Reviewed April 2022

Could your period pain be a sign of endometriosis?

could my period pain be a sign of endometriosis

Period pain, referred to medically as dysmenorrhoea, is an extremely common and entirely normal side effect of the menstrual cycle. The pain occurs when you have your period, most commonly in the first three days of bleeding. It is usually settled with simple painkillers, such as paracetamol, and a hot water bottle, although for some people the pain can be more severe.

What causes period pains?

Your womb (uterus) has walls that regularly contract or tighten. Usually, this is so gently that it cannot be felt. During your period, the walls of your uterus contract more forcefully to help encourage the lining of the womb to break down. It is the lining breaking down that results in your period.

It isn’t the contractions themselves that cause the pain, it is the fact that they cause a reduced blood supply to the uterine wall. Without a blood supply bringing oxygen to the area, chemicals are released which trigger pain, and in turn, make the contractions stronger. The stronger the contractions, the less blood supply that the wall receives and the worse the pain.1

It isn’t known why some people have more intense period pain than others, but it does appear to be a bigger problem in teenagers soon after they start their periods or in older people who have irregular cycles.

The discomfort of period pain has been described in a number of different ways, but it is often felt as painful muscle cramps that may spread to the thighs and lower back. Usually, it is described as a constant pain, but it may come in intense spasms. Symptoms may vary between cycles, so some periods may be more uncomfortable than others.

Many people have other symptoms that may occur alongside period pain, including headaches and tiredness. Hormonal fluctuations at this time are thought to contribute to breast tenderness, feeling emotional, tearful, and feeling bloated.

Severe period pain (pain that interferes with your daily activities or impacts significantly on your quality of life) does not necessarily mean there is an underlying problem, however, it is better to be safe and get checked.

Is it normal to get pain at other points in my cycle?

Yes, people can experience pain at other points in their menstrual cycle too. Pain at ovulation (release of the egg) is another commonly reported pain in the menstrual cycle, but it doesn’t affect everyone.

Ovulation typically occurs 14 days before the start of your next period. The pain, if it occurs, is known as mittelschmerz or middle pain. It is typically experienced in the lower area of the tummy (abdomen), usually on the side where ovulation is occurring. It can vary from a dull cramp lasting a day or so to a sharp and sudden twinge.2

No one is entirely sure why ovulation pain occurs, but one theory is that the discomfort is due to the egg breaking through the wall of the ovary. When this occurs, a small amount of blood or fluid is sometimes released, and this is thought to irritate nearby nerves, resulting in pain.3

Do my period pains mean I have endometriosis?

Endometriosis occurs when the cells that normally line the uterus start to grow in other locations as well. These cells are then shed each month, in a similar way to tissue in the uterus. It is this that causes intense pain, as the shed cells cannot escape.

This tissue may be found in all sorts of locations including in your ovaries, bowel, and the tissues lining your pelvis. Usually, the pain is felt in the locations you have the endometriosis. However, at times you may get “referred pain”, especially in the abdominal and pelvic regions, so you may feel it in slightly different locations, too.

There is a wide variety in the symptoms that people with endometriosis experience. Interestingly, it is thought that up to 25% of those with endometriosis do not have any symptoms that they are aware of.4 The majority of people with endometriosis, however, present with increasing pain during their periods, often worsening in their late twenties onward. If your periods are progressively becoming heavier and accompanied by severe pain, or you have other symptoms as well, this is an indication that you may have more than period pain.

For people with endometriosis, often, simple pain killers do not relieve their pain effectively and the pain may continue after the period has finished, even resulting in chronic pelvic pain. They may also experience deep pain during penetrative sex (deep dyspareunia).5

Depending on the location of endometriosis tissue, there may also be symptoms of pain or bleeding when opening the bowels, or even when passing urine, especially around the time of their period. The effects of endometriosis are varied but can be extremely debilitating.

Other conditions that can cause severe period pain

There are other conditions aside from endometriosis that may cause pain similar to severe period pain, so it is important to be reviewed by a doctor if the pain you are experiencing is not normal for you, or if it becomes more severe than usual.

These conditions include fibroids (growths than can develop in or outside the wall of the uterus), chronic pelvic inflammatory disease (chronic infection), or adenomyosis.6 This is where the tissue that normally lines the womb starts to grow in the womb wall itself and makes your periods particularly painful.

In addition, people who have an IUD (intrauterine device or coil) inserted for contraception may have more period pain, especially in the first few months after insertion, but this usually does settle. If the pain is severe or has changed recently, is accompanied by unusual discharge, or you are unwell with a high temperature, this can indicate an infection.

You should go and see a doctor If the pattern or nature of your periods change, if you are bleeding between periods or after sex, or if you have a thick or very strong smelling vaginal discharge. If your period pain or other symptoms are affecting your quality of life, getting assessed by a doctor and getting the treatment you need really can make a huge difference.

Featured image is of a person lying face-down on a bed, with their arms folded and head resting on their arms. They have a long brown plait in their hair and are wearing a cosy-looking grey jumper

Last updated April 2022
Next update due 2025

Period pain, referred to medically as dysmenorrhoea, is an extremely common and entirely normal side effect of the menstrual cycle. The pain occurs when you have your period, most commonly in the first three days of bleeding. It is usually settled with simple painkillers, such as paracetamol, and a hot water bottle, although for some people the pain can be more severe.

What causes period pains?

Your womb (uterus) has walls that regularly contract or tighten. Usually, this is so gently that it cannot be felt. During your period, the walls of your uterus contract more forcefully to help encourage the lining of the womb to break down. It is the lining breaking down that results in your period.

It isn’t the contractions themselves that cause the pain, it is the fact that they cause a reduced blood supply to the uterine wall. Without a blood supply bringing oxygen to the area, chemicals are released which trigger pain, and in turn, make the contractions stronger. The stronger the contractions, the less blood supply that the wall receives and the worse the pain.1

It isn’t known why some people have more intense period pain than others, but it does appear to be a bigger problem in teenagers soon after they start their periods or in older people who have irregular cycles.

The discomfort of period pain has been described in a number of different ways, but it is often felt as painful muscle cramps that may spread to the thighs and lower back. Usually, it is described as a constant pain, but it may come in intense spasms. Symptoms may vary between cycles, so some periods may be more uncomfortable than others.

Many people have other symptoms that may occur alongside period pain, including headaches and tiredness. Hormonal fluctuations at this time are thought to contribute to breast tenderness, feeling emotional, tearful, and feeling bloated.

Severe period pain (pain that interferes with your daily activities or impacts significantly on your quality of life) does not necessarily mean there is an underlying problem, however, it is better to be safe and get checked.

Is it normal to get pain at other points in my cycle?

Yes, people can experience pain at other points in their menstrual cycle too. Pain at ovulation (release of the egg) is another commonly reported pain in the menstrual cycle, but it doesn’t affect everyone.

Ovulation typically occurs 14 days before the start of your next period. The pain, if it occurs, is known as mittelschmerz or middle pain. It is typically experienced in the lower area of the tummy (abdomen), usually on the side where ovulation is occurring. It can vary from a dull cramp lasting a day or so to a sharp and sudden twinge.2

No one is entirely sure why ovulation pain occurs, but one theory is that the discomfort is due to the egg breaking through the wall of the ovary. When this occurs, a small amount of blood or fluid is sometimes released, and this is thought to irritate nearby nerves, resulting in pain.3

Do my period pains mean I have endometriosis?

Endometriosis occurs when the cells that normally line the uterus start to grow in other locations as well. These cells are then shed each month, in a similar way to tissue in the uterus. It is this that causes intense pain, as the shed cells cannot escape.

This tissue may be found in all sorts of locations including in your ovaries, bowel, and the tissues lining your pelvis. Usually, the pain is felt in the locations you have the endometriosis. However, at times you may get “referred pain”, especially in the abdominal and pelvic regions, so you may feel it in slightly different locations, too.

There is a wide variety in the symptoms that people with endometriosis experience. Interestingly, it is thought that up to 25% of those with endometriosis do not have any symptoms that they are aware of.4 The majority of people with endometriosis, however, present with increasing pain during their periods, often worsening in their late twenties onward. If your periods are progressively becoming heavier and accompanied by severe pain, or you have other symptoms as well, this is an indication that you may have more than period pain.

For people with endometriosis, often, simple pain killers do not relieve their pain effectively and the pain may continue after the period has finished, even resulting in chronic pelvic pain. They may also experience deep pain during penetrative sex (deep dyspareunia).5

Depending on the location of endometriosis tissue, there may also be symptoms of pain or bleeding when opening the bowels, or even when passing urine, especially around the time of their period. The effects of endometriosis are varied but can be extremely debilitating.

Other conditions that can cause severe period pain

There are other conditions aside from endometriosis that may cause pain similar to severe period pain, so it is important to be reviewed by a doctor if the pain you are experiencing is not normal for you, or if it becomes more severe than usual.

These conditions include fibroids (growths than can develop in or outside the wall of the uterus), chronic pelvic inflammatory disease (chronic infection), or adenomyosis.6 This is where the tissue that normally lines the womb starts to grow in the womb wall itself and makes your periods particularly painful.

In addition, people who have an IUD (intrauterine device or coil) inserted for contraception may have more period pain, especially in the first few months after insertion, but this usually does settle. If the pain is severe or has changed recently, is accompanied by unusual discharge, or you are unwell with a high temperature, this can indicate an infection.

You should go and see a doctor If the pattern or nature of your periods change, if you are bleeding between periods or after sex, or if you have a thick or very strong smelling vaginal discharge. If your period pain or other symptoms are affecting your quality of life, getting assessed by a doctor and getting the treatment you need really can make a huge difference.

Featured image is of a person lying face-down on a bed, with their arms folded and head resting on their arms. They have a long brown plait in their hair and are wearing a cosy-looking grey jumper

Last updated April 2022
Next update due 2025

Dr. Jennifer Kelly, MBChB(hons) MRCGP DRCOG

Jennifer is a General Practitioner, medical writer, parent, and founder of the Grace Kelly Ladybird Trust, registered charity for childhood cancer awareness and research. She also has a particular interest in women’s and children’s health, and enjoys medical writing, particularly helping make medical information easily accessible to those who want to find out more.

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References

  1. NICE, Dysmenorrhea, National Institute for Health and Care Excellence, Clinical Knowledge Summary, November 2018 [online] [accessed 4 April 2022]
  2. NHS, Ovulation pain, NHS website, August 2019, [online] [accessed 4 April 2022] 
  3. Ibid
  4. Bulletti, C., et al., Endometriosis and infertility, Journal of Assisted Reproduction and Genetics, August 2010, vol 27, no 8, pp 441-447
  5. Moradi, M., et al., Impact of endometriosis on women’s lives: a qualitative study, BMC Women’s Health, 2014, vol 14, p 123
  6. NICE, Dysmenorrhea, National Institute for Health and Care Excellence, Clinical Knowledge Summary, November 2018 [online] [accessed 4 April 2022]

With additional information from:

  1. FSRH, Intrauterine contraception, Faculty of Sexual and Reproductive Health, Clinical effectiveness unit, September 2019 [online] [accessed 4 April 2022]