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Endometriosis And Periods

Written by Endometriosis UK.

The symptoms of normal period pain and endometriosis can be very similar, and when both conditions cause pain, it can be difficult to tell the two apart!

Let’s find out more about period pain and endometriosis, their symptoms and when to seek help.

Curious About The Differences?

It can be really difficult to diagnose endometriosis as symptoms can differ from person to person, and the amount of endometriosis present does not always match the level of pain or symptoms experienced. Some people may have symptoms that have a significant impact on their day-to-day life, others may have no symptoms at all. Period Pain or Endometriosis?

It’s normal to experience mild pain, cramps or discomfort before and during your periods, this is because hormone-like substances are released from the uterus called Prostaglandins. These substances cause the muscles surrounding the uterus (womb) to contract and these contractions cause the lining of the uterus (endometrium) to shed…this is your period.

The medical term for moderate to severe period pain is dysmenorrhoea and for many, period pains can feel like a mild but dull ache lasting 1-2 days, generally no treatment is needed, but if necessary pain relief such as paracetamol or ibuprofen can be taken. For others, period pain can be more intense and last longer, this is often referred to as secondary dysmenorrhoea and this may stop someone from doing their usual activities and should be checked out by your doctor.

Although period pain is a condition in its own right it can also be a symptom of endometriosis and it’s important to understand the difference, as not everyone experiencing period pains will have endometriosis.

Common symptoms of period pains are:

  • Cramps or pains in your tummy around the time of a period.
  • Pain in your lower back or thighs around the time of a period.
  • Feeling sick. (nausea)

Endometriosis pain is caused by endometriosis tissue that is found outside of the uterus. Even though the uterus will still contract during a period, for those with endometriosis the symptoms are usually more severe, affecting other pelvic organs and leading to other symptoms such as:

Common Endometriosis symptoms are:

  • Pelvic pain.
  • Painful periods that interfere with everyday life.
  • Pain during or after sex
  • Painful bowel movements
  • Pain when urinating/peeing.
  • Difficulty getting pregnant.
  • Fatigue

We recommend seeing your GP if one or more of these symptoms are experienced on a regular basis, letting your doctor now that you suspect you may have endometriosis.

Understanding Endometriosis And Periods

The menstrual cycle is controlled by the hormones, oestrogen and progesterone.  A surge in oestrogen causes the lining (Endometrium) of the uterus to thicken and triggers ovulation, progesterone prepares the lining of the uterus for implantation should an egg be fertilised. If however, fertilisation does not take place, a fall in oestrogen and progesterone causes the lining of the uterus to be shed, this is your period.

Endometriosis is also triggered by oestrogen , however for those with this condition cells similar to the ones in the lining of the uterus are found elsewhere in the body. Each month these cells react in a similar way to those in the uterus, building-up and then breaking down and bleeding. However, unlike the tissue and cells in the uterus that leave the body as a period, the cells that have attached to other areas in the body when endometriosis is present have no way to escape, and this can cause inflammation, pain and scar tissue.

Endometriosis Where Is The Pain

Endometriosis tissue can be found in the ovaries, fallopian tubes and other pelvic organs like the bowel or bladder. It can also be found in your vagina or rectum leading to symptoms of pelvic pain. In some cases, endometriosis can be found outside the pelvis area and in places such as the chest. And because Endometriosis is oestrogen fed, it can affect you from puberty to menopause, although for many the impact and pain may be felt for life.

Endometriosis – When To See A Doctor?

If period pains are affecting everyday life, causing time off school, studies or work then you should seek help and speak to your GP.  If you feel you may have symptoms of endometriosis, then it is important to seek medical advice to investigate the cause. It’s also important to discuss any changes to your symptoms with your doctor. 

It can be easy to relate all period problems to endometriosis, but it may not always be the reason for painful periods, and an endometriosis diagnosis should always come from a medical professional, once tests and investigations have been completed.

Endometriosis Diagnosis And Treatment Options

The only way to be certain you have endometriosis is to have an operation called a laparoscopy, and a biopsy. This is known as a definitive diagnosis. During a laparoscopy the surgeon will use a small camera called a laparoscope to look inside the abdomen (tummy) for signs of endometriosis tissue.  The surgeon will then take a small sample of this tissue for analysis, this is known as a biopsy.

While some types of endometriosis can be detected and diagnosed through scans, it's important to note that not all types will appear on scans. Therefore, it's possible to have endometriosis and receive a negative scan result. This is because endometriosis can vary in appearance and location within the body, making it challenging to detect through imaging alone.

Endometriosis treatment should be discussed and agreed by you and your doctor. The type of treatment you have will depend on your own needs and priorities. The options of treatment include:

Surgery - Surgery can confirm your diagnosis and treat endometriosis. This is usually done via laparoscopy (keyhole surgery), surgical equipment is used to cut away (excise) or destroy the endometriosis.

Pain Management - Pain is the most common symptom of endometriosis and pain management is an important part of managing your condition. Pain management can include using painkillers such as paracetamol, ibuprofen or using medication that manages nerve pain.

Hormone treatment - Help control the growth of endometrial tissue. Hormone treatments work by preventing the lining of the uterus and any endometriosis tissue from growing quickly. Some treatments work by causing a ‘medical’ menopause where the ovaries stop functioning. These  treatments are temporary and are reversed once someone decided to stop taking the hormones.

When chatting to your doctor it’s also crucial to discuss the potential benefits, risks, and side effects of each treatment option to determine the most suitable approach for your individual situation. Additionally, lifestyle changes such as regular exercise, a healthy diet, and stress management techniques may also help alleviate symptoms and improve overall well-being.

Normal Period Pain vs. Endometriosis: Seeking Support

It’s important to recognise the symptoms of painful periods and endometriosis. Painful periods and endometriosis can be helped with the right diagnosis and treatment, don’t suffer in silence!

The first step to getting a diagnosis is to seek medical assistance by visiting your GP and whilst they cannot always diagnose endometriosis for certain, they can help identify symptoms, offer you treatment and refer you to a gynaecologist to investigate your symptoms further.

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Frequently Asked Questions on Endometriosis

What does endometriosis pain feel like?

Endometriosis pain can be different for different people. Pain is usually felt within the lower abdomen (tummy), back, hips and thighs. Pain can increase around the time of a period. Pain can be sharp, constant, and crampy. Pain may also be felt during or after sex or with toileting and can cause bloating.

Does endometriosis only hurt during your period?

No, some may only have pain and symptoms around the time of their period. Others may have experience pain outside of a period and some may experience pain daily.

Does period pain cause endometriosis

No, period pain does not cause endometriosis, period pain is a symptom of endometriosis.

Is period pain always endometriosis?

No, period pain can be a symptom of other conditions not just endometriosis. Some other conditions that may cause period pain are, fibroids, ovarian cysts and pelvic inflammatory disease. Some people may experience painful periods (dysmenorrhoea) without any other cause.

Does Endometriosis cause infertility?

Endometriosis does not necessarily cause infertility but there is an association with fertility problems, although the cause is not fully established. Even with severe endometriosis, natural conception is still possible. It is estimated that 60-70% of those with endometriosis can get pregnant spontaneously.

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