Pelvic Pain
As we know, the most common symptom from endometriosis is pelvic pain – that illusive term! But what is this pain really like? And what is the difference between period cramps and ‘endo pain’, as many patients call it? After all, ‘pelvic pain’ is a general term and can be used to describe symptoms for a number of conditions, including ‘normal’ period pain. In this article, we’ll be gaining perspective on this comparison with testimonials from patients living with endometriosis.
First of all, what are period cramps?
According to the NHS website, period pain is a common and normal part of your menstrual cycle and most women get it at some point in their lives. Painful cramps or muscle spasms are usually felt in the pelvis and lower abdomen but can stem to the back and thighs. These cramps can come in intense spasms or be dull and constant.
Some people’s periods may cause little or no discomfort, while other people’s may be more painful. It may even vary with each period – there’s no rule book! [1].
Painful periods, or ‘dysmenorrhea’ to use it’s scientific name, happen when the muscular wall of the womb contracts to help the womb lining shed as part of menstruation. While this is happening, tissues in the womb releases pain-triggering hormones called prostaglandins. These hormones encourage the womb to contract even more, further increasing the level of pain. Talk about a bad design! It is not known why some women experience more period pain than others, but it could be due to higher levels of prostaglandins being produced in some people resulting in longer contractions [2].
Other common symptoms of period pain, stemming from the hormonal changes that take place during the menstrual cycle, are abdominal bloating, breast tenderness, mood swings headaches and fatigue. Delightful!
What does endometriosis pain feel like?
Some of the symptoms are similar or identical to those of painful periods, hence the common misdiagnosis of endometriosis as just ‘period pain’ or IBS. But endometriosis is a chronic condition and here we are talking about a different level of pain.
In a testimonial on the Endometriosis UK website, one patient diagnosed with endometriosis describes her pain as:
‘An intense, dragging, constant feeling that just exhausts you’
Endometriosis UK, Endometriosis: Personal Stories, Available at: https://www.endometriosis-uk.org Accessed 3rd April 2020
In a video made for BBC Three’s Body Language, a woman describes her experience of endometriosis as..
‘..like someones hand is literally clenched up in a fist with knives on all the digits, and then it goes right up inside you, just near your lungs and then it kind of punches you, two, three, four, hundreds of times.’
BBC Three (2018) Body Language, S1 E3, Video Available at: https://www.youtube.com/watch?v=HLYEAQleVIU Accessed 3rd April 202
A friend of mine, diagnosed with endometriosis, told me:
‘It’s like razor blades scraping at your insides – that’s the most accurate description I’d heard yet. Sometimes it’s a constant dull ache, other times it’s sudden and sharp, or a burning sensation, or twisting, or pulling.’
No Limits
Whereas period pain is usually limited to the days of your actual period, endometriosis pain can strike at any time of your cycle. Not only that but the endometrium (tissue that usually grows inside the uterus and sheds during menstruation) can actually grow anywhere in the body. It is widely thought that endometriosis only grows outside the womb and on the ovaries, and though these are the most common places, it is not limited to these areas, therefore the pain is not limited. It has even been found in patients’ lungs or diaphragm.
It is notable that patients regularly describe how pain killers (even the strongest kind) have little effect on endometriosis pain. This degree and intensity of pain unsurprisingly has a detrimental effect on patients’ mental health and many can experience depression and anxiety and a sense of hopelessness.
PMS can be rough, but it won’t do that…
In Medical Terms
Endometriosis pain is even categorised differently to normal period pain; it comes under the umbrella of ‘Secondary Dysmenorrhea’, which can be caused by debilitating conditions like ovarian cysts, pelvic inflammatory disease and, of course, endometriosis.
The treatment for primary dysmenorrhea (a.k.a. period pain) is different to that of secondary dysmenorrhea. The latter is more drastic and invasive as the symptoms are generally much more severe.
What is ‘Normal’?
Normal period pain should not be so severe that it regularly interferes with your ability to go about your daily life. Period cramps can be very painful and uncomfortable and many women have to endure vicious bouts of PMS during their cycle – I know I do! – but these symptoms are temporary and are usually manageable with things like pain killers, gentle exercise, heat treatment or contraceptive medication.
All too often people with secondary dysmenorrhea are being panned off as having ‘period cramps’, when clearly the two are dramatically different and can stem from serious conditions that require fast and effective intervention.
References and Resources
1) NHS (2019) Endometriosis, Available at: https://www.nhs.uk/conditions/endometriosis/ Accessed 3rd Apri 2020
2) Orlando Health, Winnie Palmer Hospital for Women & Babies (2020) Gynaecology: Painful Periods, Available at: https://www.winniepalmerhospital.com/services-and-specialties/painful-periods Accessed 3rd April 2020
