Severe pelvic pain during a woman’s menstrual cycle is often dismissed as just ‘bad cramps’, when in fact it could be indicative of a more chronic gynaecological condition

Many women complain of severe pelvic pain around the time of their periods. For some, it is so debilitating that they are unable to function or perform daily tasks. Very often, women endure the pain because they feel, or have been told, that it is part and parcel of the menstrual cycle.

But severe pelvic pain could actually be a symptom of endometriosis, which typically affects women during their reproductive years.

Studies indicate that about 10-15% of all women live with endometriosis, a chronic condition where cells from the uterine lining (endometrium) grow outside the womb, in the pelvis and around the ovaries and fallopian tubes.

Dr Arthur Tseng

Exactly why it happens is still unclear. According to Dr Arthur Tseng from Arthur Tseng Women’s Health Services in Singapore, the most likely explanation is that during menstruation, some of the blood containing cells from the endometrium flows backwards into the pelvic area via the fallopian tubes.

“Once in the pelvic area, these cells attach themselves to other organs and begin to grow. With each period, more cells from the endometrium enter the pelvic area while those already present are stimulated to grow by the hormonal fluctuations of the menstrual cycle,” says Dr Tseng.

“Endometriosis can develop on the ovaries where it can form cysts as well as in or on the fallopian tubes causing fertility issues, as the growths can block the passage of both sperm and eggs. It can also take hold almost anywhere on, behind or around the womb: in the tissue lining of the abdominal walls and organs in the abdomen, on the bowel and the bladder. If it develops deep within the muscle wall of the uterus, it is called adenomyosis,” he adds.

While endometriosis is neither contagious nor cancerous, if left undiagnosed and untreated it could lead to diminished quality of life and/or infertility.

Common Misconceptions

Awareness on endometriosis has increased in recent years, in part due to celebrities like Padma Lakshmi and Chrissy Teigen who have publicly spoken about their own struggles with it.

However, there are still many misconceptions about the condition that could delay or prevent women from seeking help, such as:

It’s just a heavy period. Most women assume that painful periods or heavy bleeding are a normal part of their menstrual cycle, but they could be symptoms of endometriosis. “It is thought that almost a third of the women who suffer from painful periods have endometriosis,” says Dr Tseng.

I don’t have pain, so I don’t have endo. Not everyone experiences pain. The severity of your pain is not necessarily a reliable indicator of the seriousness of the condition. Women with severe endometriosis could sometimes have little to no pain or symptoms, and vice versa.

You can’t get pregnant with endometriosis. Not necessarily, although it can make conceiving more difficult. Depending on the severity of the condition, the likelihood of miscarriage and other complications during pregnancy could also increase. With a proper treatment plan, many women with endometriosis do conceive and deliver a healthy baby.

Diagnosing endometriosis

Diagnosing endometriosis can be complicated, and it is sometimes misdiagnosed as pelvic inflammatory disease (PID), ovarian cysts or irritable bowel syndrome (IBS).

Your doctor may suspect endometriosis if you are experiencing debilitating pain during periods, pelvic pain, and/or discomfort or pain during intercourse. Dr Tseng explains the three routine procedures that patients may need to undergo to confirm this diagnosis:

Step 1: Pelvic exam

A manual pelvic exam is usually the first step, where the doctor will palpate or manually feel areas in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus. However, it is not always possible to feel small areas of endometriosis manually, unless they have caused a cyst to form.

Step 2: Ultrasound scan

Your doctor will typically follow up the manual exam with an ultrasound scan – similar to what is used to see a baby in the womb. This is either done via the abdomen or through the vagina (transvaginal ultrasound). The ultrasound will be able to identify ovarian cysts and large growths in other areas, although it may not definitively tell your doctor whether or not you have endometriosis.

Step 3: Laparoscopy

Finally, your doctor may refer you to a surgeon for a surgical procedure called a laparoscopy. A laparoscopy requires general anaesthesia, and while you are under, a tiny incision is made near your navel, and a slender viewing instrument (laparoscope) is inserted to look for endometrial tissue outside the uterus. Tissue samples may be extracted and taken for a biopsy. A laparoscopy will be able to provide the doctor with definite information about the location, extent and size of the endometrial growths, and help determine the best treatment options.

Although there are no cures yet for endometriosis, there are several treatment and therapy options that doctors can recommend based on the severity of the symptoms and the condition.

For those living with endometriosis, early diagnosis and treatment provide the best possible outcomes for improving quality of life.