Ask an Ob/Gyn: Is Your Period Pain a Sign of Endometriosis?

Endometriosis is more common than you may think and can often go undiagnosed. Celebrities including Bindi Irwin, Chrissy Teigen and Emma Roberts have spoken publicly about their difficult experiences with the condition, helping raise awareness of how it can affect women’s health and fertility.

So why can endometriosis be so difficult to diagnose? What symptoms should you look for, and when should you consider getting a second opinion? In this Q&A, Ob/Gyn Danny Koh, DO, with Overlake Clinics Ob/Gyn, answers common questions about endometriosis, including its symptoms, diagnosis, treatment and potential impact on fertility. 

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Q: What is endometriosis?

A: Endometriosis happens when tissue similar to the lining of the uterus develops outside of the uterus. It may grow on the ovaries, fallopian tubes, bowel, bladder or other areas. This tissue responds to the hormones that control your menstrual cycle. It can swell and bleed each month, causing irritation and inflammation.  

Endometriosis is a chronic condition that can change over time. Timely diagnosis and treatment can help manage symptoms and improve quality of life.

We are still learning about what causes endometriosis. Researchers have several theories, but there is no single explanation for why it develops. It is estimated to affect about 1 in 10 women, though the true number could be higher because some may have symptoms for years before receiving a diagnosis.

Q: What are the common symptoms of endometriosis?

A: If you have endometriosis, you may have one or more of these symptoms:

• Strong cramps and menstrual pain.
• Pelvic pain.
• Pain during sex.
• Bleeding after sex
• Painful bowel movements or urination during your periods.
• Trouble getting pregnant (infertility).
• Abnormal or heavy menstrual and/or inter-menstrual flow.

Q: How is endometriosis diagnosed?

A: The gold standard for diagnosing endometriosis is laparoscopy. During the procedure, a thin surgical camera is inserted through a small incision in the abdomen to look inside the pelvis. This allows the surgeon to see the location, extent and amount of endometriosis.

Endometriosis can be difficult to detect with an ultrasound, CT scan, or MRI. However, an MRI may help identify certain types when performed and reviewed by a radiologist experienced in the condition. Your Ob/Gyn may still recommend a pelvic ultrasound as part of your evaluation.

Other tests for endometriosis are currently being studied in clinical trials. We hope these new tests will provide better diagnostic options in the future.

Overall, endometriosis can be difficult to diagnose because it can look different from person to person. Sometimes, even an experienced Ob/Gyn can miss it. If you think you may have endometriosis but don't have clear answers, it is OK to seek a second opinion.

Q: How is endometriosis treated?

A: Your healthcare provider will consider your age, overall health, symptoms and other factors when recommending a treatment plan. Whether you hope to become pregnant now or in the future will also play an important role in your treatment choices.

Treatment may include medication, surgery or a combination of both. Your treatment plan will be tailored to your symptoms, exam findings, test results and personal goals. As we learn more about endometriosis, we are taking a more proactive approach to treatment. The goal is to manage symptoms, protect your health and help you maintain your quality of life.

Q: Can endometriosis affect fertility?

A: Endometriosis can make it much harder to become pregnant and is a common cause of infertility. In some cases, treatment may improve your chances of getting pregnant. However, fertility can be affected differently from person to person.

If you have endometriosis and hope to become pregnant, talk with your Ob/Gyn as early as possible. Together, you can discuss your options and develop a plan based on your overall health and fertility goals.

Q: When should someone see an Ob/Gyn about pelvic pain?

A: Painful, abnormal periods are not something you have to live with. If menstrual or pelvic pain interferes with work, school, exercise, sex or daily activities, talk with your Ob/Gyn.