Endometriosis Symptoms: Painful Periods, Pelvic Pain and Next Steps

What it involves

MedlinePlus explains that endometriosis occurs when cells like those lining the uterus grow in other places in the body, such as the ovaries, fallopian tubes, bowel, bladder and the lining of the pelvis. These growths react to monthly hormones and can cause pain, heavy bleeding, bleeding between periods and trouble getting pregnant. MedlinePlus says about 10% of women of reproductive age have it.

Who this is for

• Women whose period pain is strong enough to disrupt work, school or daily life.
• Patients with pelvic or low back pain lasting months, with or without a link to their cycle.
• Women with pain during sex, with bowel movements or when urinating around their period.
• Women who have had trouble getting pregnant and want a primary care starting point.

What to expect

• Questions about your cycle, how heavy it is, when pain starts and what it keeps you from doing
• A review of your history, including whether a mother or sister has had endometriosis
• A physical exam, and blood work or urine testing to rule out other causes of pelvic pain
• A referral to a gynecologist for pelvic ultrasound, MRI or laparoscopy when the symptoms call for it

Pain is the main symptom

MedlinePlus lists cramps or lower belly pain that may start a week or two before a period, pain during or after sex, pain with urination, pain with bowel movements, and pelvic or low back pain lasting six months or more. Other signs include heavy bleeding, bleeding between periods and infertility. Pain does not always match how much tissue is present: some women with a lot have no pain and some with mild disease have severe pain. The abdominal pain guide and low back pain guide describe other causes of the same complaints.

Who is more likely to have it

MedlinePlus says endometriosis probably starts when periods begin but is usually diagnosed between ages 25 and 40. You are more likely to develop it if your mother or sister has it, if you started your period at a young age, if you never had children, or if your periods are frequent or last seven or more days. Its cause is unknown, and it sometimes runs in families. Knowing your family history helps a provider decide how seriously to take a pattern of painful periods.

Other causes a provider checks first

Pelvic pain has many sources, including urinary infections, bowel problems, ovarian cysts and hormone changes. Heavy periods can also cause iron loss, and the anemia and low iron guide explains how that shows up on blood work. Fatigue is common when pain, poor sleep and low iron combine, and the fatigue guide describes what a provider checks. A urine test, described in the urinalysis guide, helps rule out an infection as the source of pelvic pain.

How endometriosis is confirmed

According to MedlinePlus, a provider does a physical exam including a pelvic exam, and testing may include a transvaginal ultrasound, an MRI, or a pelvic laparoscopy, a small-incision surgery that can also remove growths. These are specialist services, so Serenity By A Dr. Sareen arranges them by referral rather than performing them. Bringing a few months of notes on pain, bleeding and cycle dates makes the first gynecology visit faster and more useful.

Treatment options MedlinePlus describes

There is no cure, but symptoms can be managed. For mild symptoms MedlinePlus lists exercise, relaxation techniques and over-the-counter pain relievers. Hormone therapy, including birth control pills, progesterone, and medicines that lower estrogen, can stop the disease from getting worse for women who are not trying to get pregnant. Surgery is considered when pain is severe and other treatments do not help. Which option fits depends on age, severity and whether you want to become pregnant, which is a conversation for your gynecologist.

Living with it and staying checked

MedlinePlus says hormone treatment often brings symptoms back when it stops, while surgery may help for years, and that not every woman is helped by every treatment. Regular exams every six to twelve months let a provider follow the disease. Gonadotropin-agonist medicines can weaken bones if used long term, so bone health matters; the bone density screening guide explains that testing. A primary care visit keeps your overall health, mood and sleep in view while a specialist handles the gynecologic side.

Sources

• MedlinePlus: Endometriosis (health topic)
• MedlinePlus: Endometriosis (medical encyclopedia)