Period Pain (dysmenorrhoea): Is it endometriosis?
Dysmenorrhoea, or painful menstruation, is a common problem experienced by females in their reproductive years. Period pain happens when your uterus muscles tighten causing cramping and heaviness in the pelvic area, and pain in the lower back, stomach or legs. Some people also experience nausea, vomiting, paleness and diarrhoea. Some people experience mild discomfort when they get their period. Others experience severe pain that stops them from doing everyday activities.
There are many ways to manage your period pain, including:
taking pain relief medicine (e.g. ibuprofen or naproxen)
use a heat pack, have a warm bath/ shower to help relax your muscles or try relaxation techniques
continue regular physical activity
try complementary therapies like acupuncture
You can also ask your doctor about hormonal treatments (e.g. Mirena IUD or contraceptive pill).
Period pain can be normal if:
it happens on the first two days of your period
it doesn’t impact your daily life
it goes away when you take simple pain-relief medicines or use hot packs.
Dysmenorrhoea is classified as primary if it results from physiological changes during a menstrual period or secondary if caused by a disorder of the reproductive system.
Primary dysmenorrhoea
Diagnosis of primary dysmenorrhoea requires the exclusion of secondary causes such as endometriosis, pelvic inflammatory disease, fibroids, adenomyosis, endometrial polyps, intrauterine devices and congenital abnormalities.
Risk factors for primary dysmenorrhoea include early onset of menarche and long duration of menstrual bleeding. Period pain that starts within 6 to 12 months of menarche is a strong diagnostic indicator of primary dysmenorrhoea; diagnosis in this age group can generally be made on history alone.
Treatment aims to inhibit prostaglandin production, using a hormonal contraceptive or a nonsteroidal anti-inflammatory (NSAID). Hormonal and anti-inflammatory treatments may be combined.
Other options for treating primary dysmenorrhoea include local heat, transcutaneous electrical nerve stimulation (TENS), acupressure, acupuncture, herbal and dietary preparations (eg thiamine, pyridoxine, magnesium, fish oil), exercise and psychological behavioural interventions.
Let’s explore causes of Secondary Dysmenorrhoea
Aspects of the medical history that suggest dysmenorrhoea is secondary include:
onset of dysmenorrhoea later after menarce
a change in the pattern of period pain
the presence of dyspareunia, heavy menstrual bleeding, intermenstrual bleeding or postcoital bleeding
irregular periods
a poor response to a 3-month trial of treatment
other symptoms or family history suggestive of a specific diagnosis such as endometriosis
Ultrasound is required if secondary dysmenorrhoea is suspected
Understanding Endometriosis
Endometriosis is a chronic condition characterised by the growth of endometrial-like tissue outside the uterus, typically in the pelvic area. It affects millions of women worldwide and can cause significant pain and other symptoms.
Endometriosis can cause a range of symptoms, which may vary in severity and may include:
Pelvic Pain: Chronic pelvic pain, often worsened during menstruation or sexual intercourse.
Menstrual Irregularities: Heavy or prolonged menstrual periods, as well as irregular bleeding between periods, are common in women with endometriosis.
Painful Intercourse: Pain or discomfort during sexual intercourse, known as dyspareunia
Painful Bowel Movements or Urination: Endometriosis lesions can affect the bowel or bladder, leading to pain during bowel movements or urination, especially during menstruation.
Infertility: Endometriosis can contribute to fertility problems in some women, although not all women with endometriosis experience infertility.
Diagnosing endometriosis can be challenging and often requires a combination of clinical evaluation, investigation and procedures. Common diagnostic methods include:
Medical History and Physical Examination: Your healthcare provider will review your medical history and perform a pelvic examination to assess for any signs of endometriosis, such as pelvic tenderness or masses.
Imaging Studies: Transvaginal ultrasound or magnetic resonance imaging (MRI) may be used to visualise the pelvic organs and detect any abnormalities, such as endometriotic lesions or ovarian cysts.
Laparoscopy: A minimally invasive surgical procedure called laparoscopy is the gold standard for diagnosing endometriosis.
Endometriosis might be reasonably suspected and managed in a primary care setting but a definitive diagnosis is usually made after gynaecological referral and surgery
Treatment Options for Endometriosis:
People with suspected or confirmed endometriosis should be offered comprehensive coordinated care from their team. While there is currently no cure for endometriosis, several treatment options are available to help manage symptoms and improve quality of life:
Pain Medications: Analgesics are first-line treatment of endometriosis-related pain; they may be used alone or together with hormonal therapies. A 3-month trial of a nonsteroidal anti-inflammatory drug (NSAID) or paracetamol (or a combination of both) is recommended.
Hormonal Therapy: Hormonal medications, including contraceptive pill, Mirena intrauterine device or gonadotropin-releasing hormone (GnRH) agonists can help regulate the menstrual cycle and reduce endometriosis-related pain.
Surgical Interventions: In cases where conservative treatments are ineffective or if there are significant symptoms or complications, surgical procedures such as laparoscopic excision of endometriotic lesions or hysterectomy may be considered.
Non pharmacological/ Non surgical options include: Cognitive behavioural therapy, relaxation techniques, pain management programs, physiotherapy, psychology, hypnosis, biofeedback, exercise (including yoga, pilates and tai chi), meditation, mindfulness, dietary intervention, acupuncture, Transcutaneous electrical nerve stimulation, manual and physical therapy, osteopathy, dietary supplements, Chinese herbal medicine, naturopathy and ayurvedic therapies.
Understanding Adenomyosis
Adenomyosis is a condition in which the glands and supporting structures of the endometrium are found in the muscle layers of the uterus. Adenomyosis effects 20-30% of women. The displaced tissues can break down and bleed during each menstrual cycle resulting in painful heavy periods. Awareness of this condition remains poor and the diagnostic delays are similar to those with endometriosis. People with adenomyosis often have endometriosis with the features of the two conditions overlapping. It is an oestrogen dependent condition and usually goes away following menopause.
Symptoms of adenomyosis can range from none, or only mild discomfort, to chronic pelvic pain, abnormal menstrual bleeding, infertility, severe cramping or sharp pelvic pain during menstruation, or painful intercourse.
For people with pain associated with adenomyosis, we us similar treatment options including analagesia, hormone therapies and lifestyle therapies. Surgical options are limited but hysterectomy, this may not completely resolve the pain associated with adenomyosis but women who have heavy menstrual bleeding will have resolution of their bleeding. A hysterectomy can cure adenomyosis but is considered major surgery, hence, it will generally only be considered where all other treatments have failed and the person with adenomyosis has no desire for future fertility.
Conclusion
Endometriosis is a chronic condition that can cause significant pain and other symptoms, affecting various aspects of a woman's life. If you suspect you may have endometriosis or are experiencing symptoms such as pelvic pain, menstrual irregularities, or painful intercourse, don't hesitate to consult with your healthcare provider. Early diagnosis and appropriate management can help alleviate symptoms and improve your overall quality of life.