Are your menstrual periods causing severe pain?
3/7/2022 by Danielle O'Laughlin, P.A.-C., M.S.
Endometriosis is a chronic condition where endometrial tissue, or the tissue that lines your uterus, grows outside of the uterus. This endometrial tissue can be found in multiple locations, including the tissue lining the pelvic cavity; ovaries; bowel; bladder; ureters; or extrapelvic structures, such as the lungs, diaphragm or belly button.
Risk factors known to be correlated with endometriosis include:
- Exposure to diethylstibestrol, which was a synthetic hormone given to pregnant women between 1940 and 1971 to prevent pregnancy complications.
- Starting your period at an early age.
- A short menstrual cycle.
- Heavy menstrual periods.
- Low body mass index.
- Decreased number of pregnancies.
What are the symptoms of endometriosis?
The presentation of endometriosis varies from person to person. Endometriosis can be asymptomatic or cause nonspecific symptoms that are often cyclical with menstruation, such as pelvic pain, painful periods, pain with intercourse, pain with bowel movements or urination, or heavy menstrual bleeding. Endometriosis also can cause fatigue, insomnia, diarrhea, constipation, bloating, nausea and infertility. And it can affect your physical, mental, sexual and social health.
How is endometriosis diagnosed?
Although symptoms of endometriosis usually begin in adolescence, diagnosis is often delayed for several reasons.
Endometriosis is a difficult diagnosis to make, as the diagnosis is generally confirmed through surgical visualization, often by laparoscopic surgery. Due to associated risks, surgery is often delayed until the severity of symptoms warrants increased risk and other conditions have been excluded. Imaging, with ultrasound or MRI, can be performed, but this requires a trained specialist. Also, sensitivity and specificity vary.
How is endometriosis treated?
Various endometriosis treatment options are available. Treatment depends on your symptoms and whether you want to become pregnant.
Treatment can include pain medications, such as nonsteroidal anti-inflammatory drugs, acetaminophen and hormone therapy. Hormonal therapies can include traditional contraceptives (oral and nonoral), gonadotropin-releasing hormone agonists and antagonists, progestin therapy, and aromatase inhibitors.
The oral contraceptive pill is often used as the first-line treatment in women who want to get pregnant immediately. Surgical intervention is often considered when women have failed pain and hormonal treatment options.
The goal of conservative surgery is to destruct or remove excess endometrial tissue and adhesions, but success varies and does not ensure improved symptoms. Definitive surgery, such as a hysterectomy, is common with endometriosis. But it is not an option for women who want to get pregnant in the future, and it comes with additional risks. Reproductive assistance may be required in women who want to get pregnant.
Since endometriosis may cause more than just physical symptoms, anti-anxiety medications, antidepressants, pelvic physical therapy, sexual therapy, pain education, mindfulness strategies, cognitive behavioral therapy, trigger point injections, acupuncture, botulinum toxin, and dietary changes also may be beneficial.
Danielle O'Laughlin, P.A.-C., M.S., is a physician assistant in Primary Care in Rochester and Kasson's Division of Community Internal Medicine, Geriatrics and Palliative Care. She is the team lead of the Primary Care Obstetrics and Gynecology Clinic and the Clinical Skills co-director of the Mayo Clinic Physician Assistant Program.