Painful menstrual periods can be more than monthly menses. It also could be endometriosis.
Endometriosis is a common cause of pelvic pain and infertility in women, when “the uterus’ inner lining — the endometrium — ends up outside the uterus where it’s not supposed to be,” said Dr. Joseph Welter, a Marshfield Clinic OB/GYN.
Welter and his colleagues care for many patients with endometriosis and about 6 million women nationwide in reproductive ages have the disease. According to endometriosis.org, its cause remains unknown.
Classic endometriosis, Welter said, is mostly found in the pelvis but also can be in distant sites, like the lungs. It typically spreads when a woman has her period and endometrium sheds vaginally. Some works its way out through the fallopian tubes, the most common cause of spreading, and is diagnosed through laparoscopy and biopsy.
“The classic symptom is severe pelvic pain during periods,” Welter said. “It’s pain that can be debilitating and impact daily living to the point of missing work or school. It often correlates to the menstrual cycle but could happen at other times like before and after periods, during ovulation, bowel movements or passing urine during a period, and even pain with intercourse and in the lower back. It also can cause heavy bleeding.”
Symptoms don’t indicate severity. Some women have great pain but fewer lesions while some with many lesions have minimal discomfort.
What causes the pain?
Endometriosis responds to estrogen fluctuation through a woman’s cycle. Lesions grow in small, confined spaces and gradually enlarge, causing inflammation and pain.
“Normally, tissue is shed but in a confined, small space it stays and grows again in the next cycle,” Welter said.
Who’s at risk?
Endometriosis is more common in women in their reproductive years, from their first through their last period, and for women who’ve not had children, who have heavy periods or started having periods before age 12. At less risk are patients with multiple pregnancies, who have breastfed for long periods over six months and with onset of periods after age 14. If your mother or sister has endometriosis you have a slight increase in your chance of having it, too.
It can be linked to infertility because of scar tissue, adhesions and inflammation that could interfere with sperm and egg function. Women then may have to go through in-vitro fertilization to get pregnant.
Treatment is key
Symptoms are managed through child-bearing years with hormonal suppression, Welter said. “An unfavorable environment for endometriosis is created with hormonal contraception like birth control pills, Depo-Provera which contains a hormone preventing ovaries from releasing eggs and other progesterone delivery systems.”
Procedures may be needed to relieve symptoms, like cauterizing or removing lesions.
“Many times this provides relief and tides women over to menopause,” he said. In severe cases, the uterus, fallopian tubes and ovaries may be removed since they produce estrogen, a source for endometriosis. “This removes estrogen women may need, though, especially for those at risk for osteoporosis,” Welter said. “Ovaries are not removed without serious discussion and consideration.”
See your health care provider if you have severe and incapacitating periods and other symptoms.
“If you have symptoms it’s good to have it diagnosed so you can learn how best it can be treated,” Welter said.