Severe Period Pain — Is Endometriosis the Culprit?

What is dysmenorrhea?

Dysmenorrhea is the medical definition for menstrual cramps or painful periods. While not uncommon, you should visit your healthcare provider if you have severe or unusual menstrual cramps that are affecting your daily routine. There are 2 types of dysmenorrhea: primary and secondary dysmenorrhea.

Primary dysmenorrhea

The most common type of dysmenorrhea is primary dysmenorrhea, which is not caused by any underlying condition.  Primary dysmenorrhea is generally experienced one or two days before your period starts, usually remaining for two or three days before fading away.

Secondary dysmenorrhea

Secondary dysmenorrhea is generally caused as a symptom of an underlying medical condition, such as endometriosis or fibroids.  It usually begins earlier in the menstrual cycle and worsens over time, lasting longer than typical menstrual cramps. These painful periods could be caused by a medical condition or infection in your reproductive organs.

Possible underlying conditions for secondary dysmenorrhea include:

1. Endometriosis is when tissue similar to uterus lining grows in other places within your abdomen or pelvic area.

2. Adenomyosis occurs when endometrial tissue in the lining of the uterus grows into a muscular layer of uterus, causing severe pain and heavy bleeding during menses. 

3. Pelvic inflammatory disease (PID) is an infection of the ovaries, fallopian tubes and uterus. PID causes fever, pain in the lower abdomen and vaginal discharge. 

4. Fibroids (benign tumour) is a non-cancerous growth in the muscular layer of the uterus, which causes heavy bleeding during menses.  

How is dysmenorrhea treated?

Treatment for dysmenorrhea largely depends on the type of dysmenorrhea you have and the severity of your condition. Some common treatment modalities include:

• Pain relief medication — Nonsteroidal anti-inflammatory drugs (NSAIDS) and other forms of pain relief, such as acetaminophen, help manage symptoms of menstrual pain.

• Hormonal therapies — Hormonal fluctuations can be treated with oral contraceptives, intrauterine devices and hormonal implants, which in turn, reduces menstrual pain.

• Home remedies — Home remedies such as heat therapy via warm compression or hot bath can help relieve menstrual pain.

• Lifestyle changes — Limit caffeine and alcohol consumption as they can exacerbate menstrual pain. Avoid smoking as this can increase the severity of menstrual pain as well.

• Surgical intervention — In some instances, surgical intervention may be required to treat dysmenorrhea unresponsive to medication, especially for secondary dysmenorrhea.

What is endometriosis?

The endometrium is the inner lining of the uterus. Endometriosis is a condition where tissue similar to the endometrium grows outside of the uterus, such as the ovaries, fallopian tubes and, in rare cases, even the intestines. 

This leads to inflammation and fibrosis that can cause intense pain and discomfort. Ordinarily, endometriosis affects women between 25 and 40 years old, but it may also affect younger people during their teenage years. 

Check for symptoms of endometriosis

People with endometriosis may experience: 

• Fatigue, diarrhoea, constipation, nausea or bloating before or during periods 

• Abdominal or back pain during periods or in between periods

• Painful bowel movements or urination 

• Heavy bleeding during periods 

• Difficulty in getting pregnant 

• Pain during sex

The main symptom of endometriosis is severe menstrual cramps that affect day-to-day activities. 

What causes endometriosis? 

• Late menopause 

• Family history of endometriosis

• Early menarche (before 11 years old)

• Nulliparous (never given birth)

• Short monthly menstrual cycles (less than 27 days)

• Heavy bleeding during menses (lasting more than 7 days)

How do doctors diagnose endometriosis?

For endometriosis to be diagnosed, your doctor will ask for any relevant medical history or family history. Following this, your doctor may then perform a pelvic exam and carry out any other relevant imaging investigations for a definitive diagnosis. 

What is the treatment for endometriosis?

Based on your age, severity of endometriosis, pain and any plans for future pregnancies, the treatment for endometriosis would be divided into non-surgical (medical) and surgical treatment. 

Non-surgical (medical) treatment: 

Hormonal therapies can be used to suppress endometriosis while pain medication may be prescribed to reduce pain caused by endometriosis. 

Surgical treatment: 

A laparoscopy and hysterectomy may be suggested to treat your endometriosis.

FAQ

How does endometriosis affect fertility?

You can still get pregnant with endometriosis. Though it should be noted that people with endometriosis may still have difficulty in getting pregnant, it would be better for you to consult your healthcare provider about the best treatment for you. 

Can I prevent endometriosis?

At present, there is no way to prevent endometriosis. However, being aware of the signs and symptoms while receiving an early diagnosis can make a big difference in slowing down or avoiding the effects of endometriosis. 

Will endometriosis go away on its own?

Endometriosis may go away on its own after menopause due to a fall in the amount of oestrogen in your body, but may still need to be treated for pain relief and any infertility issues. 

Is endometriosis cancerous?

Fortunately, endometriosis is not a precancerous condition and it does not necessarily cause cancer. However, research has shown that people with endometriosis may have a slightly higher chance of getting epithelial ovarian cancer. Therefore, it is important to talk to your gynaecologist and get a regular medical checkup.