Dr Dulcy Rakumakoe
3 minute read
28 May 2019
10:00 am

Unpacking pelvic pain

Dr Dulcy Rakumakoe

The pain of Endometriosis affects almost two out of every ten women of reproductive age.

Picture: iStock

Endometriosis is an often 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. These are called adhesions.

Endometriosis can cause pain, especially during your period. Fertility problems also may develop. 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.

Estimates suggest that 20% to 50% of women being treated for infertility have endometriosis, and up to 80% of women with chronic pelvic pain or period pain
may be affected.


The exact cause of endometriosis is not certain. The most likely cause for endometriosis is what is called retrograde menstruation, where menstrual blood, instead
of flowing out of 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, such as endometrium. Occasionally endometriosis has been seen as a complication of surgery where there is an accidental direct transfer of endometrial tissues at the time of surgery to other sites.

Risk Factors

The following women are most at risk of developing endometriosis:
Women aged 25 to 35 years, even though some cases have been reported in women as young as 12.
Those who have never given birth, because of this many women who are homosexual, or those who are delaying their first pregnancy report with cases of endometriosis.
Women who either had an early onset of menses or late menopause.
Women with 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).

It usually develops several years after the onset of menstruation and ends temporarily with pregnancy and ends permanently with menopause.

Signs and Symptoms

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

They also tend to report that the pain increases over time.

Common signs and symptoms of endometriosis 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 symptoms 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. Some women will need intervention while others can cope with the monthly pain.

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