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Extremely Painful Periods? This Might Be the Reason

March 21, 2023

Heavy, painful or irregular periods are not normal, and they can leave you feeling miserable. Many women endure countless doctor visits before finding out that they have a condition known as endometriosis.

Why Endometriosis Is Hard To Diagnose

From the time symptoms first arise, it can take years before you receive a diagnosis of endometriosis. That’s because its symptoms are similar to other conditions, so endometriosis is often diagnosed as a process of elimination.

Before your doctor can determine that you have endometriosis, they must rule out several other conditions, including:

  • Urinary tract infections
  • Pelvic inflammatory disease
  • Sexually transmitted infections and diseases
  • Ovarian cysts

What Causes Endometriosis?

Endometriosis results from the overproduction of hormones, including estrogen. These hormones in turn trigger an overproduction of endometrial tissue, which is similar to the lining of the uterus. With endometriosis, this tissue grows outside of the endometrial canal in many places where it doesn't belong.

With a regular period, menstrual bleeding starts in the endometrial canal, the area inside of the uterus. When you have endometriosis, the blood doesn’t properly exit the canal. Instead, you experience a backflow of menstrual bleeding. The blood can backflow into several spaces, including fallopian tubes, which open into the abdominal cavity. From here, that blood can collect in several areas of your body.

The result? Many symptoms, including Irregular bleeding, which can include spotting all month long to massively heavy periods.

Other common symptoms of endometriosis can include:

  • Chronic pain with periods
  • Chronic pelvic pain in the weeks when it is not your period
  • Painful intercourse

Some women living with endometriosis experience no pain or symptoms, and only learn of the condition when trying to get pregnant, as endometriosis can negatively affect fertility.

Where Endometriosis Can Show Up

Where the blood collects, endometrial lesions form. These lesions can be found:

  • In the pelvis and on the pelvic wall.
  • Near the ovaries.
  • In the fallopian tubes, which can cause scarring. The blood can also block the tube, which lowers fertility.
  • On or around the bladder.
  • As a cyst in the ovary known as a chocolate cyst, named for the brown color of the blood as it breaks down.
  • In the intestines.

Treatment Options

One of the most common solutions is oral contraceptive birth control, which helps regulate and stabilize hormones, and can diminish pain and bleeding.

If treatment methods such as birth control do not alleviate the pain, then a pelvic ultrasound may be ordered next to look for large clumps of tissue, which likely signal endometriosis. If these clumps are found, your doctor may suggest surgery to remove this tissue.

Your doctor also may perform a laparoscopy, a minimally invasive procedure that allows for a diagnostic look inside. If your doctor sees scarring and scar tissue, it is very likely that you have endometriosis.

If clumps or scarring are found, surgery is the typical next step. Most doctors will want to try medical management first and consider surgery only if necessary, choosing the most minimally invasive procedure possible.

In some cases, you might be advised to have a hysterectomy, but this is one the of the last lines of treatment.

One of the reasons doctors don’t immediately recommend surgery is that it is not a forever fix for endometriosis. In many cases, surgery only halts symptoms for anywhere from one to 10 years. There are no guarantees. However, it is also possible that surgery could mean the end to your endometriosis symptoms for good.

Endometriosis and Infertility

If left untreated, endometriosis can make it tougher for you to get pregnant. If you have endometriosis and want to have a baby, you might be referred to a reproductive infertility specialist where you might explore IVF options.

If endometriosis has caused blockage or scarring in the fallopian tubes, you might consider having your tubes removed before starting IVF. The chronic inflammation in the tubes blocks the passageways, complicating the pregnancy process. The scarring may also increase the risk of an ectopic pregnancy.

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