Pelvic pain and heavy bleeding are signs of endometriosis—and other conditions, too. It takes a good GYN to know for sure.
It’s your body and you live with it every day—but that doesn’t mean you always know what’s going on inside of it. This may be especially true if you’re a woman who battles period and pelvic pain, unusual bleeding, and other troublesome symptoms before, during, or even after your monthly menstrual cycle. If that’s you, you’ve probably asked yourself more than once: Is this normal? or not? And do I need to see my gyno?
The struggle is real for many women since some serious health conditions, like endometriosis, can bring with them symptoms that mirror other disorders, like uterine fibroids or ovarian cysts, per the Mayo Clinic. Or, if you’re feeling anxious or depressed around the time of your period, you might not know if it’s regular ole PMS (aka, premenstrual syndrome) or something more concerning, like polycystic ovary syndrome (PCOS) or even premenstrual dysphoric disorder ( PDD).
It’s not your job to figure out what’s what—it’s your doctor’s! But to help you track your symptoms, and even distinguish between a quote-unquote normal menstrual cycle and one that may need medical attention, here’s the down-low on what might be going on down there:
What It Is: Endometriosis occurs when the tissue lining your uterus grows outside of it, commonly affecting the ovaries and fallopian tubes, but sometimes causing issues with your bowels, distant organs, or even your lungs and brain. This condition can be very painful and affects 1 in 10 women in the country of childbearing age, according to endometriosis.org.
Where It Hurts: Common red flags for endometriosis are pain during intercourse or even bowel movements, but a lot of women also complain about chronic pelvic pain throughout any point of their cycle, per UCLA Health.
What Makes It Different: Endometriosis can only be diagnosed through laparoscopy (a less-invasive surgical technique than regular open surgery, using small tubes that are inserted at the belly button into the abdomen), says Cindy Duke MD, a dual fertility expert and virologist, and a founding physician of the Nevada Fertility Institute located in Las Vegas, NV. “A person can have suggestive symptoms of endometriosis but until an actual GYN surgeon does a biopsy and sends it off for testing, it’s a presumptive diagnosis,” says Dr. duke.
How to Make It Better: This condition responds well to hormone treatments, notes Dr. duke. Estrogen causes the tissue along the uterus to grow, so hormonal suppression therapy reduces the size of the tissue. Hormonal suppression therapy is designed to help control estrogen’s effect on your body. Birth control pills that only have progesterone can help control the levels of estrogen you make every month, she adds. See a pelvic physical therapist who specializes in women’s health if you’re experiencing severe pelvic pain, she advises.
These options are a good alternative to surgery, Dr. Duke says, which in her view should be a last resort. “The goal is to avoid repeat surgery, because every time you have surgery there are risks involved,” she explains. By the time someone has to have surgery there are risks to consider. In extreme cases, injury to the bowels may lead to the need for a colostomy bag, for example. “This is from poor management and leads to the patient thinking they always needed surgery to manage.”
Polycystic Ovary Syndrome (PCOS)
What It Is: Additional research needs to be done on PCOS, but it refers to when a woman’s hormones are out of balance, which can lead to infrequent or prolonged menstrual periods. It affects about 5 million women in the country, per the Mayo Clinic.
Where It Hurts: An irregular menstrual cycle can be a symptom of PCOS. In some cases, women go on to develop diabetes and high blood pressure. Some women will also develop non-cancerous cysts on their ovaries.
What Makes It Different: PCOS patients typically don’t need surgery, unlike those who have fibroids, where going under the knife may be an option.
How to Make It Better: Hormonal birth control is an effective method for managing PCOS, but this approach has its critics, says Dr. duke. Some people don’t like the idea of taking what they deem to be unnecessary medicine to manage PCOS, she explains, when lifestyle changes, like weight loss, have been proven to help reduce symptoms in some women. Hormonal birth control can help many women with PCOS, she adds.
“One of the misconceptions is that doctors just put everyone on birth control [for PCOS], and that isn’t true,” she says. Women who are not having a period, or women who have them just two or three times each year may benefit from birth control, she notes, because it regulates the menstrual cycle, which in turn may reduce risk of cancer.
why? Because without regular periods, the lining of the uterus continues to grow, which increases the risk of hyperplasia (abnormal thickening of the lining of the uterus). That, in turn, can lead to endometrial cancer. Using birth control pills or progesterone will thin the lining of the uterus, thus reducing the risk of endometrial cancer developing.
Hormonal treatments can also be helpful for those who are experiencing bad acne or excessive hair growth, Dr. Duke adds.
What They Are: According to research, a whopping 26 million women between the ages of 15 and 50 in the US have uterine fibroids. Despite their prevalence, much remains unknown about this condition. Fibroids are described as non-cancerous growths on the uterus that can range in size from a pea to a watermelon. Fibroids often lead to irregular periods, meaning you might bleed heavily or spot between periods if you have them, per USA Fibroid Centers.
Where They Hurt: Again, women who have fibroids may experience excruciating period pain or endure heavy menstrual bleeding, per John Hopkins Medicine. If pressed up against the bladder, a fibroid can cause frequent urination. Some women will also experience back pain and leg pain.
What Makes Them Different: When it comes to uterine fibroids, experts say it’s more about treating the symptoms than the cause. If there are no symptoms, in many cases women can live on with their lives without interruption, because fibroids aren’t harmful, in and of themselves, unless they trigger troubling symptoms. The only cure is a hysterectomy.
How to Make Them Better: As a fertility specialist, Dr. Duke advocates for fertility-sparing surgery whenever possible, which involves removing the fibroid and preserving the uterus. One option, she says, is uterine fibroid embolization (UFE), which is when a radiologist targets the blood vessels feeding the fibroid, arresting blood flow, causing it to shrink. Radiofrequency ablation, a medical procedure that shrinks the fibroids through radio waves is another treatment option, according to the Cleveland Clinic. Medications, such as Myfembree and Oriahnn (relugolix, estradiol, and norethindrone acetate), are available to help treat uterine fibroids and heavy bleeding, too.
Premenstrual Dysphoric Disorder
What It Is: PMDD is premenstrual syndrome (PMS) taken to a higher degree. It’s a mix of physical and psychiatric symptoms throughout your menstrual cycle. The drop and increase of estrogen and progesterone triggers lower serotonin levels, which is linked to depression and anxiety. Some women are simply sensitive to such changes. These mood shifts are severe and can damage relationships, or even impact a person’s professional life.
Where It Hurts: Symptoms of PMDD can occur before a menstrual cycle starts and lead to extreme sadness, irritability, feelings of hopelessness, and even suicide ideation. On the physical end, women may experience breast tenderness and bloating. Then, when their period comes, the feeling abruptly ends.
What Makes It Different: For this condition, it is probably best to work with a psychiatrist and a gynecologist to develop the right treatment plan, says Harold Walker Elliott, MD, chair and associate professor of psychiatry, Campbell University School of Medicine, in Lillington, NC.
How to Make It Better: Many folks with this condition will benefit from hormone treatments, Dr. Elliot explains, since people with PMDD are sensitive to hormonal swings, and the goal for them is to keep their hormones steady. “Some patients will take active birth control pills [as opposed to taking any placebo pills] for three months at a time,” he adds. dr. Campbell notes that PMDD patients may still experience PMDD symptoms, but with this method such episodes are reduced to a few times a year instead of once per month.
Selective serotonin reuptake inhibitors (SSRIs, such as Prozac) and other anti-depressants have also been effective when it comes to treating PMDD patients, Dr. Campbell says. People with this disorder can take antidepressants the week before their period, “and it converts progesterone into a metabolite that helps curb irritability and anxiety,” he adds. Women with PMDD also have the option to take antidepressants regularly and not just a week or so out of the month.
Treatment Is Available
Just know this: No matter what condition you may have, there’s help, and there’s hope. The most important takeaway is that it’s up to you to keep track of your symptoms and present the findings to your doctor. And if your doctor is not supporting you, it’s time to find a new one. Also, it’s important to remember that a wide range of symptoms can apply across all of the above conditions.
“People want to separate symptoms, but that’s how we fail patients,” says Dr. duke. “People can have pain, bloating, and sexual dysfunction with [any] of these conditions. The key is to establish a good relationship with a gynecologist who is going to be thorough, take your complaints seriously, and not dismiss them.”