Endometriosis: when severe period pain should not be ignored

English version

Endometriosis is a long-term condition in which tissue similar to the lining of the uterus grows outside the uterus. It may cause inflammation, scarring and pain, although some women have few or no symptoms.

The condition affects an estimated 10% of women of reproductive age worldwide. Symptoms and their severity vary considerably.

What symptoms can endometriosis cause?

• Severe or worsening period pain.
• Pelvic pain before, during or after a period, or between periods.
• Pain during or after sexual intercourse.
• Pain during bowel movements or urination, particularly around a period.
• Heavy menstrual bleeding, abdominal bloating, nausea or fatigue.
• Difficulty conceiving.
• Pain that interferes with work, exercise, sleep or daily activities.

These symptoms are not specific to endometriosis. Adenomyosis, fibroids, ovarian cysts, pelvic infection, urinary conditions and bowel disorders can cause similar problems. The amount of pain does not always reflect the extent of the condition.

How is endometriosis assessed?

Assessment usually begins with a detailed history of pain in relation to periods, its effect on everyday life, bleeding patterns, bowel, bladder and sexual symptoms, previous pregnancies, fertility plans and treatments already tried.

Depending on the symptoms, a doctor may recommend a pelvic examination, ultrasound or MRI. Ultrasound can identify ovarian endometriomas and some forms of deeper endometriosis, but a normal scan does not necessarily exclude the condition.

Laparoscopy—keyhole surgery to inspect the pelvis and sometimes obtain tissue—is useful in selected cases. However, surgery is not always required before beginning treatment based on symptoms and imaging.

Can endometriosis affect fertility?

Endometriosis may be associated with difficulty conceiving, but it does not mean pregnancy is impossible. Many women with endometriosis conceive naturally.

Its effect depends on age, ovarian reserve, whether the ovaries or fallopian tubes are affected and whether other fertility factors are present. If pregnancy is desired now or later, mention this before starting treatment. Some hormonal treatments prevent ovulation or pregnancy while being used; they do not permanently improve fertility.

What treatments may help?

Treatment is individualised according to symptoms, age, pregnancy plans, previous treatment and personal preference. Options may include suitable pain-relieving medicine, hormonal contraception or progestogen treatment, other hormone-suppressing medicines, pelvic-floor physiotherapy, multidisciplinary pain management, laparoscopic surgery in selected situations, or fertility care when conception is difficult.

There is no treatment guaranteed to cure endometriosis permanently. Symptoms may persist or return after medical or surgical treatment. A hysterectomy is not an automatic treatment and does not guarantee that all pain will resolve. Avoid hormonal medicine or unverified supplements without individual medical advice.

When should you arrange a consultation?

• Period pain regularly prevents normal activities, is worsening or no longer responds to usual measures.
• Pelvic pain continues between periods.
• Sexual intercourse, bowel movements or urination are painful.
• Periods are very heavy or prolonged.
• Symptoms repeatedly cause absence from work or school.
• You have been trying to conceive without success.
• Symptoms continue despite a previously normal ultrasound.
• Pain affects sleep, relationships or emotional wellbeing.

Keeping a record of periods, pain, bleeding, bowel or bladder symptoms and medicines taken can make the consultation more useful.

Severe period pain should not be dismissed as something every woman must tolerate. Timely evaluation can support an individual plan for pain, fertility and quality of life.