When Monthly Pain Isn't Normal

January 18, 2010

It’s hardly newsworthy that many women experience pain and discomfort during menstruation. In the majority of cases, menstrual pain – known by the medical term  dysmenorrhea – is a normal part of the menstrual cycle and doesn’t indicate the presence of disease or require follow-up medical treatment. But many women’s painful periods are caused by endometriosis.

PAINFUL PERIODS - When monthly pain isn’t normal

Many women’s painful periods are caused by endometriosis, a treatable condition.

It’s hardly newsworthy that many women experience pain and discomfort during menstruation. In the majority of cases, menstrual pain – known by the medical term  dysmenorrhea – is a normal part of the menstrual cycle and doesn’t indicate the presence of disease or require follow-up medical treatment.

But not all menstrual pain is normal. For women who suffer from endometriosis, the onset of each menstrual cycle marks the beginning of several days of intense, persistent pain that can severely impact their daily activities and make life very unpleasant. And in the longer term, endometriosis can cause infertility in some women, while others who are still able to conceive have greater difficulty carrying a pregnancy to full term.

Endometriosis explained

Endometriosis describes a condition that affects many teenage and adult women during their childbearing years, where clumps of tissue (called implants) that normally grow only inside the uterus, also grow outside the uterus. Implants are most often found on the ovaries, fallopian tubes, the outer wall of the uterus, the intestines, or other organs in the abdomen.

Although these endometrial cells grow in the ‘wrong’ location, they function like those in the uterus and are shed each month. As Dr. Poonsak Waikwamdee, a board certified obstetrician/gynecologist, explains, “Endometrial cells are shed, but unlike those in the uterus, they can’t be flushed out of the body through menstrual flow, so they remain in place and cause abnormal conditions such as severe pelvic pain, uterine scars and ovarian cysts, sometimes called chocolate cysts.”

The medical community is still trying to pinpoint the precise cause of endometriosis. Years of research have shown a correlation with the female hormone estrogen, as most endometriosis patients experience symptoms only during their childbearing years, with symptoms usually disappearing after the onset of menopause. 

It’s difficult to estimate how many women have endometriosis. In many cases, women may have the condition but experience only mild symptoms – or no symptoms at all. Of diagnosed patients, around 30 - 40 percent become infertile, leaving them unable to become pregnant.

Symptoms, diagnosis and treatment

Endometrial symptoms tend to vary from one patient to another. Symptoms range from none at all to mild, moderate or severe. “In some cases, symptoms can become more severe as time goes by until they begin to affect a patient’s everyday activities,” says Dr. Poonsak. “Pelvic pain during menstruation can become severe enough to make it very difficult for patients to move around comfortably and go about their normal activities. Patients with more severe symptoms tend to see their doctor and are fairly easy to diagnose as having endometriosis; among women with only mild or no symptoms, it’s more likely their endometriosis will only be found during another medical procedure such as an annual check-up, when being tested for infertility, or during preparations for other surgical procedures.”

The most common symptoms of endometriosis include: 
  • Menstrual pain and/or severe abdominal cramps during at least the first few days of the onset of menstruation. Patients with the most severe pain sometimes feel as if they have a high fever, and some women also report feeling breast tenderness and lower back pain;
  • Pain in the pelvic area, or in areas with endometrial implants, during other times of the month. Some patients experience a dull, aching pain in those areas, a stabbing-type pain during intercourse, or pain during urination or defecation;
  • Excessive menstrual bleeding or longer menstrual periods lasting more than one week;


A large number of patients only discover their endometriosis after seeing their doctor because of difficulties becoming pregnant. “Patients may have one or more of these symptoms,” Dr. Poonsak explains. “They may experience different types and different degrees of pain. The pattern, duration and severity can vary greatly among individual patients.”

Diagnosing endometriosis is fairly straightforward, with the choice of diagnostic tool usually depending on the type and severity of a patient’s symptoms. “The severity of a patient’s symptoms doesn’t always reflect the severity of the disease,” notes Dr. Poonsak. “When a patient reports symptoms that fit the endometriosis profile, the doctor may perfora pelvic exam, examine the affected area using ultrasound, or conduct a laparoscopic examination for a more precise diagnosis.”

To formulate a successful treatment plan, doctors weigh several factors that tend to vary from one patient to another. “If the patient only needs pain relief, the doctor may prescribe non-steroidal anti-inflammatory drugs, contraceptive pills or hormone analogs to help reduce or slow the growth of the lining of endometrial cells,” explains Dr. Poonsak. “If the patient also wishes to enhance her fertility, surgical treatment may be the best course of action to remove the irregular cell linings and scar tissue – though recurrence is common and to be expected.”

In the small percentage of cases where the patient experiences severe symptoms that include ongoing bleeding, and after other treatments prove unsuccessful, the “last resort” treatment option is the surgical removal of the uterus and ovaries in order to stop the production of hormones that would otherwise stimulate a recurrence of the condition. This choice must be considered carefully, as the surgery makes becoming pregnant impossible.

She who hesitates . . .

Many women don’t realize that they have endometriosis, as any symptoms they may have can be mild and appear to be a normal part of menstruation. But the symptoms may become more intense over time. “Many women wait until their symptoms progress before seeing their doctor,” Dr. Poonsak notes. “Your doctor can’t help unless he or she is aware of your symptoms. Consulting your doctor can be particularly helpful for women who haven’t yet had a child but are planning to become pregnant, as pregnancy and breast feeding may help reduce the irregular lining of endometrial cells.”

With a number of advanced treatments proving successful, earlier diagnosis usually means earlier pain relief, and a faster return to a better quality of life.

These symptoms require professional care:
  • Sharp, acute pelvic pain;
  • Menstrual pain that hasn’t occurred before;
  • Pelvic pain during intercourse;
  • Pelvic pain or bleeding during urination;
  • Severe pelvic pains that interfere with one’s daily routine;
  • Rectal bleeding upon defecation;
  • Unexplained constipation or diarrhea;
  • Failed attempt to become pregnant during prior 12 months.
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