Severe Pain During Menstruation is Not “Normal”

What are common symptoms of endometriosis?

Symptoms vary. The most common symptom is pelvic pain, especially pain that gets worse around the menstrual cycle. Many patients describe severe cramps, pain with intercourse, pain with bowel movements or urination, bloating, fatigue, low back pain or pelvic pain that continues even outside the period. Some patients also have heavy or irregular bleeding.

I always tell patients: Periods can be uncomfortable, but they should not be disabling. If pain is affecting your life, it needs to be evaluated. Women should seek care if their periods are very painful, getting worse, causing them to miss school or work, or requiring frequent medication just to function.

What risk factors might point to an endometriosis diagnosis?

A family history of endometriosis is one of the main risk factors. I also become more concerned when a patient has painful periods that started young, pain that is getting worse over time, chronic pelvic pain, infertility, ovarian cysts called endometriomas or bowel and bladder symptoms that flare during the menstrual cycle.

How can endometriosis affect fertility, quality of life and long-term health?

Endometriosis can affect fertility by causing inflammation, scar tissue, adhesions, ovarian cysts and distortion of the fallopian tubes or pelvic anatomy. It can make it harder for the egg, sperm and embryo to function normally. It can also have a major impact on quality of life. Patients may miss school, work, exercise, social activities and intimacy because of pain or fatigue. In the long term, endometriosis is a chronic inflammatory condition.

Why is this condition widely misunderstood?

It is misunderstood because painful periods are often normalized. Many women are told for years that severe cramps are “normal,” but pain that interferes with daily life should not be ignored. Another reason is that endometriosis can mimic other conditions, such as irritable bowel syndrome, bladder pain, ovarian cysts, pelvic floor dysfunction or musculoskeletal pain.

Endometriosis is an estrogen-sensitive inflammatory condition. Tissue, like the uterine lining, grows outside the uterus and can implant on pelvic organs such as the ovaries, fallopian tubes, bowel surface, bladder area or pelvic sidewall. These implants can trigger inflammation, attract nerve fibers, form scar tissue and adhesions, and sometimes create ovarian cysts called endometriomas.

The exact cause is not fully understood. Retrograde menstruation, where menstrual blood flows backward through the tubes into the pelvis, may contribute, but it does not explain everything. Immune system dysfunction, genetics, inflammation, stem-cell changes and hormonal factors likely also play a role.

How is an endometriosis diagnosis made?

Diagnosis starts with listening carefully to the patient’s symptoms. I look at the pattern of pain, whether it is related to the menstrual cycle, whether there is pain with intercourse, bowel movements, urination or infertility, and whether symptoms are progressing.

A pelvic exam and ultrasound can be helpful. MRI can be useful when deep disease is suspected. The definitive diagnosis is still made with laparoscopy and biopsy, but in many cases, we can start treatment based on a strong clinical suspicion.

What are the treatment options for this condition?

Treatment depends on symptoms, age, fertility goals, severity of disease and what the patient has already tried. Medical options include anti-inflammatory medications, birth control pills, progestins and hormonal IUDs. Surgery may be needed when pain is severe, medical treatment is not working, fertility is affected, or there are endometriomas or significant scar tissue. The goal of surgery is to remove the endometriosis, restore anatomy when possible, and improve pain and function. I also think pelvic floor physical therapy, lifestyle changes, nutrition and long-term follow-up can be very important because this is a chronic condition.