Endometriosis Pain Explained

In this article:

• What Is Endometriosis?
• Symptoms of Endometriosis
• When Should You See a Doctor?
• Endometriosis Treatment
• Endometriosis and your wellbeing

What Is Endometriosis?

A woman’s uterus is lined with tissue called endometrium. Sometimes this tissue becomes misplaced and appears outside of the uterus. The reason that the tissue becomes misplaced is not known, however there are theories that suggest that:

• Small pieces of endometrium that are shed during a woman’s period, may travel backward, into the fallopian tubes toward the ovaries and into the abdomen, rather than being shed through the vagina.
• Endometrium cells may travel in the blood or lymph vessels to other parts of the body.
• Cells outside of the uterus, change into endometrium cells.

The misplaced tissue can commonly be found on the ovaries, ligaments (tissue) that support the uterus, or tissue in the abdomen and pelvis called the peritoneum. Endometrium tissue both inside the uterus and tissue misplaced outside, respond to sex hormones called oestrogen and progesterone. Each month the endometrium builds up, then breaks down and bleeds out. However, unlike the endometrium cells in the uterus that leave the body through the vagina each month during menstrual periods, the misplaced cells outside the uterus, remain in the body which can cause inflammation, pain, cramps and the formation of scar tissue (adhesions).

There are theories suggesting that family history (genetics) may influence who can develop endometriosis. Mothers, sisters and children of women with endometriosis are more likely to develop it. There is also the possibility that problems with the immune system (the body’s natural defence system) and environmental toxins, may be responsible.

Symptoms of Endometriosis

Not everyone experiences symptoms when they have endometriosis, but some of them may include:

• Period pain that stops your day-to-day activities
• Pain in your lower back or tummy that’s worse during your period
• Feeling sick, having diarrhoea, or being constipated during your period
• Pain during or after sex
• Blood in your pee or poo during your period
• Struggling to get pregnant

Endometriosis pain

Symptoms of endometriosis can depend on where the misplaced endometrium is located. For this reason, symptoms can vary from one woman to another. Pain might be related to endometriosis occurring in these areas of the body:

• Ovaries - tummy or pelvic area (abdominal) pain
• Large intestine – pain when pooing
• Bladder – pain above the pubic area and when peeing
• Other painful symptoms include
• painful periods sometimes starting a few days before the period starts, lasting as long as the period and feeling worse than usual period pain. For some women this pain can last most of, or all month.
• pain during or after sex that can be felt deep inside and may last a few hours.

When Should You See a Doctor?

If left untreated endometriosis can improve or stay the same for some women, however it may get worse for other women.

Endometriosis may affect your fertility, so it’s important to seek professional help if you are struggling to fall pregnant.

If you think you may have endometriosis, it may help to write down your symptoms in a symptom diary, to discuss when you see your doctor. The doctor may ask to examine your tummy and vagina.

If your doctor thinks you might have endometriosis, they may recommend treatment or they may refer you to a gynaecologist for more tests. The most reliable test for endometriosis is a keyhole examination called “laparoscopy”. Sometimes a doctor may use an ultrasound scan or MRI if a laparoscopy is not possible. A laparoscopy is a procedure during which a small cut (incision) is made in your tummy and a narrow tube is inserted to allow the endometriosis tissue to be seen with a small camera. This approach is the only way to truly determine if you have endometriosis.

Endometriosis Treatment

While endometriosis cannot be cured, treatment might be able to help with symptoms. Your doctor may discuss treatment options to help manage endometriosis related symptoms. These might include:

Pain relievers

Taking pain relievers such as paracetamol, or those with anti-inflammatory properties such as ibuprofen. They can be used together if required.

Hormone medicines and contraceptives

Fortunately, for most women their symptoms can be controlled with hormonal treatment. For women who are not planning to become pregnant, hormonal contraceptives can be used to limit the growth of misplaced endometrial tissue and reduce bleeding and pain. The combined oral contraceptive pill is one option and contains oestrogen and progestogen. Other options include progestogen on its own, an intrauterine system (IUS), contraceptive injections, patches or implants.

Hormone medicines called gonadotrophin-releasing hormone (GnRH) analogues are also sometimes used to temporarily stop egg and oestrogen production. Hormone treatment will not affect your fertility if you later, plan to get pregnant.

Surgery

Undergoing surgery to remove or destroy endometriosis tissue, using keyhole surgery (laparoscopy) is the most common method. The aim of this surgery is usually to remove or destroy areas of endometriosis, drain and remove cysts caused by endometriosis, free tissue or improve fertility. In some cases, doctors may remove part or all of the organs affected by endometriosis, such as part of the colon, appendix or uterus.

Your doctor may suggest not starting treatment immediately, to see if your symptoms improve on their own. They can also discuss the benefits and risks for each treatment option. The one that’s best for you will depend on various factors, such as:

• How old you are
• How severe your endometriosis symptoms or condition is
• Your desire to get pregnant
• Treatments you’ve tried in the past
• Side effects of medicines
• Treatment risks
• How long you may need treatment

Endometriosis and your wellbeing

Endometriosis pain can affect your physical and emotional health and wellbeing. It may have a significant impact on the daily life and routine for some women. It’s important to discuss your symptoms including period pains with your doctor, especially if they are having an impact on your life and your mental health.

In addition to support from your doctor, there are support groups available that can help with information and advice.

This article is for general information only and not intended as a substitute for medical advice. All information presented on these web pages is not meant to diagnose or prescribe. In all health-related matters, always consult your healthcare professional.

Always read the product label. Use only as directed. Incorrect use could be harmful. If symptoms persist consult your healthcare professional.

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