Period cramps are common:

But, if they are not responding to normal over the counter painkillers and they are stopping you or your loved one from socialising or going to work or school then they probably are not normal and may be due to something called Endometriosis.

So, what is Endometriosis and why do we care about it?

Our uterus (womb) has a lining called the endometrium. Every month when we ovulate this lining gets thicker in case we get pregnant so that a fertilised egg can implant or burrow into it to form the foetus. If a pregnancy does not occur, then this lining gets shed and we see it as a period.

Sometimes, for reasons that are not clearly understood, bits of lining get into places where they should not be. Most commonly the fallopian tubes or the ovaries. Sometimes even the bladder, bowel, pelvis. In extreme cases, the endometrial tissue can reach as far away as the lungs!  When we ovulate, these bit of lining in the wrong paces also get thicker and when our period comes they also bleed. The bleeding is in the wrong place and can be very painful.

Bleeding in the wrong place like the tubes can cause scar tissue to build up causing blockages. This can lead to infertility if it is in the tubes. If the bleeding is in the bowel it can make it painful to pass stool. If it is in the bladder it can make it painful to urinate. Sex can be painful too. I have even seen a patient’s belly button bleed whenever she had her period because there was endometriosis in her belly button! The scar tissue can eventually cause chronic pelvic pain, not just when you have a period, but all the time.

Now, I don’t want to overly scare people- lots of people have endometrioses and do not even know it. Lots of people have endometriosis and have no problems getting pregnant. Pain is not even always a great indicator of severity of scar tissue either.

However, we really want to prevent these long-term consequences like infertility and chronic pain. To do this we have to control the bleeding, which causes the scaring, not just take painkillers. That’s why we have endometriosis awareness month every March: We do not want you to suffer. If you think your period pain is out of this world then come to see us! There are a range of treatment options to prevent bleeding and scaring. It’s not just about pain management.  On average it takes 7-8 years of severe period pain before girls or ladies get a diagnosis. This is way too long as it causes lost school time, time off work, years of pain and years of bleeding in the wrong place increasing the risk of scaring and future pain and infertility. We have to get better at this!

Here is a very quick FDA approved period quiz to help you decide if your period pain may warrant a discussion with your doctor: https://drcharlesmiller.com/wp-content/uploads/2018/10/Pelvic-Pain-Sympton-Screener-PPST.pdf