Severe Period Pain — Is Endometriosis the Culprit?

"It's just a period," but what if it's not?

You've been told your whole life that periods are supposed to hurt. Maybe your mother had painful periods. Maybe your friends complain about cramps too. So you push through, take painkillers, and plan your life around those few days each month.

But what if the pain that's controlling your schedule, affecting your work, and keeping you up at night isn't actually "normal"?

If your menstrual cramps are severe enough to disrupt your daily routine, you might be dealing with dysmenorrhoea – and it's time to get answers, not just more pain relief.

What is dysmenorrhoea?

Dysmenorrhoea 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 dysmenorrhoea: primary and secondary dysmenorrhoea.

Primary dysmenorrhoea

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

Secondary dysmenorrhoea

Secondary dysmenorrhoea 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 dysmenorrhoea 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 dysmenorrhoea 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 paracetamol, 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 dysmenorrhoea.

What is endometriosis?

The endometrium is the inner lining of the womb. Endometriosis is a condition where tissue similar to the endometrium grows outside of the womb, 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 menstruation (before 12 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.

4-in-1 women screening at Thomson Medical

If you are experiencing painful periods or managing a condition such as endometriosis, it's important to take care of your reproductive health. Having a regular check-ups can help to identify conditions that may require medical attention. Our 4-in-1 women's screening package includes:

• Consultation & examination
• Pap smear
• HPV test
• Pelvic ultrasound scan

An additional HPV vaccination is also available as an extra protective measure against cervical cancer.

If you would like more information about these screening options, contact us via WhatsApp or schedule a consultation with our women's cancer specialist at Thomson Women's Clinic and Cancer Surgery.

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.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised fertility recommendations for your specific conditions, schedule an appointment with Thomson Women's Clinic.