Understanding Pain and Endometriosis

Did you know that March is Endometriosis Awareness Month? Affecting over 11% of women between 15-44, one of the major symptoms of endometriosis is menstrual pain that is far worse than normal. This week, we’ll be talking about what that means and how this pain can manifest.

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First, a little background


Endometriosis is a disorder that occurs when the tissue that normally lines the uterus is found on other areas of the body, such as your ovaries, fallopian tubes, or outside of the uterus. These tissue growths may swell and bleed following your menstrual cycle, which can cause swelling and the most common symptom of this condition: pain.


Painful Periods


The most common symptom of endometriosis is painful periods. However, research shows that 50% of women experience period pain as part of their regular menstrual cycle, especially when they first start menstruating. So how can you tell if your pain is normal?


Normal symptoms of periods include nausea, constipation, diarrhea, cramping, anxiety, irritability, moodiness, and minimal pain (oh the joys of being a woman!). The key distinction lies in the severity of your symptoms. If you are experiencing pain that is debilitating, lasts more than two days, or does not go away after taking pain medication, you might need to talk to your provider. 


Remember, mild period pain is normal for many women. However, extreme pain is not normal. If your periods involve pelvic pain that is extreme or severe, feels like a stabbing sensation in your pelvic region, or you experience a consistent dull or throbbing ache that will not go away, these could be signs of endometriosis. 


Pain with Sex


Another common symptom of endometriosis is pain during sex. The movements involved with penetrative sex can stretch or pull at endomtrial growths, which can cause pain before or after intercourse. 


Everyone’s body is different, and this pain does vary from person to person. The signs to watch for are pain in your pelvis or lower back that feels like stabbing, pain deep in your abdomen, or severe pain. 


If you experience pain during sex at all, it’s a good idea to talk to your provider to get to the bottom of what’s going on. You can also read about tips for managing sex with endometriosis here.


Pain with Bowel Movements or Urination


A final key symptom of endometriosis is pain when going to the bathroom. Endometrial tissue can grow on the surface of your bladder or bowel, and even inside. This can cause diarrhea, constipation, and bleeding during bowel movements. The pain might get worse during your period, when the endometrial tissue swells. If you find it painful to relieve yourself, or you notice blood in your stools, especially during your period, these could be signs that you have endometriosis. 


Diagnosis following bowel symptoms of endometriosis can be challenging because many times these symptoms resemble those of IBS or other bowel disorders. If you experience pain when going to the bathroom, keep track of how often this occurs, how severe the pain is, and where in your body it hurts. That way, when you go in to speak with your healthcare provider you will be able to provide a full picture.  


No Pain At All


Did you know that endometriosis is not always painful?


Endometriosis usually manifests with painful physical symptoms, but not always. Experts call this silent endometriosis: when women have this condition but no obvious symptoms. In fact, research indicates that 20-25% of women with endometriosis are asymptomatic. 


Without the typical symptoms showing up, your provider might not even think to check for this condition. In fact, you might not even know you have endometriosis until you experience infertility. More research estimates that 30% of women with unexplained infertility have silent endometriosis. 


Diagnosing Endometriosis


If you experience the kind of pain we’ve discussed in this article, or you have unexplained infertility, your doctor may run a series of tests to see if you have endometriosis. These usually include a pelvic examination, ultrasound, and/or MRI. These help your doctor identify any abnormal growths of endometrial tissue. 


Your doctor may recommend a laparoscopy, which is a procedure that allows a surgeon to look inside your abdomen for endometrial tissue that is outside of the uterus. This can also be an opportunity to collect tissue for further testing. 


Treating Endometriosis 


Once you have your endometriosis diagnosis, your treatment options will depend on a number of factors. Here are a few options your doctor may discuss with you:


Hormone Therapy


If you are just looking to manage your condition, your doctor may recommend hormonal therapy like hormonal birth control to help control the hormones that create the buildup of extra tissue. Progestin therapies like IUDs can also help minimize the growth of endometrial implants. 


Other hormonal treatments include gonadotropin-releasing (Gn-RH) hormone agonists and antagonists. We know, this is a mouthful, but this kind of medication can help shrink endometrial tissue by preventing the production of the hormones that make you get your period. They essentially create artificial menopause, so your doctor may also prescribe a low dose of estrogen to prevent menopause side effects.  


One thing to note about hormone therapy: it’s not permanent. Symptoms may return once you stop taking your medication. The other important note: if you are looking to get pregnant, this is not the option for you. 




If you are TTC, one option may be undergoing surgery to remove the growths of endometrial tissue that might be preventing you from getting pregnant. This is usually a laparoscopic process and can also benefit people who suffer from serious endometriosis pain. 


While doctors used to favor hysterectomies as the go to surgical treatment for endometriosis, modern medicine now allows providers to treat this condition surgically without removing the uterus. These laparoscopic surgeries can be highly effective for removing extra tissue, without impacting your ability to get pregnant in the future. 


Fertility Treatment


If you are TTC, your doctor may recommend a combination of treatments to increase your odds of getting pregnant. Your doctor may recommend a combination of laparoscopic surgery to remove any tissue impeding conception alongside other fertility treatments. The treatment that’s right for you will depend on your specific situation, so it’s a good idea to discuss your options with a fertility specialist. 


Endometriosis can make it harder to get pregnant, and it might put you at risk for complications during pregnancy, but it’s not the end of the road for your dreams of having a child. Be sure to stay in conversation with your healthcare provider to figure out the best plan of treatment for your body. 


We know that dealing with endometriosis can be stressful and challenging. We are here to be a resource as you navigate this diagnosis! If you have questions, comments, or just need someone to talk to, you can reach us anytime through our chat portal or you can schedule a telehealth consultation with one of our providers here.

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