Is my menstrual pain a sign of endometriosis?

At my clinic, one of the more common conditions I treat across my female patients aged 25-35 is endometriosis, a condition in which tissue similar to the make-up of the inner lining of the womb (endometrium) grows outside the womb. Endometriosis is a fairly common condition that’s thought to affect around 10-20% of women of childbearing age. While it is not a cancer, endometriosis if not treated can cause debilitating pain and infertility.

Many women with this condition are not even aware they have it at all; one reason being its symptoms are often overlooked and confused with regular menstrual pain. What should you look out for to spot endometriosis, and how can it be managed? Let’s find out more about the condition.

What are the symptoms of endometriosis?

The symptoms of endometriosis may vary, with some women having none at all and others having very severe pain. However, it is important to note that the severity of your pain and symptoms do not indicate the stage of your condition.

The most common symptoms are:

• Painful, heavy or irregular periods
• Pain in the pelvis, lower back or lower abdomen before and after your period
• Ongoing pelvic pain
• Pain during or after sex
• Infertility
• Heavy menstrual bleeding or bleeding between periods
• Difficulty emptying bladder and bowel movements

Some women have no symptoms at all and do not realise they have endometriosis until they are checked by a gynaecologist or have difficulties getting pregnant. Hence, I encourage all women to get regular gynaecological exams, especially if they experience two or more symptoms. It would be helpful to keep a pain and symptom diary to aid with diagnosis.

What causes endometriosis?

Currently we still don’t know the cause behind endometriosis, however there are a few theories which include:

Retrograde menstruation

Retrograde menstruation happens when the lining of the womb flows backwards into the abdomen rather than leave the body during menstruation. While this occurs in most women as a monthly process, instead of the body disposing the tissues naturally, the tissues attach onto the pelvic or abdominal walls for some women resulting in endometriosis.

Genetics

If endometriosis runs in your family, you are more likely to get it too. While this condition can occur in women across all ethnicities, it is more prevalent in Asian women.

Weak immune system

It is thought that women with weaker immune systems are unable to get rid of the tissues and thus would be at a higher risk of endometriosis.

Lymphatic speed

It is possible that some cells or tissue can travel around the body through the bloodstream.

How does endometriosis affect fertility?

One of the biggest complications of endometriosis is the possibility of infertility. With that said, about 70% of women with mild to moderate endometriosis are still able to conceive even without treatment. If you have endometriosis and have difficulty getting pregnant, you might want to undergo fertility treatment or get your endometrial tissue surgically removed.

The exact link between endometriosis and infertility is still unclear, however what we do know is that the severity of the condition as well as location of the tissue appears to have an effect. For instance, it is not exactly known how a few spots of endometriosis may affect your chances of getting pregnant, but with severe endometriosis, your chances are likely affected by changes to your anatomy.

Could my menstrual pain be a sign of endometriosis?

It’s not uncommon to experience the discomfort of premenstrual syndrome (PMS) such as pain and nausea around the time of your period, but unlike PMS, pain from endometriosis is not caused by contractions of the uterus. Rather, it’s caused by cells that are implanted outside of the uterus, which leads to inflammation and pain. Women with endometriosis often find that their periods are unbearable and debilitating cramps are the norm.

Apart from pain during your period, I would advise to look out for pain during sexual intercourse or during bowel movements or urination. Track your menstrual cycle as well — a warning sign of endometriosis is irregular cycles, with a period once every few months or even every 2-6 weeks.

As endometriosis is a tricky condition that’s often overlooked, it is in your best interest to visit a gynaecologist if you exhibit any of the symptoms above. Do not assume that your “bad periods” are normal.

References

1. de Ziegler, D., Borghese, B., & Chapron, C. (2010). Endometriosis and infertility: pathophysiology and management. Lancet (London, England), 376(9742), 730–738.
   https://doi.org/10.1016/S0140-6736(10)60490-4
2. Vercellini, P., Viganò, P., Somigliana, E., & Fedele, L. (2014). Endometriosis: pathogenesis and treatment. Nature reviews. Endocrinology, 10(5), 261–275.
   https://doi.org/10.1038/nrendo.2013.255

This article was written and medically reviewed by Dr Tan Poh Kok (PK Tan), a Senior Consultant Obstetrician and Gynaecologist at PK Women’s Specialist Clinic.