Endometriosis Period Characteristics: Relief and Coping

People with endometriosis (endo) often have menstrual periods that are heavier, more painful (dysmenorrhea), and occur more frequently than those without endometriosis.

Although not fully understood, endometriosis pain is likely caused by hormonal imbalances, inflammation, and the body's inability to clear endometrial (uterine lining) debris from the uterus effectively. Over 60% of people with endometriosis report having chronic pelvic pain.

This article will explain the effects of endometriosis on people who menstruate and those who no longer have a period.

Painful Periods, One Symptom of Endometriosis

Each month the lining of the uterus thickens in preparation for pregnancy. When implantation of an egg doesn't occur, the endometrium is shed and exits the body through the vagina.

In endometriosis, the tissue similar to the lining of the uterus (endometrium) invades surrounding tissue and organs like the ovaries, bladder, and colon.

Endometrial tissue found in surrounding tissues also thickens and becomes inflamed during menstruation; however, it does not exit the body. As a result, scar tissue and adhesions develop, worsening pain during menstruation.

In addition, some endometrial lesions have nerves that are more sensitive to pain. Although worse during monthly periods, endometriosis pain often persists between menstrual cycles.

Length of Menstruation With Endometriosis

Endometriosis periods may be longer, lasting seven days or more. Interestingly, endometriosis occurs more often in people with shorter menstrual cycle (less than 27 days) or longer menstrual period (lasting more than seven days).

Flow Characteristics

Certain immune system cells help break down endometrial fragments in the uterus. However, chronic inflammation, dysfunction of the immune system, and hormonal imbalances reduce the body's ability to break down the endometrial tissue properly. Many people with endometriosis report having large blood clots and a heavy menstrual flow.

Spotting in-Between Periods

Spotting between periods is a frustrating side effect of endometriosis. Estrogen controls the growth of endometrial tissue, and increased levels of this hormone have been linked to endometriosis. Therefore, spotting in between periods is often due to the hormonal imbalance of estrogen and progesterone.

When to Talk to an OB-GYN or Specialist

You should schedule an appointment with a healthcare provider or gynecologist for the following symptoms:

• Chronic pelvic pain
• Heavy periods lasting more than seven days
• Soaking a pad or tampon within two hours
• Blood clots larger than a quarter
• Extreme fatigue
• Signs of infection (fever, shaking chills, foul-smelling vaginal discharge)
• Psychological distress, such as depression and anxiety

Endometriosis Pain Without Menstruation

People who do not menstruate can also experience endometriosis pain. However, since reduced estrogen levels improve the symptoms of endometriosis, natural or medically induced menopause may decrease the pain associated with the condition.

Menopause

Natural menopause usually occurs in a person's 40s or 50s, with an average age of 52 in the United States. When the ovaries stop producing estrogen, menstruation also ceases. Therefore, postmenopausal development of endometriosis is not common.

Since a lack of menstruation often alleviates endometrial pain, postmenopausal people report less pain with endometriosis than premenopausal people.

Medically-Induced Menopause

Although some therapies like chemotherapy and radiation inadvertently cause menopause, premenopausal people with endometriosis pain may be placed on medications that purposefully result in medically induced menopause. These medications include:

• Aromatase inhibitors: Arimidex (anastrozole), Femara (letrozole)
• Gonadotropin-releasing hormone agonists: Lupron (leuprolide), Zoladex (goserelin)
• Hormonal contraceptives: Birth control doesn't induce menopause but does help regulate hormones that influence endometriosis period pain.

Surgical Menopause

The ovaries are a primary source of estrogen. Surgical menopause happens when the ovaries are removed (oophorectomy). This reduces estrogen levels and removes endometriosis lesions that have invaded the ovaries. Endometriosis pain is diminished when the ovaries and the endometriosis lesions are gone.

How to Cope Through Endometriosis Periods

Enduring chronic pelvic pain, dysmenorrhea, fatigue, and psychological distress caused by endometriosis periods can negatively affect the quality of life for many people with this condition. Depression and anxiety among people with endometriosis are higher than those without endometriosis.

Fortunately, there are ways to improve the physical and psychological pain of endometriosis periods.

Lifestyle

The following lifestyle changes have been shown to reduce painful endometriosis periods:

• Diet: Limit the consumption of red meats, processed foods, and heavy dairy-based foods. Instead, commit to a diet high in anti-inflammatory properties such as omega-3 fatty acids, leafy greens, and colorful fruits and vegetables.
• Exercise: Regular exercise can decrease inflammation, thereby reducing endometriosis period pain.
• Eliminate alcohol
• Comfort measures: Using a heating pad on your abdomen or lower back, taking a warm shower, and sleeping with a pillow between your legs can help ease pain.

Holistic

Incorporating the following holistic interventions into your routine can improve physical comfort and mental health:

• Acupuncture
• Massage
• Mindfulness
• Yoga
• Hypnosis
• Relaxation
  

Medication

The following over-the-counter (OTC) therapies have been shown to alleviate painful endometriosis periods:

• Nonsteroidal anti-inflammatories (NSAIDs): Decrease inflammation and pain
• Cannabis: Some studies suggest that an improperly functioning endocannabinoid system (a network of chemical messengers and receptors in the body) contributes to endometriosis pain; therefore, cannabis use may improve comfort and well-being. Cannabis products may require a prescription or may be illegal in some jurisdictions.
• Herbs: Cinnamon twig, licorice root, green tea, ginger, and turmeric may help relieve pain or inflammation.
• Vitamins, minerals, and supplements: Vitamin B1, magnesium, and omega-3 fatty acids may also help.

Speak to a healthcare provider before taking any new medications, herbs, or vitamins.

Prescription medications to reduce endometriosis pain include:

• Hormonal contraceptives
• Orilissa (elagolix)
• Myfembree (relugolix/estradiol/norethisterone acetate)
• Prescription pain relievers, such as opioids
• Medications to induce menopause (previously described)
  

Surgery

Surgery to remove painful endometriosis lesions and adhesions can help reduce or eliminate period pain. This may be laparoscopy using excision (cutting out lesions) or ablation (burning away lesions). For the best results, surgery for endometriosis should be performed by a specially trained gynecological surgeon who does minimally invasive surgery (MIS).

Less commonly, laparotomy (open surgery with a larger incision) may be performed. Hysterectomy (removal of the uterus) with removal of both ovaries in a person close to menopause is sometimes a final option for pain resolution.

Other Causes of Painful Periods

It's important to speak to a healthcare provider about dysmenorrhea rather than assume you have endometriosis. Other reasons you could be experiencing painful periods include:

• Fibroids (benign uterine growths)
• Pelvic inflammatory disease (inflammatory infection of the uterus, ovaries, and fallopian tubes)
• Adenomyosis (endometrial lining infiltrating the muscular wall of the uterus)
• Cervical stenosis (narrowing of the opening of the cervix)
• Fibromyalgia (a chronic condition of widespread pain and fatigue)
• Ectopic pregnancy (a non-viable pregnancy that implants outside the uterus)
• IUD (intrauterine device) side effects

Summary

In endometriosis, tissues similar to the uterine lining proliferate outside of the uterus. These tissues respond to the hormones of the menstrual cycle, swelling and bleeding like the endometrial lining. This can cause chronic pelvic pain, heavy menstrual flow, spotting between periods, and other complications.

Fortunately, there are pharmacologic, lifestyle, holistic, and surgical therapies that can improve painful endometriosis periods. Call a healthcare provider for painful periods lasting more than seven days, expelling blood clots bigger than a quarter, or if you are soaking a pad or tampon within two hours.

It's essential to incorporate healthy mental and physical lifestyle changes when diagnosed with endometriosis. Joining a support group or talking to a counselor can also help manage the psychological effects of this condition.