Endometriosis: Managing period pains

Endometriosis is a painful disorder in which tissue that normally lines the inside of your uterus, the endometrium, grows outside your uterus.

Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. It can happen that the endometrial tissue may spread beyond pelvic organs.

With endometriosis, displaced endometrial tissue continues to act as it normally would, it thickens and breaks down and bleeds with each menstrual cycle.

Because this displaced tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form.

Surrounding tissue can become irritated, eventually developing scar tissue and abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other called adhesions. Endometriosis can cause pain, especially during your period.

Fortunately, effective treatments are available.

This condition is estimated to affect over 15% of women of reproductive age even though some may not have the symptoms.

Causes

The exact cause of endometriosis is not certain. The most likely cause is what is called retrograde menstruation, this is where menstrual blood, instead of flowing out the vagina, flows back through the fallopian tubes and into the pelvic cavity.

The endometrial cells then stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.

The cause of this retrograde flow is not known. Another possible cause is that areas lining the pelvic organs possess primitive cells that are able to develop into other forms of tissue.

Risk factors

Women are most at risk:

• Women aged 25 to 35 years, even though some cases have been reported in girls as young as 12.
• Those who’ve never given birth (or delay their first pregnancy) – because of this many women who are homosexual report with cases of endometriosis.
• Early onset of menses or late menopause.
• One or more relatives (mother, aunt or sister) with endometriosis.
• Any medical condition that prevents the normal passage of menstrual flow out of the body.
• History of pelvic infection or pelvic surgery.
• Any other abnormalities of the uterus (example fibroids).

Signs and symptoms

The primary symptom is pelvic pain, often associated with your menstrual period. Although many women experience cramping during their period, women with endometriosis typically describe menstrual pain that’s far worse than usual.

Common signs and symptoms may include:

• Painful periods (dysmenorrhea) – Pelvic pain and cramping may begin before your period and extend several days into your period. You may also have lower back and abdominal pain.
• Pain with intercourse – Pain during or after sex is common with endometriosis.
• Pain with bowel movements or urination – You’re most likely to experience these during your period.
• Excessive bleeding – You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
• Infertility – Endometriosis is first diagnosed in some women who are seeking treatment for infertility.
• Other symptoms – You may also experience fatigue, diarrhoea, constipation, bloating or nausea, especially during menstrual periods. The severity of your pain isn’t necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have intense pain, while others with advanced endometriosis may have little pain or even no pain at all.

Complications

The main complication of endometriosis is infertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant. Endometriosis may block the fallopian tubes.

Some studies suggest that women with endometriosis have an increased risk for development of certain types of ovarian cancer. This risk is highest in women with both endometriosis and primary infertility (those who have never been pregnant).

Diagnosis

If you suspect, based on the information above, that you might have endometriosis, it is important that you see your doctor to conduct a pelvic examination and an ultrasound. If need be the GP may refer you to a gynaecologist for a laparoscopy.

This can provide information about the location, extent and size of the endometrial implants to determine the best treatment. Sometimes tissue biopsy of the implants is necessary, where bits of the tissue are taken for inspection under the microscope.

Treatment

Commonly, Nonsteroidal anti-inflammatory drugs (NSAIDs) – such as brufen or naproxen sodium) – are used to help relieve pelvic pain and menstrual cramping.

They relieve the pain but have no effect on the endometrial implants or the progression of endometriosis. Oral contraceptive pills are also used and are usually well-tolerated in women with endometriosis.

Depo Provera, the injectable contraceptive, is effective in halting menstruation and the growth of endometrial implants, thereby relieving the signs and symptoms of endometriosis.

These have side effects and are best used when prescribed and supervised by a medical practitioner. Surgery has been used as a last resort, also dependent on whether the woman still wishes to have children.

The following home remedies have worked in some women:

• Warm baths and a hot water bottle can help relax pelvic muscles, reducing cramping and pain. v Over-the-counter NSAIDs such as ibuprofen or naproxen.
• Regular exercise may also help improve symptoms.