It Hurts! Painful Period or Endometriosis?

We’ve all been there. That feeling when your period arrives early, and you don’t have any tampons with you. Bursting into tears for no reason at all and then realizing why when you start your cycle a day later.  Or digging through the linen closet to find the heating pad when your cramps flare up. Dealing with a normal menstrual cycle can be challenging enough. But you should know the difference between customary symptoms and something more serious, which could be endometriosis. 

What is a normal period?

Your normal will always be different from everyone else’s. However, most of us can count on a menstrual cycle that falls within these parameters:

  • Occurs every 21 – 35 days
  • Lasts from 2 – 7 days
  • Blood flow is light to moderate (no more than 1 soaked pad/tampon every 3 hours)

Typical symptoms often include:

  • Mood swings 
  • Cramps in the lower abdomen and back
  • Breast tenderness
  • Bloating
  • Trouble Sleeping
  • Feeling tired
  • Food cravings
  • Breakouts

How to tell normal period discomfort from something more serious.

To discover what your normal is, you should keep a period diary. You can either do it the old school way by tracking it in a notebook, or you can use one of several online period tracking apps (Clue; Eve; Flo; Period Tracker Period Calendar; Spot On) —whatever works for you. Having this information readily available will make it easy for you to share it with your provider and make it easier to notice any irregularities.

“It’s not uncommon for your period to change over the years,” says VWC’s Dr. Keith Berkle, MD, MBA. “I often see longer and more irregular cycles in teen patients and perimenopausal women in their 40s, while women in their 20s and 30s tend to have shorter and more consistent cycles.  When a patient has tracked her cycles and symptoms over a period of months, it makes it easier for me to determine if her period pain is on the normal reproductive health spectrum or if a more serious problem is indicated, and what treatment options we should explore.”

Track your period to understand your body better

  • Start and end dates
  • Flow (Changes from prior months? How often do you change tampons or pads?)
  • Cramping (Is it severe? Does it impact your daily activities?)
  • Bleeding between periods
  • Late or missed periods
  • Gastrointestinal issues (constipation, diarrhea, nausea, vomiting)
  • Mood or sleep changes
  • Food cravings
  • Pain during intercourse or other sexual activity, if applicable

Don’t think you have to tough it out.

There are many things that can cause periods to become abnormal.  Hormonal, anatomic, even stress-related changes can occur that cause irregular bleeding or worsening pain during the menstrual cycle.  Unfortunately, many women ignore pelvic pain because they think, “It’s just like this in my family.”  “I thought every woman went through this.”  “Isn’t it normal to miss school or work because my period is so bad?”  To be clear, discomfort and mild pain are “normal” for many women during their periods.  But debilitating pain is anything but normal.  If you are experiencing debilitating pain month after month, don’t ignore it!  Don’t be brave or laugh it off when speaking with your provider.  Make sure that they understand the severity of your pelvic pain and that it is stopping you from living your life to the fullest.  

Severe pain should not be swept under the rug—by you, or your provider.

Pain that stops you from doing your normal activities—not easily managed by over-the-counter pain remedies, painful urination or bowel movements during your cycle, or pain between periods or during sex –could indicate a condition called endometriosis.  Endometriosis affects 1 in 10 women.  Many women see 4-6 providers over a number of years for their pain before they are diagnosed.  Don’t let this happen to you.  Track your periods and share the data with your provider.  Information is critical goes a long way toward a correct diagnosis.  

With endometriosis, an abnormal form of the tissue that normally lines the inside of the uterus grows outside your uterus. These glands may be found on your ovaries, fallopian tubes, or intestines. They can infiltrate the muscle of the uterus or the peritoneum of the pelvis or bladder.  They can even spread to other parts of your abdomen, including your diaphragm and liver or to your abdominal wall.  In very rare instances, endometriosis has been found in the chest as well.  

Endometriosis typically causes pain in your lower abdomen or pelvic area.   This pain may be severe or debilitating.  Other red flags could include abnormally heavy bleeding, missing a period if you’re not pregnant, bleeding longer than a week or in between your periods, or soaking through a pad or tampon every hour or two. 

If you notice any of these recurring issues,  schedule an appointment and discuss your concerns with your doctor. It’s important to seek treatment as soon as you notice symptoms. That way, your provider can work with you to control endometriosis before it can spread to other organs in your pelvis and abdomen. Endometriosis rarely gets better by itself.  

Treatment Options for Endometriosis 

Before talking with your provider about prescription pain relievers, hormone treatments, or even surgery, you may find relief with these over-the-counter, diet and lifestyle options.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) — ibuprofen or naproxen
  • Heating pads or warm baths to relax your muscles and ease cramping
  • Yoga and stretching to strengthen and relax the muscles in your pelvic area
  • Relaxation and meditation — reduces stress associated with pain
  • Add more fiber to your diet — fruits, veggies, beans and lentils help minimize excess estrogen that can make your symptoms worse

If you are unable to control your pain, your provider may suggest prescription pain medications, muscle relaxants, antidepressants, and in rare instances anticonvulsants. More importantly, you will go over the various ways endometriosis can be managed so that pain medicines are not necessary. Contraceptives (birth control pills, patches, vaginal rings) or various hormone therapies may also help reduce your pain and make your periods lighter, shorter or eliminate them altogether. Other kinds of medication may be used to specifically fight the growth of endometriosis and manage the inflammation in the pelvis that it causes.  One of the most effective ways to get long-lasting relief from endometriosis is to surgically remove the disease.  Physical therapy for your pelvic floor and electrical nerve stimulation can also offer relief. 

Endometriosis is a disease that may require a multidisciplinary approach.  Your provider will work with you to customize a treatment plan to address your symptoms, goals, and lifestyle. 

Virginia Women’s Center has eased the pain of thousands of women suffering from painful periods and endometriosis. Don’t suffer unnecessarily. Make an appointment today. 804.288.4084. 


Keith Berkle, MD, MBA is a much-loved provider at our Mechanicsville office. In addition to caring for women throughout their life journey, Dr. Berkle is the president of Virginia Women’s Center and works to improve women’s health care every single day.