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Menstruation is a fact of life. But painful periods don't have to be. Cramping and bloating may not indicate a serious health concern, but talk with your gynecologist about your symptoms to be sure.
If your period pain is caused by endometriosis, a healthcare provider can suggest options -- from medications to diet changes -- that may help.
Endometriosis, or endo for short, affects 10 percent of women of childbearing age -- most commonly in their 20s and 30s, although it can happen in teenagers. The tissue that typically lines the uterus grows in other parts of your body. It usually grows in the lower abdomen, attaching to the ovaries, fallopian tubes and the outside of the uterus. It can also attach to the bladder, bowel and tissue lining the pelvis.
With endometriosis, the endometrial tissue outside the uterus acts the same way as it does inside the uterus, responding to the hormones the ovaries make each month, thickening and breaking down. But because the tissue is outside the uterus on surfaces where it doesn't belong, inflammation occurs.
Endo causes irritation and scarring of the surrounding tissue. Symptoms include:
-- Painful periods that keep you from working, studying or enjoying other activities
-- Bleeding between periods
-- Heavy menstrual bleeding
-- Cramps during the weeks around menstruation
-- Pain during or after sex
-- Bloating
-- Nausea and occasionally vomiting
-- Constipation or diarrhea
-- Pain or urgency when you urinate
-- Infertility
-- Lower back pain
If your period is usually so painful it interferes with your daily life, it's time to talk with your healthcare provider. Many endo symptoms mimic those of other illnesses, so it may take several doctor visits to find an answer.
There's no easy way to diagnose endometriosis. No physical examination, test or scan can find the lesions. Usually, your healthcare provider will listen to your symptoms and try various treatments.
Recent research finds endometriosis may run in families and be related to other types of pain disorders. Share family history and your medical conditions with your doctor. Usually, doctors diagnose endometriosis with a laparoscopic surgery.
You can help your doctor by tracking your symptoms. Record your answers to these questions:
-- Do you have pain at certain times during your menstrual cycle?
-- Where is the pain?
-- How does the pain feel? Sharp? Aching? Throbbing?
-- How long are your periods and your menstrual cycle?
-- Do you have bleeding between periods? If so, how much?
Treatments for endometriosis include:
-- Medicine to reduce inflammation and pain such as ibuprofen
-- Contraceptives such as birth control pills, the patch or the ring as well as Mirena IUD
-- Other medications that adjust hormone levels, such as GnRH agonists or GnRH antagonists
-- Laparoscopic surgery
Researchers found simple changes may help you be more comfortable. Lifestyle changes can help, including meditation and regular exercise like walking or yoga. Diet changes may lessen pain, too, so try eating less red meat and more fiber, fruits and vegetables. Foods or supplements with vitamin D and omega-3 and omega-6 fatty acids may also be helpful.
Your doctor will weigh the best treatments for your symptoms, considering whether you wish to have a child. Contraceptive and hormone treatments decrease pain by pausing the menstrual cycle, but they also prevent you from conceiving.
One procedure used to treat endometriosis is laparoscopic surgery to remove scar tissue and cysts that build up as a result of the condition. A surgeon inserts a tube with a camera on the end into a small incision in the abdomen to find and remove the endometriosis.
Laparoscopic surgery that keeps the ovaries and uterus intact may help someone who is trying to get pregnant, and it can reduce pain for other patients. However, endometriosis and pain can come back after surgery.
In some cases, traditional abdominal surgery with a larger incision is used to remove widespread endometriosis. Rarely, hysterectomy and oophorectomy -- removal of the uterus, cervix and ovaries -- are necessary to fully treat advanced endometriosis.
Removing the ovaries will cause estrogen levels to drop, which will most likely reduce pain symptoms. However, the decrease may also spur menopause symptoms. This type of surgery is often a last resort for women with unmanageable pain who've tried other treatments with no success.
Endometriosis can make it difficult to have a baby. Scar tissue can block the fallopian tubes or cause other problems. Early diagnosis and treatment of endometriosis may improve your chances of conceiving later in life. Some people don't learn they have the disease until they have trouble getting pregnant.
About one-third of women with endometriosis have trouble conceiving naturally without some medical intervention. In such cases, a surgical procedure may be necessary.
There's no cure for endometriosis, but it's possible to decrease your pain and the disruption to your life. Work closely with your doctor to find the best treatment option for you and visit them regularly. The treatment that's best today may change as you age, as your desire for children changes or as researchers learn more about the disease. With options from medications to surgery available, you can find relief from your pain.
For the latest health and wellness tips and advice, visit geisinger.org/balance.
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Dr. Jennifer Gell, MD, is a reproductive endocrinologist at Geisinger.