Painful periods are something women suffer through every month. Whether women find relief in exercise, heating pads, ibuprofen or a pint of ice cream, the pain for some can be agonizing. But should this pain always be considered normal? For one in ten women, the answer is no.
An estimated 6.5 million women in the United States suffer from endometriosis, a severe and painful gynecologic condition that occurs when tissue similar to the endometrium (the lining of the uterus) grows outside of the uterus and on areas where it doesn’t belong. Most often, endometriosis is found on the ovaries, fallopian tubes, tissues that hold the uterus in place, outer surface of the uterus, bowels or bladder.
Endometriosis can develop in any female of reproductive age, but is more common in women in their 30s and 40s. The cause is still unknown, but it can be linked to women that have menstrual periods lasting more than seven days, short menstrual cycles, if a woman has never had children or if a family member has previously been diagnosed with endometriosis.
“There are several different working theories as to the cause of endometriosis,” said Michelle Hopkins, certified physician assistant at Novant Health Pelvic Health & Surgery. “I think endometriosis is one of the most complex diseases, and there is still a lot to be learned about it.”
Historically, many women have had their pain dismissed by doctors. Women reported seven visits to their primary care physician before getting a referral to a specialist. More often than not, those visits resulted in anti-inflammatory medicines such as ibuprofen to help alleviate the pain. In some cases, women were told it “was all in their head.”
In a 2001 comparison where both men and women presented the same symptoms, health care providers were more likely to give pain-relieving drugs to men, whereas women are more likely to receive sedatives. Women are more likely to have their pain discounted as emotional or psychogenic and therefore not real, the study concluded.
As doctors and researchers look deeper into the condition, today many women are now feeling that their once ignored pains and concerns are being heard.
Endometriosis most frequently causes long-term pain in the lower back and pelvis, pain during or after sex, intestinal pain and painful bowel movements. Other symptoms include bleeding or spotting, fatigue, nausea, constipation, bloating, diarrhea and infertility. As many as one in every two women with endometriosis have difficulty getting pregnant, according to the U.S. government.
The severity of pain isn’t necessarily an indicator of the extent of endometriosis, however. “Sometimes women have advanced endometriosis but don’t experience any symptoms,” Hopkins said.
“The only way to 100 percent diagnose and confirm endometriosis is through a laparoscopic procedure or minimally invasive surgery,” said Dr. Nicholas Bodenheimer of Novant Health OB/GYN in Bolivia, North Carolina. “We take biopsies of the lesions (tissue) to confirm a diagnosis.”
While there is no known cure, treatment is aimed at controlling pain and preventing the progression of endometriosis. Hormonal therapy is one of the first ways to help alleviate symptoms and keep the progression of symptoms at bay, Hopkins said.
Hormonal therapy works by regulating the levels of your natural hormones. Some of these hormonal medications may prevent ovulation and periods. Most often the first line of hormonal medication is one of the many available hormonal contraceptive options, as this can help treat endometriosis and also provide birth control. Hormonal contraceptive options include birth control pills, vaginal ring, an injection, intrauterine device (IUD) or a hormonal implant inserted under the skin in a woman’s upper arm.
Initially, doctors focus on treating the symptoms. If symptoms subside, doctors refrain from the surgical route because there’s always a risk with surgeries and procedures. However, if problems continue and endometriosis is still suspected, then a procedure is done.
“Doctors can’t confirm a patient has endometriosis without surgery, but the initial treatment of hormonal therapy stays the same,” Bodenheimer said. “Hormonal therapy not only helps women with endometriosis but also women who experience painful periods.”
The other treatment option is minimally invasive surgery to remove any endometriosis tissue. Minimally invasive surgery is used to cut or burn off any tissue while minimizing the recovery time for women. Hopkins still recommends hormonal treatment following surgery.
“Endometriosis is a chronic disease and it’s something we have to continually manage,” Hopkins said. “It’s something we have to manage surgically coupled with hormonal therapy.”
What about getting pregnant?
It is important to talk frankly with your doctor to determine your best treatment option. You should discuss the frequency and severity of your symptoms, how they affect your daily life, and whether you want to have children now or in the future.
“There is a higher prevalence of endometriosis in women having difficulty getting pregnant, but someone with endometriosis may not have any issues conceiving,” Hopkins said. “The most important factor in conceiving is age.”
If any of these symptoms sound familiar, talk with a doctor. Get informed about your options. On average, women go six to eight years between their first symptom and getting diagnosed. Don’t wait to speak up.
“Second opinions are really common these days,” Hopkins said. “Women should plan on seeking care as soon as they have symptoms and plan on being an active participant in the plan developed to care for this chronic condition. The goal is to empower women to be an advocate for their care and to have an understanding of the options they have.”
If you think you may have endometriosis or want to discuss your symptoms with a doctor, schedule an appointment today with an OB-GYN. Click here to find a provider near you.
Healthy Headlines team member Jennifer Meadows contributed to this story.