But the aches and annoyances we’re taught to expect and suck up aren’t all benign — in fact, they can all be symptoms of endometriosis, a frustrating and sometimes debilitating condition that affects one in 10 women during their reproductive years.
While experts don't know the root cause of endometriosis, it's an often painful disorder in which tissue that normally lines the inside of the uterus grows outside of it. Under normal circumstances, our endometrial tissue sits inside the uterus and sheds during our period. But for women with endometriosis, that tissue escapes the uterus and attaches to other parts of the body, like the ovaries, fallopian tubes, exterior of the uterus, or even the bowels, which can trigger major pain and even mess with your fertility.
“The best way to describe endometriosis is to think of painter Jackson Pollock, the artist that would take brushes and splatter paint everywhere—when we shed the lining of the uterus during our period, some of it leaves the body, but in women with endometriosis we believe that tissue travels backwards and lands on other organs, where the tissue cells attach and begin to grow,” says ob-gyn Maria Sophocles.
These splattered, displaced tissues swell and fill with blood during your menstrual cycle (just like they would in the uterus) but without a clear route to escape the body, they can cause inflammation, trigger pain, and form cysts or scar tissue around the ovaries, fallopian tubes, and uterus, which can spell trouble if you're trying to conceive.
The bummer news is that there's no cure for endometriosis, but docs often prescribe birth-control hormones (which can help prevent flare-ups by steadying hormones) and anti-inflammatory meds (like ibuprofen) to tamp down pain. In more severe cases, patients may have surgery to remove some of the endometriosis (and that resulting scar tissue) to minimise symptoms and help preserve fertility.
Wondering how to tell the difference between endometriosis and plain old PMS? Here are five signs that your below-the-waist woes may actually be endometriosis.
1. THE PAIN STARTS EARLY AND ENDS LATE
While cramps related to PMS usually show up right before your period (as those uterine muscles start squeezing to shed their lining), pelvic pain caused by endometriosis may show up days or even weeks earlier than you might expect to see PMS discomfort, and last for days afterwards, says Sophocles. (Another difference from PMS—you may not experience those tell-tale PMS-y mood swings with endometriosis.)
But pain itself doesn’t always indicate endometriosis, which is why a diagnosis can be tricky: “Some women get this horrible bulky, boggy, heavy feeling in their pelvic area, while others have very little pain, and there’s not always a correlation between the severity of pain and the severity of the endometriosis,” says Sophocles.
The same goes for your period flow—while some women with endometriosis suffer from heavy bleeding, others get away with a light flow.
2. YOU’VE GOT GASTROINTESTINAL OR BLADDER ISSUES
Can't get control over your IBS or that painful bladder syndrome of yours? There's a chance that you really have endometriosis.
“We often have women who come in and have seen a GI specialist or urologist but haven’t been able to find relief, and that’s because they actually have endometriosis, and not something like IBS,” says Sophocles. Reason being: Sometimes the uterine lining can travel and attach itself to the bladder of bowels, leading to painful issues like constipation, diarrhea, or the feeling that you’ve got a bladder infection. If you’ve got unresolved stomach or bladder problems, always bring them up to your gyno, says Sophocles.
3. DEEP PENETRATION IS PAINFUL
There’s a laundry list of reasons those Os during sex can feel more like O-Ws, including undiagnosed STDs, vaginal infections, or a lack of lubrication. But if you’re feeling the pain most during deep penetration (as opposed to say, the insertion of the penis) your gyno may suspect endometriosis.
“When the penis goes deep, toward the back of the vagina, you might be putting pressure on the ligaments that hold the uterus in place [called utero ligaments], and those are a hotspot for endometriosis,” says Sophocles. Sometimes, during a physical exam, a gynaecologist can feel a nodularity in these spots if it’s endometriosis, which is why it’s worth bringing up any issues with painful sex during your appointment.
4. YOUR LOWER BACK OR ABDOMEN ACHES
In rare cases, the endometrial glands travel and spread to far off places like the lung (or even the eye — Sophocles has a patient who bleeds, gulp, in her eye every month), but most of the time they land right near the pelvic cavity.
“We commonly see the glands travel along the back wall of the pelvic cavity, facing the spine, which triggers back pain, or the front wall of the pelvic cavity, facing your belly button, which would cause an ache in your lower tummy,” says Sophocles.
5. YOU’RE NOT GETTING PREGNANT
According to stats, up to half of women with endometriosis struggle to get pregnant (in fact, it’s one of the top causes of infertility), and for some women, it’s the first and only symptom of endometriosis they’ll ever exhibit. When endometriosis is severe, it can damage or block the fallopian tubes or distort the pelvic cavity, lowering your odds of reproductive success.
"As a surgeon, I’d say two out of 10 times I put my camera in to do a laparoscopic surgery (the only way to truly diagnose endometriosis), and we’ll find someone with no endometriosis symptoms who has tremendous endometriosis,” says Sophocles. The good news is that medication and surgery can up your odds of getting pregnant, as can assistance with reproductive technologies like IVF, but an early diagnosis is always your best bet at controlling endometriosis-related complications.