cystitis.

Why it takes so long to diagnose

The NHS² says diagnosis is often delayed because the symptoms can be similar to other conditions, such as adenomyosis, fibroids, pelvic inflammatory disease and irritable bowel syndrome. And the NHS says it’s not known what causes endometriosis. Cleveland Clinic³ says researchers are looking at retrograde menstruation, immune system conditions and hormone disorders, and that there’s a genetic link: if your mother, grandmother or sister has it, tell your provider.

OWH¹ says it’s most frequent in women ages 30 to 40.

How it’s confirmed

The NHS² says a GP does an exam and blood tests, and may refer you to a gynaecologist. Ultrasound and MRI can be used. OWH¹ and Cleveland Clinic³ both say laparoscopy, a surgery where a small camera looks inside the pelvis, is the only definitive way to diagnose it. The NHS says a laparoscopy can confirm endometriosis. OWH adds that doctors may also try hormonal medicine to see if symptoms improve.

What treatment looks like

The NHS² and OWH¹ both say there’s no cure, but treatment can help manage symptoms like pain. The options on the lists:

• Pain medicine. Over-the-counter painkillers, per OWH¹ and Cleveland Clinic³.
• Hormonal medicine. Hormonal birth control, per the NHS², OWH¹ and Cleveland Clinic³, and GnRH medicines, which OWH and Cleveland Clinic list.
• Surgery. The NHS² describes removal of the lesions, up to hysterectomy. Cleveland Clinic³ says surgery can relieve pain and improve fertility.

Cleveland Clinic³ says that yes, you can get pregnant, but it may be more challenging than for people without endometriosis.

The play

Try this: a pain and period diary

For two or three cycles, write down the days of your period and the pain level each day from 0 to 10.

Count how often you change your pad or tampon on heavy days, and note when pain hits outside your period, and with sex, peeing or pooping.

Add missed work, school or plans, and anything that helped. The NHS² says symptoms affecting everyday life, work and relationships are the reason to see a GP, and the diary shows it.

When to get checked

Don’t wait if

1. Urgent

   If you have pain or bleeding in your chest with shortness of breath or you cough up blood, get care right away. The NHS² lists these as rare signs of endometriosis outside the pelvis.

The NHS² says to see a GP if you suspect endometriosis, if your symptoms affect your everyday life, work and relationships, or if your treatment isn’t working. Cleveland Clinic³ says to contact a provider for pelvic pain or heavy, long periods. OWH¹ adds severe menstrual pain, chronic pelvic discomfort, fertility difficulties or unusual bleeding.

Book an appointment if any of these fit:

• Period pain keeps you from your normal activities
• You change pads or tampons every 1 to 2 hours on heavy days
• You have pain with sex, peeing or pooping
• You’ve been trying to get pregnant for a while without success
• A close relative has endometriosis
• Pain medicine and hormonal birth control haven’t helped

You didn’t make this up. Take the diary, say the word “endometriosis” out loud, and ask whether it’s been considered.