I Have Really Painful Periods. How Do I Know If I Have Endometriosis?

Q: I have really painful periods. How do I know if I have endometriosis?

A: The lining of the uterus, which is called the endometrium, thickens with your cycle, responding to normal hormonal shifts every month. The endometrium is then shed when women menstruate.

Endometriosis is a condition where deposits of that endometrial tissue happen outside of the uterus where they don’t belong — on the ovaries for instance, or the fallopian tubes, or the bowel.

Since these tissue deposits can grow pretty much anywhere in the pelvis or even the abdomen, you can imagine the wide array of symptoms that result. One of the classical symptoms of endometriosis is painful periods, which can range from mild to moderate, but typically worsen over time. In some cases, the pain can be strong at the onset of a period, causing women to miss days of school or work. Pain can also occur outside of a woman’s period, lasting for longer stretches of time or even present as low back or abdominal pain. It may even feel like pain that is shooting down your leg, so nothing like typical lower abdominal menstrual cramps.

Women may have pain with intercourse, with bowel movements or with urination or experience abnormal menstrual bleeding patterns, or problems with fertility. Endometriosis can present as a collection of these symptoms, or just one. In other words, endometriosis can have a very broad array of symptoms, which can make it hard to recognize, both for women and their health care providers.

There also isn’t an easy test to confirm endometriosis. Pelvic examinations and ultrasounds are often appropriate but they don’t always yield answers. An ultrasound together with an MRI can be more specific. The gold standard for a diagnosis is a laparoscopic examination, which means surgery – something women should discuss thoroughly with their doctors.

Sometimes it’s appropriate to treat endometriosis without a surgical diagnosis, but other times surgery may be the right step toward treating symptoms – it depends on the individual case and how a woman has responded to medications, her interest in childbearing and the progression of the disease.

Endometriosis is often treated either with anti-inflammatory pain relievers or with a form of hormonal treatment which can include pills or an IUD – which obviously isn’t helpful to women trying to get pregnant. Surgery can be quite successful at removing the abnormal deposits, but it’s typically reserved for when women have had other failed, non-surgical attempts at trying to alleviate symptoms or they are trying to get pregnant.

If you are worried your symptoms are something more than normal menstrual pain, try to be specific about how your function is affected. Saying “I have pain” is one thing, but saying “25 days out of the month I jump out of bed in the morning and feel great, but 4 days out of the month I am flattened and cannot do the things I normally do,” is a better way to communicate the intensity and significance of pain.

When women work in partnership with their health care team to identify and treat endometriosis, there is a much better chance at diagnosing the problem earlier on, which means that treatment can begin sooner. It’s important to remember that endometriosis can nearly always be successfully diagnosed and managed.