Period Cramps or Endometriosis

You’re curled up in bed with a heating pad on your stomach and wondering for the umpteenth time, Is this normal? While almost all women experience period cramps from time to time, severe pain during your period could be a sign that you have endometriosis. Here’s how to tell the difference, and when to see a doctor. 

What Causes Period Cramps?

Each month, your body releases one egg from your ovary. If the egg isn’t fertilized, your uterus begins the process of shedding its lining (the endometrium) in preparation for a new egg to be released. During this process, your body releases substances, called prostaglandins, that make your uterus contract. The pain you feel from period cramps is caused by these uterine contractions.

Your cramps may be more or less intense, depending on the amount of prostaglandins your body releases. Larger amounts of prostaglandins trigger stronger uterine contractions and higher amounts of pain. This pain may begin a few days before your period and should lessen two or three days after your period starts.  

What Is Endometriosis?

If you have endometriosis, tissue similar to the endometrium grows outside of your uterus in other areas of your body, such as your intestines and ovaries. This tissue also builds up and sheds monthly, but instead of being expelled from your body, it sheds into your abdomen.

Like the endometrium, tissue that grows outside of your uterus also causes bleeding when it’s shed. Because this tissue isn’t expelled, your body must break it down. Pain, inflammation, and even scarring occur as your body attempts to remove the tissue in your abdomen. Endometriosis also worsens over time and can affect your entire body, increasing the risk for things like heart disease along with anxiety and depression.

How Do You Know if Your Pain is from Period Cramps or Endometriosis?

Both period cramps and endometriosis pain occur just before and during your period, but there are some important differences. Period cramps typically involve a throbbing or dull and achy pain in your abdomen that may radiate to your back or thighs. It may be accompanied by nausea, headaches, dizziness, bloating, and loose stools, but shouldn’t be so severe that they interfere with your daily life.

While endometriosis also may cause all of the above symptoms, the pain is typically much more severe and can be disabling, worsening over time as the disease progresses. Endometriosis may also cause pain while you’re urinating or having a bowel movement. And you are likely to experience pain during sex. 

Signs and Symptoms of Endometriosis

In addition to severe menstrual pain and pain after sex, there are several other signs and symptoms that could mean you have endometriosis. These include: 

  • Heavy Periods. Needing to change your pad or tampon every hour, bleeding for more than seven days, and passing large clots are signs that your period is too heavy.
  • Bleeding Between Periods. Bleeding between periods is common, but bleeding frequently during a month or between periods for several months may be cause for concern.
  • Worsening Cramps. If you never used to have period cramps but now experience severe cramps, or if your cramps have worsened over time, it may be a sign of endometriosis. 
  • Ovarian Cysts. Many women experience ovarian cysts, however, cysts that occur with endometriosis, called endometriomas, are often more severe and need to be removed.
  • Chronic Pelvic Pain. If you regularly experience pelvic pain over a long period of time, it could be caused by scarring or by endometrial tissue adhering to other organs in your body.
  • Infertility. If you’ve had unprotected sex for more than 12 months (or six months if you’re over 35) and have not been able to conceive, endometriosis could be to blame. 

How Endometriosis Impacts Fertility

Researchers believe that as many as 50 percent of all women experiencing infertility have endometriosis. Scarring and inflammation can damage your reproductive tract, including your fallopian tubes. Endometriosis also impacts both the quality and quantity of your eggs. 

Fortunately, treatments are available to both minimize symptoms and help you conceive. While you may need surgery to remove adhesions, many women who have endometriosis are able to conceive with the help of in vitro fertilization. If your endometriosis is so severe that you’re considering a hysterectomy, you may also wish to freeze your eggs in order to preserve your fertility. That way, having a baby via a gestational carrier is also a possibility.

When to Call Your Doctor

It’s important to call your doctor if you’re  experiencing any of the above signs and symptoms of endometriosis. Be sure to ask your gynecologist whether the pain you’re experiencing is caused by normal period cramps or endometriosis. And don’t be afraid to seek a second opinion to ensure a correct diagnosis.

Seeing a fertility specialist is also important if you’ve been trying to conceive for longer than 12 months. Fertility specialists can diagnose and treat endometriosis, but because it’s a progressive disease, it’s important to seek treatment as soon as possible. Schedule a consult with Dr. Ghazal to learn about your treatment options. 

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