Know the difference between regular period pain and endometriosis

Endometriosis can severely affect women's day-to-day life and relationships. The condition on average affects one in 10 women across the UK and can cause debilitating pain, heavy periods and, in some instances, infertility.

Unfortunately, endometriosis can be hard to detect, as the symptoms can mimic heavy and painful periods, leading to a delayed diagnosis and serious consequences to your pelvic health.

So, we spoke to Mr Ian Currie, a consultant obstetrician and gynaecologist based in and around London, to walk us through the differences between painful periods and endometriosis.

What is endometriosis?

Endometriosis is a condition in which the lining of your uterus (womb) starts to grow outside of the uterus and elsewhere in the pelvic region. It can affect the ovaries, fallopian tubes and the pelvic tissue.

When a woman has a regular period, the lining of her uterus sheds; however, with endometriosis, the tissue that has grown outside the uterus in your pelvic area does this too, meaning the endometriosis tissue thickens, breaks down and bleeds with each menstrual cycle. This tissue, however, doesn’t have a way to exit the body, so it gets trapped and causes irritation of the surrounding tissue and eventually leads to scarring.

Endometriosis can happen in any girl or woman who has menstrual periods. However, it is much more common in women in their 30s and 40s.

There are two instances in a women’s life in which endometriosis doesn't affect them - before the onset of menstrual periods and after the menopause. This is because women don’t have a menstrual cycle during these instances.

What symptoms can women experience during regular periods?

The pain from regular periods comes from the contractions of the uterus, and there are usually two things that happen:

• Pain — standard period pain typically appears on the first day you begin your period, and is at it’s highest intensity when your period is at its maximum. You may feel abdominal cramps, tender breasts, bloating and possibly lower back pain.
• Blood loss — the quantity of blood loss can increase. Most women will lose less than 80ml of blood, which is around 16 teaspoons. On average, women lose around 6 to 8 teaspoons. Heavy menstrual bleeding is when you lose more than 80ml or more in each period.

What are the main symptoms of endometriosis?

Unlike during regular periods, the pain from endometriosis isn’t caused by contractions of the uterus, but instead, comes from uterus tissue growing elsewhere in the pelvic cavity. This causes inflammation and can result in a lot of pain.

Classical symptoms of endometriosis are painful periods, but the pain - when compared to regular period pain - typically follows a slightly different pattern. This pattern may not be the same for all women and many may well just have more painful and severe pain with their periods:

• Very painful periods (also known as dysmenorrhea) — pelvic pain and cramping may begin several days before and builds up as your menstrual period progresses. Some women can even experience pain 7-10 days before their period. You may also have lower back pain and heavy menstrual bleeding.
• Painful sex — endometriosis can lead to scarring inside of the pelvis, so it can be associated with painful sex (dyspareunia) or pain following sexual intercourse.
• Subfertility and infertility — the damage that endometriosis can do can impair your fertility. This is usually what drives younger women into further investigations. When women have heavy and painful periods, they tend to Google their symptoms, and upon understanding that infertility is a complication, it drives them to see a doctor.

It’s important to stress that the severity of your pain doesn’t indicate the degree of the condition. For example, you may experience a mild form of the disease yet experience severe pain. Likewise, you may have a severe form but only experience a little bit of discomfort.

How is endometriosis pain different to period pains?

Period pain for each woman is different; however, the majority describe it as sharp and cramping. Women with endometriosis also use these same descriptions, however, the pain is typically more severe. Another difference is that pain from endometriosis can occur on a regular basis, even when you are not having your period.

While normal menstrual pains can usually be managed with over-the-counter medication, endometriosis pain can be so severe that it affects your day-to-day activities and these pain medications usually aren’t enough to control it.

When should a woman see a doctor?

You should seek advice from a doctor if:

• you consider your menstrual cycle changes in particular regarding pain and discomfort and it’s affecting your day-to-day life
• you notice changes in your cycle, such as bleeding more or at unusual times
• ibuprofen and paracetamol aren’t working to reduce your pain and discomfort
• you have had a normal sex life, then you start experiencing painful sex. The pain is usually felt deep within the pelvis.
• If you are trying to conceive and you are experiencing the above symptoms

How do doctors check for endometriosis?

As beforementioned, the severity of symptoms doesn’t always correlate with the level of pain, so certain clinical investigations may be needed.

• The first step to diagnose the condition is to typically undergo a pelvic examination and ultrasound scan. This can only pick up on severe stage endometriosis and only when it is affecting the ovaries.
• MRI scans can be useful to assess the soft tissues and pick up endometriotic nodules - ones that are aligned within the vagina and the rectum.
• There is also a blood test known as a CA 125. This has been traditionally used as an ovarian cancer screen test, but there is some evidence that the protein CA 125 is elevated in women with endometriosis. While the presence of an elevated level of this protein adds weights to the diagnose, it isn't that specific and more tests would be needed.
• A laparoscopy is the most definitive way to diagnose endometriosis and is also the most common way to treat mild to moderate cases too. I tend to see patients to both diagnose and treat them at the same time. It’s usually a day case procedure and involves inserting a telescope (laparoscope) into the belly button to assess the pelvis. This procedure, however, is not without risks, so doctors tend to try non-invasive testing first.

This is the first part of a two-part article aimed at familiarising women on the signs and symptoms of endometriosis and the diagnostic procedures and treatments available. The second part of Mr Currie's article will explain the various treatment options for women with endometriosis.

If you are worried about anything mentioned in this article, book an appointment to discuss your symptoms with Mr Ian Currie through his Top Doctors profile.