Period pain that isn't 'just normal'

What is endometriosis?

In endometriosis, tissue similar to the womb lining grows outside the womb — for example on the ovaries, fallopian tubes, the lining of the pelvis, the bowel or the bladder. This tissue responds to hormones during your cycle, which can cause inflammation, pain and scar tissue (adhesions).

It can affect anyone who has periods, from teenagers onwards. The severity of symptoms doesn't always match how much endometriosis there is: some people with small areas have a lot of pain, and some with more extensive disease have few symptoms.

Common signs of endometriosis

Symptoms vary, but the most common are:

• Period pain that affects your daily life — missing school, work or plans, or painkillers not really helping
• Pelvic or lower tummy pain that may happen at other times in your cycle too
• Pain during or after sex, often felt deep inside
• Pain when peeing or pooing, especially during your period
• Bowel symptoms such as bloating, constipation or diarrhoea that get worse around your period
• Heavy periods
• Difficulty getting pregnant
• Fatigue and feeling worn down

It can also take a real toll on mental health, relationships and work. If your symptoms are affecting your life, that's reason enough to seek help.

Why diagnosis can take so long

Many people wait years for a diagnosis. Period pain is often dismissed as normal, symptoms overlap with other conditions like irritable bowel syndrome, and there's no simple blood test.

Painful periods are common, but pain that regularly stops you living your life is not something you just have to put up with.

How endometriosis is diagnosed

Your doctor will ask about your symptoms and may offer a pelvic examination. You might then be referred for:

• An ultrasound scan, often transvaginal, which can show some types of endometriosis such as cysts on the ovaries
• An MRI scan in some cases, to look for deeper endometriosis
• A laparoscopy — keyhole surgery where a surgeon looks inside your pelvis with a camera. This is the most reliable way to confirm endometriosis, and tissue can sometimes be removed at the same time.

A normal scan doesn't rule endometriosis out, because smaller areas often don't show up. If your symptoms continue, it's reasonable to ask about referral to a gynaecologist or a specialist endometriosis service. Doctors may also suggest trying treatment for symptoms before a definite diagnosis.

How to prepare for your appointment

Going in with clear information can make a big difference:

• Keep a symptom diary for a few cycles: when pain happens, how bad it is on a 0–10 scale, and what helps
• Note how it affects your life — days off work or school, cancelled plans, disturbed sleep
• List the painkillers or treatments you've already tried and whether they worked
• Mention any family history of endometriosis
• Write down your questions, and consider bringing someone with you

It's fine to ask directly: 'Could this be endometriosis, and what are the next steps to find out?'

Treatment options

There's no cure yet, but treatment can reduce symptoms and improve quality of life. Options include pain relief, hormonal treatments such as the contraceptive pill or a hormonal coil, other hormone medicines, and surgery to remove areas of endometriosis. Pelvic physiotherapy, pain management services and mental health support can help too.

The right approach depends on your symptoms, your age and whether you want to get pregnant, so it's worth talking through the pros and cons of each option with your doctor.

When to get help urgently

Seek urgent medical care if you have sudden severe pelvic pain, pain with fever, fainting or vomiting, or severe pain with a positive pregnancy test. These need checking straight away for other causes such as infection, a twisted ovary or an ectopic pregnancy.