Terribly intense menstrual cramps, heavy flow, pain during sex; are these just period pains, or could it be endometriosis?

Endometriosis occurs when the type of tissue that normally lines your uterus grows in your body where it doesn’t belong, like on your ovaries or fallopian tubes, bladder or bowels—even in your abdomen. During your period, you shed the lining that has built up since your last bleed.

When endometrial tissue grows outside of your uterus, it reacts to the same hormonal changes as the tissue of your uterine lining—shedding and bleeding. Your body absorbs this small amount of blood, and you feel it as severe cramping, inflammation and other symptoms. Women describe the pain as severe cramps, inflammation or painful bowel movements or urination. Endometriosis can make sex during your period painful.

Women living with endometriosis may have heavy periods, and heaving bleeding between periods, and cramps that can get more painful over the months and years.

What Causes Endometriosis?

No one knows for sure what causes endometriosis. Some think it may be caused by what’s called backward menstruation, where menstrual blood containing endometrial cells flows through the fallopian tubes into the pelvis, causing cells to grow outside the uterus. Endometriosis may also be an immune or lymphatic system disorder.

Risk factors

Endometriosis can happen to any woman, but you may be more at risk for developing endometriosis if you:

  • Drink alcohol
  • Had your first period before age 12
  • Have never been pregnant
  • Experience short cycles (less than every 25 days)
  • Have low body mass index or are underweight
  • Have a uterine problem, such as an abnormal shape
  • Have a family history of endometriosis

Diagnosing Endometriosis

Unfortunately, endometriosis is pretty hard to diagnose. You’ll need to track your period dates, bleeding patterns and symptoms to discuss with your care provider. They may want you to have a pelvic ultrasound to look for cysts.

The only way to diagnose endometriosis for sure is with a surgical procedure called a laparoscopy. Your care provider will insert a small camera-like scope through tiny incisions on your abdomen to look for lesions or scar tissue, which may be removed via laser during this time.

Treating Endometriosis

Mild pain symptoms may be managed with ibuprofen or naproxen. In many cases, though, hormones are needed to improve the severe pain. Your care provider may suggest hormonal contraceptives, such as the patch, pill or ring to make periods shorter, lighter or less crampy. IUDs may stop periods, eliminating the pain of menstruation. One drug blocks ovulation. In severe cases, surgery may be the best option.

Not every woman who has painful periods has endometriosis. But if your periods are making you miss work, school or other activities, have a dedicated discussion with your healthcare provider about endometriosis.

Find out about endometrial cancer here.

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