Understanding the Differences Between Endometriosis and Period-Related Pain
May 2023 | Dr. Ashley Southern
Affecting approximately 190 million people worldwide, endometriosis is a condition where the endometrium – the tissue that lines the uterus – grows outside of the uterus in places it shouldn’t be. It is often associated with severe menstrual and pelvic bleeding, pain, and fertility issues. It is estimated that about 1 in 10 women within their reproductive years has endometriosis, though as research continues to improve, it’s believed that this number is much higher.
Why It’s Important to Know the Difference
Yet despite it being so common, endometriosis is a challenging condition to diagnose; statistics show it can take up to 10-15 years to get a proper diagnosis. This is cause for concern, as not only is that a long time to have to live with pain and discomfort, but when left untreated endometriosis can cause symptoms like intense pelvic pain, excessive bleeding, chronic fatigue, digestive issues and more to worsen over time. Further, these endometrial lesions can cause high levels of inflammation within the pelvic and abdominal areas, which can increase risks of scar tissue damage, infertility, and ovarian cancer (Coppa, 2019).
Diagnosing endometriosis can be tricky because symptoms often replicate those of painful, heavy periods, and as such it often gets misdiagnosed and dismissed as menstruation. Also, from this place, it needs to be recognized that we exist in a belief system that has normalized period pain, and perpetuates the expectation that period-related pain is something women should just accept, “deal with,” and live with.
But pain is not something people need to live with. If you suspect you may have endometriosis, it is important to listen to your body and pay attention to any pain, discomfort, and fluctuations, not only in your period but in your overall health. Distinguishing period-related pain and endo-related pain is crucial for detection and diagnosis. The best first step you can take towards getting a proper diagnoses is to recognize and understand the differences so that you can advocate for yourself and get the proper support you need.
Period Pain vs. Endometriosis
While both can have similar symptoms, there are significant distinctions between period pain and endometrial pain. It’s important to note that pelvic pain is not directly correlated with endometriosis. While the majority of people with endometriosis do experience intensified menstrual-like pain and other symptoms around the timing of their periods, not every person with endometriosis experiences menstrual pain. It’s important to note that someone with endometriosis might also not experience any symptoms, while someone without endometriosis can still experience severe pain, cramping and nausea. This is why it’s important to note even mild changes in the types of pain or symptoms you experience not just while you are on your period, but throughout the whole month as well.
Period Pain
Menstrual-related pain typically occurs during ovulation or at the beginning of your period. Pain and other symptoms are often heightened during the first few days but then subside. Often managed with over-the-counter pain medications, symptoms include:
- Abdominal pain and cramping
- Mood swings
- Cravings
- Breast tenderness or swelling
- Body aches and pain
- Back pain
- Bloating
- Feelings of fatigue or sluggishness
- Acne
Lifestyle and diet can also affect period pain. Pelvic inflammation and gut health are both significant factors that can cause or increase pain. Consuming higher amounts of sugar, caffeine, and dairy products may cause your symptoms to become more severe, as these foods are known to increase inflammation in the body.
Endometrial Pain
Endometrial-related pain tends to be a more severe, whole-bodied type of pain than menstrual pain. While typically heightened during ovulation, endometrial flare ups can occur throughout the month. In some cases, over-the-counter pain medications are not enough to help manage pain and other symptoms. Symptoms of endometriosis include:
- Excessive bleeding before, during or after your period
- Pelvic pain that can worsen before, during or after your period or sexual activity
- Significant pelvic cramping that can often interfere with daily activities
- Dyspareunia, or pain with intercourse
- Painful bowel movements
- Painful urination, such as burning and discomfort
- Vaginal pain, such as burning and discomfort
- Significant changes or an increase in digestive issues, such as diarrhea, chronic constipation, and bloating
- Hip pain
- Back pain
- Significant increase in sciatic pain
- Vomiting and nausea
Knowing the Nuances
As can be seen above, endometriosis and menstruation share many symptoms. Especially when considering the severity of them can vastly differ from one person to the next, it’s hard to know the difference. However, there are some unique distinctions that can help when distinguishing between endometriosis and menstruation.
- Severity and duration: endo-related pain is typically more severe, and can occur at any time throughout the month beyond your period. Period-related pain and cramping, on the other hand, usually directly correlates with your period, and generally subsides after a few days.
- Impact on daily life: endometriosis can significantly impair a person’s quality of life, and can affect their ability to work, engage in hobbies and daily activities, enjoy intimate relationships, and can impede on fertility goals.
- Other associated symptoms: endometriosis often comes hand-in-hand with digestive issues like chronic constipation, diarrhea, and excessive bloating. While menstruation can also come with these symptoms, they are often significantly heightened and can be chronic with endometriosis.
- Response to treatment: While over-the-counter pain relievers are typically enough to help alleviate and manage period-related pain, they often provide limited relief for endo-related pain. In some cases, those with endometriosis may require more specialized medical support, including surgery to remove the growths in order to find lasting relief.
Other signs your symptoms may be indicative of something more than menstruation include:
- Your pain impacts your daily life and prevents you from participating in usual activities
- You experience nausea and vomiting
- Your pain is consistent or worsens throughout the week leading up to your period
- You experience excessive or unusual bleeding, including bleeding that lasts beyond a week
- You have to change your pad, tampon, or cup every hour
- You require more than one standard pad at a time due to heavy bleeding
- You have blood clots larger than the size of a quarter
More Blog Articles
Coppa, A. M. (2019). What Happens if Endometriosis is Left Untreated? Retrieved from https://www.drcoppaobgyn.com/blog/what-happens-if-endometriosis-is-left-untreated
What Is the Difference Between Period Pain and Endometriosis? (2021, June). Retrieved from The Woman’s Clinic: https://www.arobgyn.com/what-is-the-difference-between-period-pain-and-endometriosis/
WHO (2021, March). Endometriosis. Retrieved from World Health Organization: https://www.who.int/news-room/fact-sheets/detail/endometriosis