When It’s Not Just a Painful Period: Signs of Endometriosis

Pain before and during menstruation is common for most women. But how do you know when extremely painful menstrual cramps might be a sign of something more serious? Below we go over how to tell if menstrual pain could be a symptom of endometriosis or just the result of premenstrual syndrome (PMS).

The following is a brief guide, but if you are concerned about your reproductive organs, then it is recommended to schedule an appointment for a physical examination with your gynecologist or health care provider.

What is endometriosis?

Endometriosis is when endometrial tissue similar to the lining of the uterus grows outside the uterus and attaches to other parts of the body. Endometrial tissue sheds each month during menstruation. However, the tissue outside the uterus has no way to leave your body so it becomes stuck. Endometriosis is commonly found on the ovaries, fallopian tubes, outer surface of the uterus, the bowel, areas surrounding the uterus, and membrane lining the pelvic cavity.

Endometrial implants can also be found on the vagina, cervix, vulva, and bladder. More than 11% of American women may experience endometriosis, from adolescent girls to women in their 40s. The condition can cause extremely painful periods and may cause fertility problems.

The difference between menstrual cramps and endometriosis

Menstrual pain in the lower abdomen is normal for PMS and can usually be treated with medications like ibuprofen and aspirin. However, endometriosis causes severe menstrual cramps that can make it difficult to go about your normal routine.

The menstrual pain can get worse with age. In addition to painful periods or dysmenorrhea, other symptoms can include long or heavy menstrual periods, nausea, fatigue, pain during a pelvic exam, and diarrhea. Below is a list of common symptoms:


  • Dysmenorrhea (painful period): Pelvic pain and menstrual cramps can occur before and during menstruation and last for several days. Menstrual pain can be severe and sharp. Pain in the lower abdomen and back are also common given your uterus and ovaries are located near your back.
  • Infertility: Endometriosis may cause fertility issues if the tissue outside the uterus causes scarring, especially around the fallopian tubes. It may also stop a fertilized egg from implanting in the lining of the uterus.
  • Pain during bowel movements or urination: This will likely occur during your menstrual period.
  • Pain during intercourse: This pain may be described as “deep” or “stabbing” and occur during sex and last for a couple of days after.
  • Bloody urine: This may occur during menstruation.

Pain during your menstrual cycle is the primary symptom, but can often vary from mild to severe. Endometriosis is sometimes confused with other conditions like pelvic inflammatory disease (PID) or ovarian cysts.


The causes of endometriosis remain unknown, but researchers have a few theories. Retrograde menstruation is one of the likely causes. This is when the bloodshed during menstruation flows back into the pelvis through the fallopian tubes. Another possible cause is that areas around the pelvic organs have cells that can turn into the endometrium.

Researchers are also looking at whether the condition has to do with the body’s hormone system as the hormone estrogen seems to trigger endometriosis. Some risk factors include a family medical history of endometriosis, shorter menstrual cycles, higher levels of estrogen, and unusually long blood flow.

Diagnosis and treatment

Gynecologists typically diagnose the disorder and other conditions causing pelvic pain by conducting tests such as a pelvic examination, ultrasound, magnetic resonance imaging (MRI), or laparoscopy. For treatment, your gynecologist may suggest taking pain medications like ibuprofen, Motrin, and nonsteroidal anti-inflammatory drugs (NSAID) or doing hormone therapy like birth control pills and other forms of contraception.

A better understanding of the condition is helpful for both patients and clinicians. If you are planning to work in a medical assisting job in the field of gynecology, then understanding the symptoms and treatments for dysmenorrhea and other pelvic pain disorders is crucial. Medical assistant training will certainly cover this, but it is a good idea to be prepared, especially for job interviews. Medical assistant interview questions will range from discussing clinical skills to computer skills to the daily activities associated with a medical assistant position.

Ruby Guzman

Style Editor

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