It's Not Normal: Your Painful Periods Might be a Sign of Endometriosis or Adenomyosis
Updated: Jul 25, 2019
Is your period pain disrupting your day? Have you missed work or school because of the pain? Have you been told this intense pain is normal?
If not you, then it's likely you know someone who suffers from abnormally painful periods.
While a woman's period is rarely described as "comfortable", period-associated pain that disrupts life is not normal. In fact, heavy, painful periods, as well as painful intercourse, may actually be symptoms of endometriosis or adenomyosis. Endometriosis and adenomyosis are not only responsible for intense pelvic pain, but are also important causes of infertility. Given all these factors, these conditions are significant health concerns.
Unfortunately, many women suffering from endometriosis and adenomyosis (and they can co-occur) have no idea these conditions actually exist.
Part of raising awareness about these conditions is knowing they exist and learning about the symptoms. Scan through any thread on Twitter about endometriosis and you'll find plenty of frustration from women who have suffered from intense pelvic pain for years and were dismissed by their doctors.
There is understandably a lot of outrage about the normalization of women's pain by doctors. In particular, the average length of time it takes to get an endometriosis diagnosis is difficult to understand (it's about 7 years).
But what can we do to fix this?
I read the following in an article the other day that really stuck with me: "Maybe frank conversations in popular culture can help to change the way women’s bodies are perceived and treated medically."
I'm going to start doing this, and I hope you'll join me.
As awkward and uncomfortable as it is, we're not going to change the situation if we can't talk about women's periods and the very serious health problems women suffer from. Endometriosis and adenomyosis are not cancer and maybe that's why they are not always taken seriously. But they should be.
This is not just a call for women - we need men too. These are your mothers, your sisters, your wives, your girlfriends, and your friends. These conditions may even impact your ability to have children someday.
I recently teamed up with clinicians to help start a conversation about endometriosis and adenomyosis. Throughout this article, I've provided links to a video of my conversation with specialists about the diagnosis, treatment, and fertility effects of both endometriosis and adenomyosis. A lot of questions that often come up regarding these conditions are answered in the video, so be sure to check it out. You can also watch it in full at the bottom of this page.
What is endometriosis?
About 10% of women suffer from endometriosis, which occurs when the tissue that lines the uterus (the endometrium) is found outside the uterus, often attached to pelvic organs like the bowel, ovaries, or bladder.
But how does this tissue get outside the uterus?
Every month, one of the two ovaries (where the eggs are stored) releases an egg into the corresponding Fallopian tube, which leads to the uterus. Once in the uterus, the egg waits for a few days to be fertilized. During this time, the tissue that lines the uterus, the endometrium, thickens to prepare for implantation of a fertilized egg. However, if the egg is not fertilized, a woman will menstruate (aka have her period), which is the shedding of that thickened endometrium. Once menstruation is complete, the cycle begins again.
Unfortunately, is is not known how endometrial tissue gets outside the uterus and into the abdominal cavity. However, one of the most popular ideas is through retrograde menstruation, which is when menstrual fluid (which includes endometrial tissue) flows backward. In this case, instead of exiting the body through the cervix and vagina, it goes backward through the fallopian tubes, which are open-ended. Endometrial tissue in the retrograde fluid can then attach to pelvic organs. There, it can actually grow, thicken, and bleed as though it was still in the uterus.
Endometriosis can currently only be definitively diagnosed by laparoscopic surgery, which is performed by putting a small camera through a small incision in the abdomen to look around the body cavity. To learn more about the diagnosis and treatment options for endometriosis, check out the diagnosis and treatment options tabs in the video.
What is adenomyosis?
If few people have heard of endometriosis, even less have heard about adenomyosis.
Adenomyosis occurs when those same endometrial cells that line the uterus invade and grow into the wall of the uterus. There is very little known about adenomyosis and how it develops, largely due to the fact that it used to only be diagnosed by hysterectomy (surgical removal of the uterus). However, experienced clinicians are now able to diagnose adenomyosis using ultrasound. For more details about adenomyosis, check out the "What is?" tab in the video (~1:13).
What happens when you have endometriosis or adenomyosis?
The main symptom of these conditions is pain (often quite extreme) that coincides with menstruation, which is typically referred to as cyclical pain. Since it is not understood what the actual cause of the pain is, it is difficult to treat with something more targeted than painkillers.
We don't usually connect gastrointestinal issues with a woman's period. But what some don't realize is that patients with endometriosis may also experience bowel symptoms, which may mimic irritable bowel syndrome or inflammatory bowel disease. Without knowing about the potential of endometriosis, these types of symptoms can significantly complicate diagnosis.
Finally, endometriosis and adenomyosis can impact fertility. Many women with these conditions experience difficulty with pregnancy, or are infertile. Check out the video here or below to learn more about infertility related to these conditions. Find information related to fertility under the "What causes the pain?" tab (~1:30).
While I can discuss a general overview of endometriosis and adenomyosis, I am not a clinician and I wanted their expertise. Below is the entire video of my discussion with two specialists. I encourage you to watch it in whole as it answers in detail a lot of the questions I had, and provides some insight into why these conditions are so difficult to diagnose and treat.
Can't see the video in your web browser? Find it here.
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