Severe period pain: when it could be endometriosis

The NHS advises making an appointment with a doctor if your periods become more painful, heavier or irregular, or if pain stops you doing your usual activities. The same applies if you have pain during sex or when peeing or pooing, bleeding between periods, a swollen tummy, loss of appetite or unexplained weight loss.

If pelvic or period pain is severe or worse than usual and painkillers have not helped, the NHS recommends seeking urgent help.

Endometriosis is a condition in which tissue similar to the lining of the womb grows in other places. According to the World Health Organization, it affects an estimated 10% of women of reproductive age worldwide, around 190 million.

Its most common symptoms are severe pain during menstruation, heavy periods, chronic pelvic pain that does not go away when the period ends, difficulty getting pregnant, abdominal bloating and nausea. It can also affect sex, going to the toilet and mood.

The WHO says the average time to diagnosis is between 4 and 12 years. Symptoms vary a great deal from one woman to another and are easily mistaken for a painful period, so they are often not recognised.

The same source says that early diagnosis and good health care may slow or halt the progression of the disease. That is the underlying reason not to resign yourself to living with the pain.

We start by listening: what the pain is like, when it comes, how much it limits you and since when. Then there is an examination and a gynaecological ultrasound scan, which can show ovarian cysts or signs that point towards a diagnosis. A normal scan does not completely rule the condition out, so the work-up is completed according to your case.

The NHS mentions anti-inflammatory painkillers such as naproxen or mefenamic acid, a TENS machine that eases pain with mild electrical impulses, and hormonal contraception, which thins the womb lining and makes periods lighter and less painful. If the pain does not improve or there may be another cause, such as fibroids, referral to a gynaecologist is recommended.

At the clinic we adapt the plan to your situation, including any plans for pregnancy, and we are open about when a minimally invasive surgical technique makes sense.