Does menstrual pain always mean endometriosis?
Contrary to the common belief amongst women that every case of persistent menstrual pain is endometriosis or that endometriosis means only painful period pains, medical experts have said that the two do not mean the same thing.
They said there are many causes of period pains and endometriosis is one of them. Some of the other conditions they could cause it include fibroids, chronic pelvic inflammatory disease, urinary conditions and adenomyosis where the tissue that normally lines the womb starts to grow in the womb wall itself, and make periods particularly painful, among others, they said.
Therefore, it is important to see a doctor when you have pains that you consider not normal or that becomes more severe than usual.
However, the experts add that severe period pains in adolescence may be a significant pointer towards endometriosis, and so should be investigated further through visit to the hospital or to a gynaecologist.
“Endometriosis occurs where the cells that normally line the uterus start to grow in other locations as well. These cells are then shed each month, similar to the tissue in the uterus. It is this that causes intense pain, as the blood shed cannot escape,” said Dr. Jennifer Kelly Jennifer, a General Practitioner, medical writer, with Fermedic.
“This tissue may be found in all sorts of locations including in your ovaries, bowel, and the tissues lining your pelvis. The symptoms experienced are dependent on the locations of the endometriosis.
“Usually the pain is felt in the locations you have the endometriosis. However, at times you may get ‘referred pain’, especially in the abdominal and pelvic regions, so you may feel it in slightly different locations too,” she said.
Dr Kelly said women with endometriosis experience several symptoms, adding that majority of women with endometriosis, however, present with increasing pain during their periods, often worsening in their late twenties onward. “If your periods are progressively becoming heavier and accompanied by severe pain, or you have other symptoms as well, this is an indication that you may have more than period pain,” she said.
The doctor said for women with endometriosis, often, simple pain killers do not relieve their pain effectively and the pain may continue after the period has finished, even resulting in chronic pelvic pain. Women may experience deep pain on intercourse (deep dyspareunia), and problems with pain at the ovulation, she said.
Depending on the location of endometriosis tissue, women may also have symptoms of pain or bleeding on opening their bowels, or even when passing urine, especially around the time of their period, the Dr Kelly.
According to Dr. Eche Ugochukwu, a general medical practitioner at the Federal Medical Centre, Keffi, Nasarawa State, endometriosis occurs when endometrial tissue (innermost part of the uterus) is found somewhere else away from the endometrium.
He said while endometriosis has similar symptoms to menstrual pain, endometrial tissue can develop anywhere in the body.
“They usually occur in the pelvic area. Possible places it may affect are the ovaries, peritoneum, lymph nodes, and fallopian tubes. While anyone can develop endometriosis, it is most common in women in their late 20s - 40 years,” he said.
He said endometriosis can result from problems with menstruation flowing inwards into the fallopian tubes instead of outwards; unnecessary termination of pregnancy, surgical scars, and maybe genetic too.
The physician said some of the symptoms of endometriosis are severe menstrual cramps, spotting or bleeding between periods, lower-back and pelvic pain, and periods lasting longer time of than seven days.
Others include nausea and vomiting, fatigue, pain during intercourse, heavy menstrual bleeding where the pad or tampon needs to be changed every one to two hours, bowel and urinary problems including pain, diarrhoea, constipation, and bloating, and bloody stool or urine, amongst others.
He added that the pain often resolves during menopause, as the body stops producing estrogen.
On prevention, he said it can be prevented if unnecessary surgeries such as surgical termination of pregnancy is avoided to prevent transfer of endometrial tissue to other parts of the body.
He said though there is currently no cure for endometriosis, most women were able to relieve the painful symptoms and still be able to have children by exercising, eating healthy food, going for regular checkups, and avoiding anything with caffeine among others.
Dr Ugochukwu advised women experiencing menstrual pains to always go for regular medical checkups to determine if the pain is endometriosis, just menstrual pain or other conditions.
Narrating her experience Bilkisu, 35, said she suffered from menstrual pains for several years. She said initially she thought it was just period pain and nothing more, and that people around her encouraged her to believe same.
She had to go to hospital when it was accompanied with excessive bleeding and pain during urination. She said she had to go through series of painful surgeries after diagnosis adding that things would have been a lot better if she sought diagnosis and treatment earlier.